OPM Call Letter Released

OPM Headquarters a/k/a the Theodore Roosevelt Building

Happy OPM Call Letter Day. The call letter is OPM’s call for 2022 benefit and rate proposals from FEHB carriers. Here’s the letter’s summary:

OPM maintains its focus on improving quality and affordability in the FEHB Program, as well as supporting the Biden Administration’s priority focus on health care access and equity. We expect FEHB Carriers to continueto offer forward-thinking proposals that focus onthe strategicprioritiesdescribed in this Call Letter. Our quality initiatives for the 2022 plan year relate to the COVID-19 pandemic, mental health and substance use disorder services, opioids, and prior authorizations for prescription drugs. We also remain focused on enhancements to price and quality transparency, as well as addressing surprise billing and low-value care. We are encouraging FEHB Carriers to expand coverage of certain medical foods for those affected by Inborn Errors of Metabolism (IEM), and to cover fertility preservation related to infertility caused by medical treatment (iatrogenic infertility).

The FEHBlog has provided links to topics that he does not routinely cover. The proposals are due on May 31, 2021. Good luck carriers.

On the COVID-19 front, MedScape encouragingly reports that

Researchers know by now the available COVID-19 vaccines prevent people from getting COVID around 95% of the time. But the million-dollar question remains: Are people less likely to spread the illness after they get the vaccine? According to preliminary data, the odds are good.

“The looming question is, if the person who’s been vaccinated gets infected, does that person have the capability to transmit it to another person,” Anthony Fauci, MD, the White House COVID-19 Response Team’s chief medical adviser, said during a White House briefing Wednesday. “Some studies are pointing in a very favorable direction.”

Fauci cited studies from Spain and Israel published this month, showing the amount of viral load — or the amount of the COVID-19 virus in someone’s body — is significantly lower if someone gets infected after they’ve been vaccinated, compared with people who get infected and didn’t have the vaccine. Lower viral load means much lower chances of passing the virus to someone else, Fauci says.

“There’s a direct correlation with viral load and transmission,” he says. “In other words, higher viral load, higher transmissibility; lower viral load, very low transmissibility.”

Also, the Department of Health and Human Services announced today “new actions to expand COVID-19 testing capacity across the country. These actions will improve the availability of tests, including for schools and underserved populations; increase domestic manufacturing of tests and testing supplies; and better prepare the nation for the threat of variants by rapidly increasing virus genome sequencing.”

From Capitol Hill, this Congressional Budget Office report to the House Ways and Means Committee on the COVID-19 budget reconciliation bill provides a useful overview of the healthcare and employee benefit proposals in the bill. The Speaker intends to pass the $1.9 trillion relief measure by the end of this month.

Health Payer Intelligence discusses a recent Health Affairs article positing that “whether care is affordable for members depends on more than just pricing; affordability is also tied to how clustered healthcare events—and, by extension, healthcare spending—are in a single year.”

The conclusion of this study has clear implications for payers. When members skip care due to affordability, they miss key preventive care services which can result in higher healthcare spending downstream in the members’ healthcare journeys. During the pandemic, payers have waived primary care costs in order to incentivize members to continue receiving care for this very reason. The researchers called on payers, employers, and lawmakers to explore methods for spreading members’ healthcare costs out over time [e.g. monthly deductibles rather than annual deductibles, low copays for essential medicines like insulin].

As we reach the end of the 4th Quarter 2020 financial reporting season, Healthcare Dive summarizes the reports from major health insurers.

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