Mid holiday week update

Oh by gosh by golly does the FEHBlog love commuting during the week between Christmas and New Years. What a joy.

Time does march on. OPM issued a final rule a final rule on the Indian tribal employee coverage program within the FEHBP in today’s Federal Register.  The rule formalizes the processes for this program which was created by the ACA and has been running for a few years.

The Health Affairs blog provides an update on the bench trial where the federal government seeks to enjoin the proposed merger of health insurers Anthem and Cigna on antitrust grounds.

With the first phase of the trial in the government’s challenge to the merger of Anthem and Cigna wrapping up last Tuesday [December 20], several things seem to be coming into focus. The government has put on a strong case that the merger will produce significant market concentration in the sale of insurance plan services to large national employers. The merging parties’ best hope relies on potential large cost savings resulting from their ability to extract price concessions from hospitals and physicians. Less clear, however, is whether those savings are either legally cognizable or sufficient to offset the harms resulting from increased market power.

More detail is available in the article.  U.S. District Judge Amy Berman Jackson’s  decision on the first phase is expected early next month. If the government prevails on the first phase, then there won’t be a second phase. Anthem and Cigna would have the right to an immediate appeal.

Last week, the FEHBlog noted news about progress in developing certain vaccines and treatments. Over the holiday weekend, he noticed this article from Science Explorer reporting that

An experimental Ebola vaccine was highly protective against the deadly virus in a major trial in Guinea, according to results published in The Lancet. The vaccine is the first to prevent infection from one of the most lethal known pathogens, and the findings add weight to early trial results published last year.


Last week, the President signed into law the National Defense Authorization Act for the current federal government fiscal year. Modern Healthcare notes that

A provision in the defense bill calls for a program that will reduce or eliminate co-pays and other cost sharing for certain drugs and services considered high quality because they offer proven results.
Providers considered high-value would be reimbursed at higher rates as well.
The Secretary of Defense must submit a report within the next six months detailing which providers, services and medications will be considered high value. The Secretary must also identify the co-pays or cost share amounts that will be reduced or eliminated when Tricare patients opt for high-value care.
If the pilot results in people with certain conditions, such as heart disease and diabetes, having better outcomes, reduced emergency room visits or hospitalizations, and enhanced care, it may be rolled out to the entire Tricare population, according to a press release.

Tricare is leading from behind so to speak.  CMS is implementing the approach in Medicare Advantage. The article adds that “Private insurers that use value-based plans with their under-65 population have reported reduced overall costs on chronic-disease patients as early as three years after implementation.”  OPM also has supported the use of value-based coverage in the FEHBP.

Also on the idea front, Health Payer Intelligence discusses four ways payers could improve transparency for consumers. Interesting ideas.