Aon Consulting and the International Society of CEBS just released the results of a survey of 434 employers on the topic of consumer driven health plans (CDHPs). 28% of the surveyed employers offer CDHPs, up from 22% in 2005. 43% of the CDHPs offer health reimbursement arrangements (HRAs) and 48% offer health savings accounts (HSAs) — a flip flop from 2005 in which 67% offered HRAs and 15% offered HSAs. Only 10% of the employers offering CDHPs gave their employees a choice of HSA or HRA down from 15% in 2005. The FEHB Program provides an HRA option for enrollees who cannot contribute to an HSA, e.g, due to Medicare eligibility.

Yesterday’s Wall Street Journal included a special section on senior living. I was intrigued by an an article by Sarah Lueck about the future of health care (subscription wall). The article described products designed to help seniors live in their homes as long as possible, such as as Accenture’s online home medicine cabinet , the Personal Watcher, a wrist watch that monitors vital signs, and Motiva, an interactive TV / health platform by Phillips Electronics. Many of these products were demonstrated at a White House aging conference last year. Ms. Lueck points out that the the manufacturers still need to prove that their products are cost effective because at this point money as well as the lack of interoperability standards are major barriers to widespread adoption.

Interestingly, the article also discusses an Orwellian aspect to these products — a theme which I find raised more frequently now in health information technology articles. That is another widespead adoption hurdle.

According to a recently released National Center for Health Statistics report, “Americans made more than 1.1 billion visits a year to doctors’ offices and hospital emergency and outpatient departments in 2004, up by 31% in the last 10 years.” The study attributes the increase, in part, to an 11% population growth and a 19% per capita utilization increase.

Other interesting tidbits from the study include:

• “One-half of the 1.1 billion visits (48.1 percent) were to primary care doctors in office-based practices. The rest were to medical specialists (18.3 percent) and surgical specialists (16.0 percent) in office-based practices and emergency departments (10.0 percent) and outpatient departments (7.7 percent) in nonfederal general and short-stay hospitals.

• “Essential hypertension was the primary diagnosis recorded most frequently (42.1 million) at ambulatory care visits. Significant increases over the last 10 years were found for most of the leading primary diagnoses at ambulatory care visits including diabetes (up by 117%) and spinal disorders (up by 94%).

• “There was no change in the average time a patient spent face-to-face with a physician in office settings. The amount of time a patient waited before seeing a physician in the emergency department increased from 38.0 minutes in 1997 (first year collected) to 47 minutes in 2004.”

On June 22, the Center for Studying Heath System Change reported that the net income of doctors dropped 7.7% on average from 1997 through 2003. “‘Flat or declining fees from both public and private payers appear to be a major factor underlying declining real incomes for physicians,'” said HSC Researcher Ha T. Tu, M.P.A, a study coauthor.” Nevertheless, according to the study, medicine remains of one of the best paid U.S. professions (thanks to third party payers). This change may provide impetus for the various pay for performance programs that third party payers are implementing to incent quality and technology improvements.

The House of Representatives had been planning to hold its own Health Week this week. The apparent centerpieces of Health Week were the HIT bill ( H.R. 4157 ) and a bill implementing the President’s HSA improvement initiatives (H.R. 5262) – bills that would directly impact the FEHB Program. According to the Kaiser Health Report, the House also will be considering several other health care system related bills that don’t directly impact the FEHB Program. As previously blogged, two House committees cleared different versions of HR 4157 and to make matters worse for proponents of HR 4157, the Congressional Budget Office has concluded that the bill, and in particular the ICD-10 mandate, would cost the Government money. Moreover, Rep. Eric Cantor (R VA) who sponsored the HSA improvement bill has now withdrawn it for retooling. Because it will take some work to resolve the issues with H.R. 4157, the House leadership has postponed its Health Week until next week.

As noted in a June 18 post, Zocor, one of the statin heart drugs, goes generic this Friday, and its manufacturer Merck is fighting back. According to the Wall Street Journal and other press accounts, Merck negotiated with United Healthcare Group a Zocor price that is below the price that generic manufacturer Teva is charging for its generic equivalent to Zocor. United Healthcare will be treating cut rate Zocor as a Tier 1 drug with the lowest copay and the generic Zocor as a Tier 3 drug with the highest copay in its health plans.

In a letter to the Federal Trade Commission, Sen. Charles Schumer has accused Merck of foul play. It looks like competition to me.

Judge Federico Moreno of the U.S. District Court for the Southern District of Florida has been presiding over the In Re Managed Care case, MDL No. 1334, for several years. It would cost over $45 at 8 cents a page to download the docket sheet from PACER. The case is a physicians class action against the major health insurance companies alleging improper reimbursement practices. Over the years, most of the defendants, including Aetna, CIGNA, Wellpoint, and Humana, settled. The holdout defendants were United Healthcare and Coventry Healthcare. Those companies’ perserverance was rewarded on Monday when Judge Moreno dismissed the claims against them.

The Washington Post reports that an ING Financial Services agent’s laptop computer was stolen from his southeast D.C. home last weekend. This laptop contained the unecrypted personal data, including Social Security Numbers, on 13,000 D.C. government employees and annuitants who had retirement accounts with ING. ING is taking remedial action including notifying the affected individuals and securing its other company laptops. Talk about closing this barn door.

OPM announced last week that its flexible spending account (FSA) contractor SHPS is piloting a debit card for GEHA enrollees to use with their optional FSA. According to OPM, the FSA program has 7,600 GEHA participants, and “these pilot participants must continue to save all receipts so that SHPS, Inc., the FSAFEDS administrator, may verify expenses that can’t be substantiated through paperless reimbursement. (For example, over-the-counter medicines.)” A good explanation of how these FSA debit cards work can be found here.

On June 12, I blogged about a new Merck blockbuster diabetes drug called Januvia, which is awaiting FDA approval. It turns out that next Friday June 23 Merck will lose its patent protection on a current blockbuster heart drug, the statin Zocor ($4.4 billion in 2005 sales — estimated zero dollars in 2007).

According to Forbes Magazine, the Israel based generic drug powerhouse Teva Pharmaceutical Industries expects to receive FDA approval of its generic version of Zorcor, known as simvastatin , later this month. Although Pfizer’s patent on the best selling statin Lipitor ($13 billion in sales) does not expire until 2011, prescription benefit managers are expected to encourage switchovers from patent medications like Lipitor and Crestor to the generic version of Zocor, particularly in low risk patients. Indeed, a research company Decision Resources recently found that “primary care physicians and cardiologists expect to substantially decrease their prescribing of Lipitor when generic simvastatin is available in June 2006.”

What’s more, Pfizer’s patent on the best selling anti-depressant drug Zoloft ($3.3 billion in 2005 sales) expires on June 30. A US subsidiary of Teva, Ivax, received FDA approval of a generic version of another best-selling anti-depressant Lexapro ($1.2 billion in 2005 sales) on May 23. However, Teva cannot market that generic until Forest Lab’s patent on Lexapro expires in 2009 unless it wins its legal challenge to that patent.

Express Scripts, one of the major PBMs, issued a report earlier this month estimating that there are $20 billion in untapped generic drug savings.