Midweek Update

The Wall Street Journal is reporting tonight that Anthem, a major health insurer, was struck by an enormous hacking attack.  Anthem certainly appears to be handling the matter appropriately.  Anthem detected the attack, immediately hired an investigator, reported the crime to the FBI, and less than a week after the detection, publicized the attack today.

Following up on a few items that the FEHBlog has been following —

  • Here is a link to a Federal News Radio report explaining how the President’s FY 2016 budget affects each department and major agency in the government.   The Washington Post reports on six ways that the budget could impact federal employees.  Finally, the Post reports that 

Regarding the Federal Employees Health Benefits Program, the budget repeats previous proposals to make domestic partners eligible, expand the types of plans available, centralize the purchasing of pharmaceuticals as a cost-saver, and allow plans to charge more to enrollees who do not participate in certain wellness programs deemed appropriate for them. Those proposals would require the approval of Congress.

In the FEHBlog’s view, centralizing the purchasing of pharmaceuticals is an odd proposal that is inconsistent with the Affordable Care Act’s push for better integrated care which is the FEHBP status quo. 

  • Speaking of prescription drug costs, Bloomberg reports that “The average discount for [Gilead’s very expensive Hepatitis C drugs] “took investors by surprise and is higher than consensus of 25 to 30 percent or so,” said Michael Yee, a San Francisco-based analyst at RBC Capital Markets, in an e-mail.  Competition is good. 
Also on the good news front, Forbes is joining Modern Healthcare in reporting that major insurers are leading the charge to move the market from fee for service to quality / outcome based health benefit coverage. 

Health plans are moving quickly from the traditional fee-for-service approach that can lead to overtreatment and unnecessary medical tests and procedures.Value-based pay is tied to health outcomes, performance and quality of care of medical-care providers who contract with insurers via alternative models like accountable care organizations (ACOs), a rapidly emerging care delivery system that rewards doctors and hospitals for working together to improve quality and rein in costs. 

“We continue to make great strides as we signed contracts with 28 new ACO partners since year-end 2013, launched multiple new products backed by ACO contracts, doubled our membership covered by value-based contracts to more than 3 million members, and increased the percent of our medical costs that run through value-based contracts to 28% of total spend,” Aetna chief executive officer Mark Bertolini told Wall Street analysts and investors on the company’s fourth-quarter earnings call Tuesday.

Leave a Reply

Your email address will not be published.