Friday update

David Ermer–Uncategorized–
Here’s an interesting Wall Street Journal article about the merger talks between Walmart and Humana. Same basic business logic as the CVS-Aetna proposed merger (big data, etc.) but it’s not quite the no-brainer that the CVS-Aetna proposed merger presents because CVS has a much wider retail footprint in the FEHBlog’s opinion.

Fierce Healthcare reports that 

The Department of Health and Human Services (HHS) has created two new positions to lead efforts to bring down prescription drug costs and confront the opioid epidemic.
Daniel M. Best, the former corporate vice president of industry relations for CVS Health’s Medicare Part D business, will serve as senior adviser to the secretary for drug pricing reform. Brett Giroir, M.D., will add to his duties as the assistant secretary for health, serving in a dual role as a senior adviser to the secretary for mental health and opioid policy. The appointments represent two of the four priorities HHS Secretary Alex Azar recently laid out as part of a “transformation agenda” for the agency.

 Good luck to these gentlemen.

Speaking of the opioid crisis, Modern Healthcare reports that

The Blue Cross and Blue Shield Association has adopted a new standard that opioids should not be the first or second treatment options to manage pain, mirroring guidelines set by the Centers for Disease Control and Prevention.

In most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for the Blues association, which has about 106 million members. It’s important that physicians understand that alternatives like medication-assisted treatment exist, which pairs medication with behavioral counseling, he said.

It’s not an absolute decree. In many cases, particularly related to cancer treatment or end-of-life care, opioids may be the best remedy, said Haywood, adding that the association will aid physicians in making the best clinical decision.

And, on the business trends front —

  • Healthcare Payer Intelligence informs us that 

A group of commercial payers and other healthcare organizations have formed a coalition to explore how addressing the social determinants of health can lower care costs and improve outcomes.  A number of large payer companies have joined the Aligning for Health (AFH) coalition, including the BlueCross BlueShield Association, CareSource, Humana, UPMC Health Plan, and WellCare. AFH stakeholders cited research that suggests social factors including access to healthy food, safe housing, and financial security account for nearly 70 percent of all health outcomes. Addressing these social factors can have positive effects on healthcare outcomes, costs, and utilization, the coalition said.

Insurers and employers are recognizing the value of providing a consumer advocate who can work directly with a consumer, supported by a team of multidisciplinary professionals, says Tom Meier, vice president of market solutions at Health Care Service Corporation (HCSC), a consumer-owned health insurer in the United States and a licensee of Blue Cross Blue Shield, serving nearly 15 million members.

The increased interest comes partly from the realization that the higher deductibles currently in use don’t make consumers more thoughtful and engaged in using healthcare resources wisely, as many employers hoped, according to a recent healthcare industry survey. Instead, they just make them avoid healthcare altogether, including preventive healthcare.

Some health plans are developing health advocacy programs, and there are companies such as Accolade that offer services to both employers and health plans. Accolade promises employers savings of up to 15% and says health plans can improve utilization and the member experience while reducing medical claims spend.

HCSC is addressing those goals with a program called Health Advocacy Solutions for large employer customers. It’s a personal concierge program to address healthcare issues, answer questions, and encourage members to become advocates for their own health, Meier says. 

The FEHBlog is concerned about the lack of interoperability in electronic medical records. Last evening he ran across this Sure Scripts service which helps bridge interoperability gaps by using its vast database of prescription records to locate related medical providers for specific patients (fully HIPAA compliant of course). Apple has taken a different tack by transmitting a patient’s medical records for about 40 facilities directly to their i-phones. Very cool.