OPM released 2020 FEHBP premium rates this afternoon. The Washington Post, Govexec.com, Federal Times and Federal News Radio all have articles on the rate action. The Federal Employee Benefits Open Season begins on November 11. Check plan websites for 2020 benefits information.
Today is the beginning of the 2020 federal fiscal year.
The Health Affairs Blog posted an article about the demise of OPM’s Multi-State Plan Program created by the Affordable Care Act. I was interested to learn that
Recently the Office of Personnel Management (OPM) decided to discontinue operations of the Multi-State Plan (MSP) Program. The decision came as the program, which provided health insurance through the Affordable Care Act (ACA) health exchanges, had gone from providing coverage to more than 400,000 people in 35 states and the District of Columbia in 2015 to one state this year.
The article discusses why the program failed. In my view, it was too complicated.
Becker’s Hospital CFO Reports informs us that
In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report.
Ouch.
Becker’s Hospital Review has created a list of the thirteen U.S. hospitals that received the most emergency room visits in 2018. They are spread around the country, at least at first glance.
Federal News Radio reports that last Friday the President signed into law the continuing resolution funding the federal government in the new fiscal year that begins on Tuesday October 1 through November 21.
In traditional coverage, insurance payments for some women are delivered as bundled payments for portions of their prenatal care, said Suzanne Delbanco, executive director of Catalyst for Payment Reform, an organization that helps advise employers and other organizations that buy health coverage. However, the latest version is different because insurers are adding quality measures that increase accountability and additional services, such as delivery costs, to the bundle.
On September 28, 1959, sixty years ago today, President Dwight D. Eisenhower signed the FEHB Act into law. (This photo does not identify the bill being signed but you get the idea.) The FEHBlog owes his livelihood to this law. Enjoy the day and reflect with me on the benefits that this law has bestowed on federal and postal employees and annuitants over the years.
The Senate approved the House passed continuing resolution (“CR,” HR 4378) which funds the federal government from October 1, 2019, through November 21, 2019. The bill goes to the President who is expected to sign it.
The Federal News Network reports that
Notably, the CR includes an additional $48 million for the Office of Personnel Management, which faces a funding shortfall on Oct. 1 when the National Background Investigations Bureau and the governmentwide security clearance portfolio transfers to the Pentagon [with full Congressional authorization]..
In addition, the CR gives OPM the authority to transfer roughly $29.7 million from “appropriate trust funds … without regard to any other provision of law” to maintain agency operations. OPM administers health and retirement benefits to more than 2.7 million active employees and nearly 2.6 million annuitants, survivors and their family members through the Earned Benefits Trust Funds, which have close to $1 trillion in combined assets
The Senate also confirmed Eugene Scalia as the Secretary of Labor. Mr. Scalia is the son of the late Supreme Court Justice Antonin Scalia and has been a partner at the law firm of Gibson Dunn and Crutcher. His confirmation is relevant to the FEHBP because the Secretaries of Health and Human Services, Labor and Treasury are the principal Affordable Care Act regulators
The Centers for Medicare and Medicaid Services announced the issuance of its
Omnibus Burden Reduction (Conditions of Participation) Final Rule{. The rule] strengthens patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule advances CMS’s Patients over Paperwork initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving doctors more time to spend with their patients.
The FEHBlog dreams of OPM granting such massive deregulatory relief to FEHB carriers.
CMS also announced issuing a Discharge Planning final rule.
[The rule] empowers patients preparing to move from acute care into post-acute care (PAC), a process called “discharge planning.” Today’s rule puts patients in the driver’s seat of their care transitions and improves quality by requiring hospitals to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures – including measures related to the number of pressure ulcers in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital. The rule also advances CMS’s historic interoperability efforts by requiring the seamless exchange of patient information between healthcare settings, and ensuring that a patient’s healthcare information follows them after discharge from a hospital or PAC provider.
This rule could help payers and providers better avoid hospital readmissions.
The Wall Street Journal calls our attention to the Kaiser Family Foundations annual survey of employer healthcare costs.
Annual premiums rose 5% to hit $20,576 for an employer-provided family plan in 2019, according to the yearly poll of employers by the nonprofit Kaiser Family Foundation. On average, employers bore 71% of that cost, while employees paid the rest.
For an individual employer plan, the average total premium cost was $7,188 in the 2019 survey, or 4% higher than last year.
Health Payer Intelligence reports on the National Business Group on Health’s annual survey on large employer health benefit plan trends.
“While most large employers are not planning major changes to their plan design, they continue to increase efforts to improve quality, access and convenience by providing workers with more plan choices and greater access to virtual care solutions and mental health services,” said Brian Marcotte, president and CEO of the National Business Group on Health. “Additionally, more employers are providing decision-support tools and technology to simplify their employees’ experience and help them navigate the health care system.”
The FEHBlog received an email from NCQA today inviting him to vote in Modern Healthcare’s annual poll of the 100 most influential people in healthcare. You too can vote at this link until October 7. The ballot offers 300 candidates and allows a reader to make five choices. Out of gratitude for NCQA alerting me to this vote, one of my five votes went to Peggy O’Kane, NCQA’s president. The FEHBlog is not among the 300 candidates so you have all five of your votes.
As we now are in the middle of National Healthcare Information Technology Week, here’s a link to the HIMSS trade association’s celebratory site.
Fierce Healthcare informs us that CVS Health is launching
a new pharmacy solution aimed at cutting down the time it takes for patients to obtain specialty drugs. The new tool is built in two parts: Specialty Expedite and Specialty Connect. The former is designed to cut down the prior authorization and onboarding process significantly with the goal of reaching a three-day process.
Onboarding for a new medication can take a long time—sometimes weeks—for some patients, which can leave them falling off the wagon for needed care, CVS said in a brief on the new solution.
The Centers for Medicare and Medicaid Services today announced Medicare beneficiary premiums for Medicare Advantage and Medicare Part D prescription drug plans. It’s good news. The next step will be for CMS to announce beneficiary premiums and other cost sharing amounts for traditional Medicare Parts A and B. The Medicare open season begins on October 15.
The federal Agency for Healthcare Research and Quality is celebrating its 20th anniversary.
After spending the last 18 months listening to patients, systems leaders, researchers, policymakers, and other stakeholders, we have identified the following three challenges that are front and center in the minds of healthcare experts, and which require long-term strategies to address.
Improving care for Americans living with multiple chronic conditions (MCC) —
More than 25 percent of Americans live with MCCs, including 80 percent of Medicare beneficiaries. Care for these patients is often fragmented, leading to poor outcomes and increased costs. We stand ready to support a multifaceted initiative designed to augment primary care and leverage AHRQ’s core competencies in health systems research, practice improvement, and data and analytics.
Providing data and analytics to policymakers to empower informed decision making — Many policymakers still make decisions based largely on expert opinion rather than tapping into the explosive potential of new data resources and analytic strategies. We plan to transform the delivery of vital information by establishing an integrated data and analytics platform, one to help Federal, State, and local policymakers get access to timely and accurate data and analytic resources to make informed policy decisions. Central to this effort will be continued expansion of AHRQ’s premier data resources—the Medical Expenditure Panel Survey and the Healthcare Cost and Utilization Project.
Reducing diagnostic errors — An estimated 12 million people per year are affected by diagnostic errors, including 4 million suffering serious harm. Research suggests the cost to the U.S. healthcare system exceeds $100 billion annually. Our initial work should focus on the three largest areas of diagnostic errors: cancer, vascular conditions, and infections.
Kaiser Health News reports on how local healthcare authorities are using data to help reduce suicide rates. For example,
data revealed a surprising number of suicides at hotels and motels. It also showed a number of those who killed themselves had experienced eviction or foreclosure or had a medical visit within weeks or days of their death. It revealed that people in crisis regularly turn their pets over to the animal shelter.
But what to do with that information? Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s [Oregon] suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.
The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.
Bravo.
Congress remains in session on Capitol Hill this coming week. Sixty years ago this week, on September 28, 1959, the Federal Employees Health Benefits Program was enacted into law.
This coming week is National Health IT Week. The themes are Supporting Healthy Communities and driving transformation of our health and wellness ecosystem to promote better health outcomes and health equity.
The Robert Wood Johnson Foundation has updated its Culture of Health Action Framework which it introduced in 2015.
Since 2015, what do the data tell us about our progress in creating a Culture of Health in America? We are seeing small but positive changes in the appreciation of the social determinants of health and the need for broader community health investments. However, there has been less movement in many of the structural and systems-level factors that critically influence health, well-being and equity.
In that regard, Fierce Healthcare reports
The Centers for Medicare & Medicaid Services (CMS) recently finalized new flexibilities to allow MA plan sponsors to offer nontraditional benefits that target the social determinants of health such as air quality tools, transportation and meals for the 2020 plan year. CMS broadened those options beginning in the 2019 plan year.
Researchers at the Urban Institute conducted a series of interviews with MA insurers, health insurance experts and social services providers that highlighted several barriers to embracing benefits that target the social determinants of health: funding challenges and struggles in targeting the right beneficiaries. * * *
As CMS did not allocate additional funding for these benefits, health plans are stuck with limited financial resources to try supplemental benefits, the report noted. To pay for supplemental benefits, MA plan sponsors must pull from rebates CMS pays out to make up the difference between an insurers’ bid and the national benchmark, if the bid is below that marker.
However, these rebates are often small, averaging about $107 per member per month in 2015, according to the study. Additionally, insurers pull from these funds for other efforts to lower cost-sharing or to cover benefits such as dental and vision care or gym memberships, which are popular with beneficiaries.
Quite a conundrum.
The FEHBlog has been contemplating the Centers for Disease Control’s aggressive approach to the vaping crisis. It occurs to him that if the CDC had taken such an approach with the opioid crisis, that crisis may bave been more manageable. See, for example, the Wall Street Journal’s most recent article on Purdue Pharma, Better to live and learn when it comes to public health.
As we approach the time when OPM announces the 2020 government contribution, the Mercer actuarial consulting firm disclosed that
Health benefit costs will grow by nearly 4% in 2020, according to early results from the latest Mercer National Survey of Employer-Sponsored Health Plans. Based on responses from 1,511 US employers1, Mercer projects that the average total health benefits cost per employee will rise by 3.9% in 2020.
The Hill reports on the House leadership’s bill to lower drug costs now. The plan hinges on government effectively setting the prices of 250 drugs annually. The lower prices would be available to both government and private payers. Speaker Pelosi reported plans a vote this yea.
On the technology front —
Armed with the results of a telehealth program that greatly reduced hospital readmissions, a Detroit health system is now looking for payer partnerships to expand their reach.
Executives at the Henry Ford Health System say their e-Home Care service, which provides mHealth and telemedicine technology for the Henry Ford at Home program, reduced rehospitalizations by some 45 percent during the first half of 2019, as compared to the same time period in 2018, with a monthly readmission rate dropping to as low as 7 percent.
Federal News Network brings us up to date on fiscal year 2020 appropriations issues —
Despite the hype surrounding the importance of social determinants of health, just a quarter of hospitals and 16% of physician practices screen patients for social needs that affect health outcomes, according to a JAMA study published Wednesday.
The JAMA study concludes
Although across stakeholders there is swelling momentum for addressing social needs, our study findings suggest that most physician practices and hospitals are not screening across 5 key social needs associated with health outcomes. We found that organizations participating in payment reform models were more likely to screen, and that organizations that do not screen reported misaligned incentives as a major barrier to innovations in care delivery. We believe systematic use of screening is a required first step to attend to social needs and improve health; addressing resource barriers, such as time, information, and money, may be a key element in supporting physicians and hospitals in efforts to screen patients for social needs.
Rome, of course, was not built in a day.
On the public health front
The C.D.C. provided the first demographic snapshot of the afflicted: Nearly three-quarters [of the 580 afflicted people] are male, two-thirds between 18 and 34. Sixteen percent are 18 or younger. “More than half of cases are under 25 years of age,” Dr. [Anne] Schuchat [of the C.D.C.] said. Illnesses have now been reported in 38 states, and one United States territory.
A 4-year-old child from Perris [CA] who recently died tested positive for influenza, health officials said today. The child had underlying health issues and passed away at a medical facility outside of the county.
It is considered the first pediatric flu-associated death of this flu season (2019-20) in Riverside County. There were nine flu-associated deaths in 2018-2019, and 23 during 2017-2018.
According to Dr. Cameron Kaiser, Riverside County Public Health Officer, the child’s death is a tragic reminder of how deadly influenza can be.
“We should never forget that the flu still kills,” Kaiser said. “I always recommend people get their flu shots every year, but a death so early in the flu season suggests this year may be worse than usual. Our hearts go out to the family and loved ones who are grieving.”
It is not too early to get a flu shot, Kaiser said, adding that the Centers for Disease Control and Prevention recommend all persons 6 months of age and older receive a flu vaccination each year, and many providers have this year’s shot already in stock. Children 8 years old and under who haven’t received at least two flu shots in prior seasons may need two shots to be fully protected; consult your primary care provider.