Mid week update

Following up on Monday’s post about the final HHS 2017 benefits and payment parameter notice (to be published in the March 8 Federal Register), Prof. Tim Jost published three blog entries — here, here, and here where you can find out everything about this annual monster notice.  For FEHBP purposes, the key aspect of the notice is that the maximum out of pocket limits for group health plans in 2017 will be $7,150 for self only coverage and $14,300 for other than self only coverage. The current limits are $6,850 for self only coverage and $13,700 for other than self only coverage. Most of notice applies to the ACA marketplace plans.

The New York Times reports on the resurgence of HMO plans in the ACA marketplaces. The new HMOs typically feature lower cost sharing, no primary care gatekeeper to limit access to specialists, and a narrow provider network.

[P]atients must sacrifice choice for the promise of lower costs and managed care, whether the plan is called an H.M.O., an A.C.O. or a narrow network. Insurers are able to get low prices for care when they can offer doctors and hospitals a large volume of patients, and providers say they need to have more control over where their patients can get care if they are going to be responsible for costs and the long-term quality of care.

That’s a logical product of the ACA.

OPM’s call letter included several points on Rx benefits, including speciality drugs and medication adherence, Business Insurance lead me to this 2016 Pharmacy Benefit Management Institute Report on  Specialty Drugs (sponsored by Walgreen’s). If you want a copy, you’ll have to register with PBMI.  The FEHBlog nearly fell off his chair when he read on Medpage Today that

Getting physicians to focus on patients’ medication adherence may
result in more patients taking their medicines, but it does not
necessarily lead to improved health outcomes, a small pilot study has


Finally, Physicians’ Briefing reports that according to a New England Journal of Medicine study hospital readmissions are down since the ACA began imposing readmission penalties on hospitals. What’s more, “After implementation of the ACA there was no significant correlation between changes in observation-unit stays and readmissions, within hospitals.”

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