Last Friday. the President announced a policy change. The Federal Times reports that in lieu of a pay freeze for 2020, the President will support a 2.6 percent base pay increase for federal employees with no locality pay adjustment. Congress can override the President’s decision, The Federal Times further observes that “Funding legislation passed by the House would have also increased federal base pay by 2.6 percent, while also granting a 0.5 percent bump on average to locality payments.”

Congress remains on a district / State work period for the next week.

Health Payer Intelligence reports that

In the face of uncertain data regarding wellness programs’ efficacy and employees’ utilization, employers are revolutionizing their approach to employee wellness programs with an increased focus on the employee, as opposed to healthcare spending, according to a new Optum study.

“Employers are getting smart, serious and sophisticated in their approach to employee health and well-being,” the Optum study begins. “They are using data, demographics and technology in smart ways to fuel program innovation, relevancy and engagement.”

Beckers Hospital Review informs us that Walmart is dipping its toe in the primary healthcare market.

The new clinic, called Walmart Health, is in Dallas, Ga., and the first appointments are available on Sept. 13. Patients can schedule appointments at Walmarthealth.com. The clinic, which is next door to a Walmart store, will offer primary care and a variety of other services, including labs, X-rays, counseling, dental, and audiology, according to CNBC. Depending on the success of the clinic in Georgia, the retailer may open more Walmart Health clinics in the future, sources told CNBC.

On this Friday before the last three day weekend of the summer, the FEHBlog offers you a potpourri of information:

• The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules issued its Summer 2019 Cybersecurity Newsletter on the topic of Managing Malicious Insider Threats. 

On Monday August 26, the Affordable Care Act (“ACA”)regulators issued ACA FAQ 40.  Prescription benefit managers offer health plans the option of using co-pay accumulators to ensure that prescription drug manufacturer coupons are not counted toward member cost sharing limits. For example, if a member pays $100 out of pocket and uses a manufacturer coupon for the balance, only the $100 payment counts toward, e.g., the plan’s annual out of pocket limit.

In the 2020 ACA Notice of Benefit and Payment Parameters, the ACA regulators advised that health plans are permitted to so exclude the value of manufacturer coupons from the ACA’s member out-of-pocket spending limits when a generic substitute is available. First the advice created confusion over whether the ACA regulators were requiring health plans to adopt co-pay accumulators. That confusion dissipated because the advice was clearly permissive. However, the health plans engaged in broader use of co-pay accumulators reasonably asked for clarification. In FAQ 40, the ACA regulators advised that they would resolve this ambiguity in the 2021 Notice of Benefit and Payment Parameters. Until that Notice takes effect on January 1, 2021, health plans may continue broader use of co-payment accumulators, e.g., beyond prescription drugs with available generic substitutes.

Fierce Healthcare reports on the results of the American Medical Group Association’s annual survey of primary care and specialist physician compensation.  “The 2019 survey shows that physician compensation in 2018 rebounded from a stagnant 2017,” said Fred Horton, AMGA Consulting president. “While productivity also increased, it did not increase enough to surpass the decline we saw in last year’s survey, meaning productivity still has not risen since 2016.”

Modern Healthcare warns that “Physician groups’ public relations, advertising and lobbying blitz against Congress’ front-line proposals to end surprise medical bills reached such a pitch this month that congressional staff worry the entire effort will collapse.”

Forbe’s Healthcare Brainstorm columnist sums up a recent JAMA study on heart disease in the U.S. as follows: “diabetes and high blood pressure are still killing millions of people [in the U.S.]. And communities of color continue to be disproportionately affected by this reality.”

Medicare’s Plan Finder has received an u noteworthy upgrade, according to CMS.

The updated Medicare Plan Finder also provides [Medicare beneficiaries] and their caregivers with a personalized experience through a mobile friendly and easy-to-read design that will help them learn about different options and select coverage that best meets their health needs. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer. 

Here are some worthwhile articles to consider:

• HR Dive reports on the efficacy of employee wellness programs. 

Congress is out of town again this week. Both houses will return to Capitol Hill on September 9.  Here’s a link to a Washington Post article on four charts which are causing Democratic policitians to rethink Medicare for All.

OPM’s latest call letter warned about the risks of e-cigarettes. Wired Magazine provides an update on those concerns,

SOMETIME BETWEEN WEDNESDAY and Friday, an Illinois resident died of an unknown respiratory illness that may have been the result of vaping. The death was one of nearly 200 cases of mysterious respiratory problems across 22 states whose only known link is the recent use of electronic cigarettes, or vapes, according to the Centers for Disease Control and Prevention.

The CDC, a federal agency, is now working with state health agencies and the Food and Drug Administration to try and find the cause, part of an investigation launched in mid-August after dozens of people, mostly teenagers and young adults, started showing up in hospitals reporting symptoms including difficulty breathing, fatigue, weight loss, and chest pain. That population has increased to 193 cases, all of whom had vaped in the month prior to their illness. Some were smoking nicotine, others THC or cannabinoids. The victims used different products, and no one ingredient stood out as a potential culprit.

Late last week, the Department of Health and Human Services proposed changes to the so-called Part 2 which creates stricter privacy standards than the HIPAA Privacy Rule for substance use disorder treatment by government funded providers. Fierce Healthcare provides a useful overview of the situation.. The changes are intended to “support better care coordination and reduce provider burden while maintaining privacy safeguards for patients, HHS officials said.”

Finally FedSmith helpfully reports on how to carry Federal Employee Dental and Vision Program coverage into retirement.

If you plan to carry dental or vision coverage in retirement, there are several important nuances to make note of. As mentioned earlier, FEDVIP is a different program from FEHB, which means enrollment in FEDVIP for five years prior to retirement does not count as enrollment in FEHB. Unlike FEHB, FEDVIP does not require you to be enrolled in the program for five years prior to retirement. You can even enroll in a vision or dental plan in retirement if you need to. 

To be eligible for FEDVIP in retirement, you must retire on an immediate annuity. If you are receiving a deferred annuity you will not be eligible for retaining your dental and/or vision coverage. If you retire under Minimum Retirement Age+ 10 with a postponed annuity, you will be able to retain FEDVIP in retirement.

Fedsmith reports that OPM has announced that this year’s Federal Benefits Open Season will take place from Monday November 11 through Monday December 9, 2019.  This is time when federal and postal employees and annuitants can make changes to their FEHBP and FEDVIP coverage for 2020 and employees can enroll for a flexible spending account (FSAFeds) for 2020.

“Willis Towers Watson’s Rx Collaborative, an employer-based pharmacy benefit group purchasing coalition, disclosed in a statement to HR Dive that 40% of its total drug costs were spent on specialty drugs that accounted for less than 1% of its prescriptions in 2018. It also noted that the top 10 drugs by cost made up a fifth of its pharmacy spend that year. * * * The coalition reported a steady decrease in drug price inflation rates over the last three years: 3.5% in 2018, 4.2% in 2017 and 6.8% in 2016.”

According to Health IT Analytics, “Sixty percent of healthcare executives are using predictive analytics within their organizations, according to a recent survey from the Society of Actuaries (SOA), and 20 percent of payers and providers plan to begin using predictive analytics within the next year.”

Health Data Management reports that “The American Academy of Family Physicians and Health Level Seven International are teaming on a new project to improve the interoperability of social determinants of health data.The Gravity Project, part of HL7’s program to accelerate the adoption of its Fast Healthcare Interoperability Resources (FHIR), is meant to standardize medical codes to support the use of SDOH-related data in patient care, care coordination, population health management, value-based payment as well as clinical research.”

Finally Prof. Timothy Jost offers his overview of current Affordable Care Act litigation.  The FEHBlog finds it interesting that while litigation opposing the Trump Administration’s association health plan and short term limited duration health plan initiatives, no litigation has arisen as yet opposing the Trump Administration’s more recent individual coverage health reimbursement arrangement initiative. The ACA regulators have estimated that once employer become familiar with this rule, 800,000 employers may take advantage of it by 2029 which would result in 11,000,000 more Americans with individual coverage.

The FEHBlog ran across two articles on successful healthcare quality improvement efforts —

• Health Payer Intelligence discusses a Geisinger data analytics effort focused on getting five Medicare Stars, and 
• Employee Benefits News features an Pacific Business Group on Health CEO’s article on a primary care focused initiative to improve quality for large employers in California.

The Office of the National Coordinator is in talks with Congress and the White House on how to regulate secondary uses of healthcare data. ONC doesn’t have statutory authority to vet third-party apps and what they do with consumer data, agency chief Don Rucker told Healthcare Dive, but the agency is looking into a variety of solutions including legislative language on privacy and security provisions or voluntary attestation standards for the apps themselves.  ‘

Experts are concerned privacy and security have been an afterthought for the agency as it continues to push interoperability into the healthcare industry. But “there’s a number of people interested on both sides of the aisle and both sides of the Hill” in addressing the issue, according to Rucker.

The FEHBlog has noted that he has enrolled in the National Institutes of Health’s All of Us program.  Fortune Magazine reports that

NIH has an official genetic counseling partner for its ambitious, million-person All of Us research program: Color, a DNA testing and genomic counseling specialist. 

The NIH announced Wednesday that Color will receive a $4.6 million grant (part of $25 million over multiple years) in order to provide what Color describes as the “technological backbone” for the All of Us project. The company is also the sole grantee selected to set up and deliver genetic counseling for Americans participating in the program. 

All of Us is an NIH initiative that was announced under former President Barack Obama. It aims to ultimately collect health and biometric data – including DNA and blood samples, lifestyle information, and environmental data – from one million Americans. The goal is to use this vast dataset in order to better understand what affects health for people of different races, genders, and geographic locations – and, in the process, help spur the development of personalized medicine.

It’s all good new tidbits today!

• The Associated Press reports

After years of frequent list price hikes, many drugmakers are showing some restraint, according to the analysis of drug prices provided by health information firm Elsevier.  In the first seven months of 2019, drugmakers raised list prices for brand-name prescription medicines by a median of 5 percent. That’s down from about 9 percent or 10 percent over those months the prior four years, the AP found. From January through July this year, there were 4,483 price hikes, down 36 percent from that stretch in 2015.

• Fierce Healthcare reports that last week the Food and Drug Administration approved an AbbVie drug that competes with the blockbuster Humira drug to treat rheumatoid arthritis.  The new product Rinvoq should be available in the U.S. by late August, AbbVie said. Rinvoq bears a list price of $59,000, which “is lower than the current leading treatments for moderate to severe rheumatoid arthritis,” an AbbVie spokeswoman said by email. 

• HHS announced the issuance of its 2018 SAMSHA National Survey on Drug Use and Health. “This year’s National Survey on Drug Use and Health contains very encouraging news: The number of Americans misusing pain relievers dropped substantially, and fewer young adults are abusing heroin and other substances,” said Health and Human Services Secretary Alex Azar. “At the same time, many challenges remain, with millions of Americans not receiving treatment they need for substance abuse and mental illness.”  This has been the FEHBlog’s point. Health plans need to focus on covering evidence based treatment for these problems

• The American Association for the Advancement of Science informs us that “The U.S. Centers for Disease Control and Prevention report on the use of antibiotics in health care settings across the United States in 2018 tell us that while progress has been made to promote appropriate use of infection-fighting drugs, strengthened and continued efforts and greater resources are needed to protect some of the most valuable medicines we have and prevent the accelerating development of illness-causing bacteria that are resistant to treatment.”

Primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool,” wrote the panel in the journal JAMA. “Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.”

The Peterson-Kaiser Health System Tracker has released its latest report on the rise in employee premiums and cost sharing for employees with large employer coverage.

For most of those with employer coverage, the cost of the premium is split between the employer and employee. Looking only at the health spending for which workers are responsible (their families’ premium contributions and cost-sharing payments), the average family spent $4,706 on premiums and $3,020 on cost-sharing, for a combined cost of $7,726 in 2018. This represents an 18% increase in the health costs borne by employees and their families from five years earlier ($6,571 in 2013), outpacing the 8% increase in inflation and a 12% increase in workers’ wages over the same period.

Employee Benefit News discusses the use of employer incentives to encourage their employees to price shop for healthcare services.  “These programs [such as Direct Path and Health Joy] both educate employees about the fact that they should price shop for many healthcare services, and encourage them to choose lower-cost options by putting money back in their pockets.”

Fortune’s Brain Storm newsletters discusses the healthcare companies that landed on the magazine’s annual Change the World list. Check it out.

The FEHBlog was bowled over when he read in Modern Healthcare that only this week the federal Environmental Protection Agency is “prohibiting healthcare organizations from flushing hazardous waste pharmaceuticals [like opioids] into the sewer system.” Apparently there are healthcare organizations who must come into compliance with this rule. That’s nuts.

Congress is now just about half way through its August recess.  This is the time of the year when OPM completes its benefit and rate negotiations with carriers.

The Washington Post had a lengthy front page story today on how medical debt adversely affects rural people and rural hospitals. Much of the debt arises from emergency room use according to the article but the underlying problem is that rural areas don’t have the webs of walk-in clinics and urgett care centers found in urban areas. The federal government is planning to funnel more Medicare money to rural hospitals and as noted here last week, Sen. Check Grassley has introduced a bill to permit rural hospitals to do away with inpatient beds in favor of telehealth.  It’s a serious public health problem that the Affordable Care Act does not address.

Health Payer Intelligence offers an article with examples of how health plans and insurers are moving from reactive to preventive care.  In the same vein, Fierce Healthcare discusses how

As the number of high-cost treatments continues to grow, Anthem is launching a new program in Kentucky that aims to work with providers to protect patients from “shock” bills for these therapies. Anthem has teamed up with St. Elizabeth Healthcare, one of the state’s largest providers, as the first partner in the new program. In the model, the health system will absorb part of the cost of these services, discounting them by as much as 45%. 

And NPR’s Shots provides “pro tips’ on how to stick with healthy habits.