Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

Because OPM’s press release links to 2020 premiums, here are OPM’s charts for

OPM also distributed this interesting chart comparing nationwide fee for service plan and local HMO plan premium increases for 2021.

FEHB plans post benefit change information on their respective websites before OPM does next month. Blue Cross FEP and Kaiser, among others already have done so.

On the pharmacy / PBM front —

  • Fierce Healthcare reports on Cigna CEO David Cordani’s talk at the HLTH Conference yesterday and Drug Channels discusses the improving relationship between Prime Therapeutics and Cigna’s PBM Express Scripts.
  • Fierce Healthcare also reports on the HLTH Conference talk by Jim Peters, Rite Aid’s chief operating officer, speaking at the HTLH 2020 virtual conference. It appears that Rite Aid is looking to pull the Health Hub page out of CVS Health’s playbook.

Today, the American Hospital Association’s lawyers argued before a three judge panel that the U.S. Court of Appeals for the D.C. Circuit should reverse the District Court’s decision upholding an HHS rule requiring to post payer-negotiated rates for popular hospital services. The AHA’s lawyer wants to place this burden on the health plans. A friend of the FEHBlog told him that the oral argument was “wild.” Unfortunately, the FEHBlog’s MacBook Air could only get through five minutes of the online argument. In any event Fierce Healthcare reports that the oral argument did not go well for the AHA’s lawyers. “The judges, all of which were appointed by Democratic presidents, were skeptical of the AHA’s argument that HHS doesn’t have the authority to implement the rule.” The appellate court will release a decision in three months or so.

Federal News Network reports that OPM is creating a new federal pay locality for Des Moines Iowa and expanding the Los Angeles pay locality to include Long Beach California. The change affects 3,800 Iowa employees and 1860 California employees. However, “Trump’s federal pay plans for 2021 may also complicate matters. The president proposed a 1% across-the-board pay raise for federal employees next year. To date, he hasn’t proposed any locality pay adjustments, and Congress hasn’t suggested it will step in and pass its own raise for federal workers, meaning employees in Iowa and California may not see a change in 2021.”

The FEHBlog was wondering today whether any progress has been made in the COVID-19 relief bill negotiations. CNET has the answer. Not much. But you never know in an election year.

Finally Forbes reports

According to the results of the Envoy Return to Work Survey that was released today, 73% of Americans are afraid of putting their personal health and safety at risk by returning to the workplace, with 75% saying they would consider quitting their jobs if the Covid-19 prevention measures by employers were inadequate or inappropriate. Workers in the business or tech services are more likely to consider leaving their job than those in the construction, manufacturing, retail or service industries. * * *

Their concerns notwithstanding, 90 percent of workers miss their workplace. Most miss their friends and teammates (47%), perks such as lunch and snacks (36%), and small talk at the coffee machine or water cooler (31%). Slightly more workers — 94% of those polled — said they want to spend at least one day a week in the office.

The survey indicates that some employers need to do a better job ensuring that the workplace is safe to come back. Of those who returned to their place of employment, 42% said they experienced preventive measures that were either ineffective or not enforced, including six-foot distancing measures (25%), mask requirements (21%), and hand washing requirements (18%).

What a crazy year.

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

The FEHBlog did catch part of the LAN Summit today. The FEHBlog understands that recordings of the sessions will be available at no cost in the near future.

  • The LAN released a Healthcare Resiliency Framework which is particularly appropriate 2020.
  • The FEHBlog was impressed by a talk given by Alan Levine, the CEO of Ballad Health which was created by the 2018 merger of two rural health systems in southwestern Virginia and eastern Tennessee. This program caught the FEHBlog’s attention:

Ballad Health is implementing the Strong Starts/Strong Pregnancies Program to connect with the 300-member STRONG Accountable Care Community (ACC) it facilitated, which consists of churches, schools, employers, healthcare providers and social services agencies in the Appalachian Highlands. More than 6,000 babies are delivered each year in Ballad Health facilities, and beginning in 2021, Ballad Health and participating independent obstetricians in the region will provide assessments and screenings to help connect families with a community navigator who will work to make sure each child receives the strong start they deserve. This includes connecting families with the supports and services provided by the members of STRONG and other community partners.

Here are a couple of tidbits from the virtual HLTH Conference:

  • Fierce Healthcare reports that “In the months after Walgreens announced a $1 billion partnership with VillageMD to build hundreds of primary care clinics next to its retail pharmacy stores, there are still only a few locations in Houston. “But that will be changing quickly, said Walgreens’ co-Chief Operating Officer Alex Gourlay. “Within the next fiscal year, the company plans to have at least 40 locations open, Gourlay said, speaking at the HLTH 2020 virtual conference Monday. The company has previously said it expects to have at least 500 locations open within the next five years.”
  • Healthcare Dive reports that “Integrated health giant Kaiser Permanente said it intends to put a stronger focus on equity and inclusion in one of Greg Adams’ first major moves as CEO. The Oakland, California-based nonprofit plans to bring ethnicity and race factors into how it evaluates quality and care across the organization, Adams said Monday at the HLTH virtual conference. Kaiser’s board, which finished strategic planning in the middle of the pandemic, is still figuring out what that means in practice.” As a board we made the decision that we would own healthcare disparities for all care that we provide,” Adams said. “We haven’t quite figured out how we’re going to do that… [but] the point the board made is, owning it for a few conditions is not sufficient.”

On the COVID-19 front

  • The NIH Director Dr. Francis Collins has an encouraging post today about COVID-19 vaccine development.
  • The Wall Street Journal reports that Johnson & Johnson put a pause on their Phase III vaccine trial in order to investigate an unexpected illness in a participant. The FEHBlog is pleased to read about occasional pauses like this because it shows that the trial system is working.
  • CNN Health reports that “there were 20% more deaths than would normally be expected from March 1 through August 1 in the United States — with Covid-19 officially accounting for about two-thirds of them, according to new research published Monday in the medical journal JAMA.” COVID-19 is one bad disease.
  • A friend of the FEHBlog called to his attention the fact that on October 8, 2020, the Department of Health and Human Services renewed the nationwide public health emergency for the opioid crisis. It is surprising to the FEHBlog that the first such declaration was made only three years ago.
  • This lead the FEHBlog to discover that on October 2, 2020, HHS also renewed the nationwide COVID-19 public health emergency through January 21, 2021. This act extends the CARES Act COVID-19 testing mandate on health plans at least through that date.

Finally Federal News Network reports that “Social Security recipients will get a modest 1.3% cost-of living-increase in 2021, but that might be small comfort amid worries about the coronavirus and its consequences for older people. The increase amounts to $20 a month for the average retired worker, according to estimates released Tuesday by the Social Security Administration. That’s a little less than this year’s 1.6% cost-of-living adjustment, or COLA. The COLA affects the personal finances of about 1 in 5 Americans, including Social Security recipients, disabled veterans and federal retirees, some 70 million people in all.”

Monday Roundup

The Wall Street Journal reports today that

Photo by Sven Read on Unsplash

“Public-health experts increasingly agree—including critics of the Great Barrington Declaration—that the broad, months long lockdowns imposed in March may be too unpopular to sustain [again]. Experts who backed lockdowns in the spring now worry another round of the same type could backfire if the public ceases to comply.

Even proponents of more lockdowns are generally pushing for briefer, more targeted closures, dubbed circuit-breakers, in which governments would shut specific businesses for two or three weeks, such as bars, restaurants and possibly universities. Other institutions that appear to be lower risk—including day cares, elementary schools and outdoor facilities—could remain open.

“The opinion of public health experts is changing very rapidly,” said Jayanta Bhattacharya, a professor of medicine at Stanford University, who is one of the co-authors of the Great Barrington Declaration. “In March, I felt alone. [Now] I think there are a very large number of public health experts, epidemiologists, and doctors who oppose further lockdowns.”

That’s a consensus that the FEHBlog can support.

Fierce Healthcare reports from the HLTH Conference on Humana CEO Bruce Broussard’s talk on how he adjusted his leadership style to the COVID-19 public health emergency. “He said that a virtual work environment has forced him to be much more “intentional” in his leadership approach, which meant adopting new strategies to reach workers and being more thoughtful about how he approaches communicating with Humana’s employees. * * * In addition,Broussard said he believes COVID-19 is putting a spotlight on the value of taking a whole-person approach to care. Having flexible access to a number of different services at home was crucial for the insurer’s largely-Medicare Advantage member base, who were at high risk from complications if they caught the virus. Broussard said he doesn’t foresee the momentum toward those options going away once COVID-19 is under control.

Today, the FEHBlog ran across another interesting conference which is being held later this week — American Healthcare Information Management Association (“AHIMA”) 20. The FEHBlog, who is an AHIMA member, purchased access to this virtual conference. The conference runs from October 14 to October 17.

A related organization, the Workgroup for Electronic Data Interchange (WEDI) holds its virtual annual conference from October 20 to 22. WEDI focuses on the HIPAA standard transactions while AHIMA focuses on the HIPAA-coded data included in those transactions. It is the umbrella law that piques this lawyers interest among other things.

Weekend update

Thanks to ACK15 for sharing their work on Unsplash.

Congress does not plan to hold votes this week. The Senate Judiciary Committee begins Judge Amy Coney Barrett’s Supreme Court nomination confirmation hearing tomorrow.

Fox Business brings us up to date on the COVID-19 relief bill negotiations, and Federal News Network outlines new federal employment bills to watch.

This week the HLTH conference will virtually occur. Healthcare Dive describes five conference highlights.

On the afternoon of Tuesday October 13, the HCP-LAN will hold its virtual summit meeting. The FEHBlog has enjoyed these summits and, in contrast to HLTH, there’s no charge to attend. “The 2020 LAN Virtual Summit will center around how value-based payment models and the larger health care system have adapted to become more responsive and resilient in the wake of the public health emergency.”

On Thursday October 15, the Medicare Open Season begins. This is time when Medicare beneficiaries can enroll in or switch Medicare Advantage and Part D plans. The Open Season end on December 7.

Hopefully this week also will spotlight OPM’s 2020 Open Season announcement.

In recent news —

  • Health Payer Intelligence discusses a PriceWaterhouseCoopers report on strategies that health plans are implementing to control prescription benefit costs.
  • The Wall Street Journal considers “Lessons for the Next Pandemic—Act Very, Very Quickly / Scientists and public-health leaders are working on new ways to find infections before they spread; smarter lung scans and screening blood samples.” It’s never too early to start evaluating and planning.
  • The Federal Times reports on the virtual ceremony held to honor the federal employees who received the 2020 SAMMIE awards. SAMMIE is short for Samuel J. Heyman Service to America Medals. Congratulations SAMMIE winners.
  • NPR reports that

When developing a vaccine, scientists have a few strategies to try. They can take a piece or component of the bacteria and use that to trigger an immune response in a person. They can kill the pathogen and use its corpse as the vaccine. Or they can take a live pathogen and weaken it in the lab.

The latter are called “live, attenuated vaccines,” and over the past century, scientists have noticed something peculiar about these vaccines: They seem to offer some protection, not just from the targeted disease, but also against many different diseases, including respiratory infections.

COVID-19, of course, is a respiratory infection.

The nasal flu vaccine, in contrast to the injection, is a “live, attenuate vaccine.” However, it is only available to certain age groups. The Centers For Disease Control explains “The nasal spray flu vaccine is approved for use in healthy non-pregnant individuals, 2 years through 49 years old. People with certain medical conditions should not receive the nasal spray flu vaccine.” Of course, this is a conversation to hold with your doctor if you are eligible for the nasal flu vaccine.

Friday Stats and More

Based on the Centers for Disease Control (CDC) Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 40th weeks of this year (beginning May 14 and ending October 7; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

Because the FEHBlog does look at his charts which are intended to show trends, he realized that new deaths chart is flat because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths over the same period (May 14 through October 7 (nearly five months).

Chris Conover recently wrote about your risk of dying from COVID-19 in the Forbes Apothecary. Three takeaways from the article:

  • Covid-19 has increased the risk of death for the average American by about 10 percent, but this increase in risk is much higher for seniors than children.
  • For seniors age 70 and older, getting Covid-19 is riskier than climbing Mt. Everest; in contrast, for those under age 20, the infection fatality risk is equivalent to driving a car for 7,500 miles.
  • Those under age 50 who get infected with the coronavirus lose less than one day of discounted quality-adjusted life expectancy; seniors age 70 or older lose nearly 90 days.

Today the CDC released the first weekly influenza update for this flu season in our country. The key update is brief: “Seasonal influenza activity in the United States remains low.” In contrast, the key update from this week’s COVID-19 update from the CDC is more nuanced:

Nationally, indicators that track COVID-19 activity continued to decline or remain stable (change of ≤0.1%). However, one region reported a slight increase in the percentage of specimens testing positive for SARS-CoV-2 and four regions reported slight increases in the percentage of visits for influenza-like illness (ILI). Mortality attributed to COVID-19 declined but remains above the epidemic threshold.

Today, the CDC also issued its National Action Plan for Combating Antibiotic Resistance 2020-2025, a worthy goal. “The U.S. Government will report annually on progress toward the objectives set in the Plan.”

In his Libertarian podcast this week, law professor Richard Epstein discussed why the Supreme Court will uphold the constitutionality of the Affordable Care Act in the California v. Texas case, which will be argued on November 10. The FEHBlog is buying what the good professor is selling. The discussion is in the first 10 minutes of the podcast which is less than 30 minutes overall.

The HHS Office for Civil Rights took its second scalp this week from a healthcare provider that allegedly failed to give patients HIPAA required access to their medical records, a big OCR priority. “NY Spine Medicine (NY Spine) has agreed to take corrective actions and pay $100,000 to settle a potential violation of the HIPAA Privacy Rule’s right of access provision. NY Spine is a private medical practice specializing in neurology and pain management with offices in New York, NY, and Miami Beach, FL.”

Have a good weekend.

Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

Well, this year’s FEHBP / FEDVIP Open Season announcement will be the latest in recorded history as the FEHBlog found on opm.gov that the past champion turtle was the Open Season announcement issued on October 7. OPM did send out its second Benefit Administration Letter on the Open Season today but that’s not the same thing as announcing 2021 premium changes. What’s particularly odd is that OPM usually settles all of the FEHBP premium negotiations by mid-August. What possibly could be the reason for this hold up? The FEHBlog hopes that this is not the new normal as the ongoing delay impairs FEHBP competition.

In an example of good corporate citizenship, Forbes reports today that

The large hospital operator HCA Healthcare Thursday said it will “return, or repay early” about $6 billion in federal stimulus money from the Coronavirus Aid, Relief, and Economic Security Act, known as CARES. HCA, one of the nation’s biggest hospital operators, has been performing well financially and earlier this year reported a profit of more than $800 million in its second quarter thanks to CARES Act funds.

In other business news, Fierce Healthcare reports that

[Telehealth vendor] Amwell’s stock climbed 38% Wednesday just three weeks after raising an outsized initial public offering of $742 million. Investor interest in Amwell was fueled by speculation that insurer UnitedHealth may buy the telehealth giant, according to healthcare analysts, Business Insider reporter Blake Dodge reported.

The article adds that “UnitedHealth Group also is reportedly in talks to buy online pharmacy DivvyDose that would put the insurer in direct competition with Amazon’s PillPack.” Interesting moves.

On the COVID-19 front today, the Wall Street Journal confirmed by its investigational reporting, at least to the FEHBlog’s satisfaction, that the COVID-19 virus was spreading across our country months before the mid-March commencement of the great hunkering down. “While the country was still looking outward [in January and February 2020, researchers now believe the earliest infections in many states came mostly from travel within the U.S.” This reminds me of the course of the Great Influenza in 1918 according to J.M. Barry’s Great Influenza book. Again, the difference between then and now is 100 years of medical advances. The FEHBlog continues to have faith in the U.S. healthcare system as well as the common sense of the American people.

Midweek Update

Photo by Maria Teneva on Unsplash

The Blue Cross Blue Shield Association has a new president and CEO effective January 4, 2021 — Kim A. Keck. Ms. Keck, who will be the first woman to hold this position, is currently president and CEO of Blue Cross of Rhode Island. She worked for Aetna for 28 years. Of course, she succeeds Scott Serota. Congratulations, Ms. Keck.

Congratulations as well to the 2020 winners of the Nobel Prize in Chemistry, Emmanuelle Charpentier of the Max Planck Institute in Berlin and Jennifer Doudna of the University of California, Berkley, for their work in developing “genetic scissors” known as CRISPR-Cas9 “that can cut DNA at a precise location, allowing scientists to make specific changes to specific genes.” NPR explains that

“Once in a long time, an advance comes along that utterly transforms an entire field and does so very rapidly,” says Francis Collins, director of the National Institutes of Health, which has long supported Doudna’s research. “You cannot walk into a molecular biology laboratory today, working on virtually any organism, where CRISPR-Cas9 is not playing a role in the ability to understand how life works and how disease happens. It’s just that powerful.”

In other good news Precision Vaccinations reports that

The CDC researchers noted in the Morbidity and Mortality Weekly Report published on October 2, 2020, that during the 2019-20 flu season, 61.2 percent of surveyed pregnant women received the flu vaccine, which was 7.5 percentage points higher than the previous flu season. In addition, 56.6 percent of the women received the Tdap vaccine during pregnancy, and 40.3 percent received both vaccines. The percentage of women receiving both vaccines significantly increased from 35 percent just one year ago.

These increases were driven by increased vaccination coverage among Black and Hispanic women and those of other races reported the CDC. The CDC authors stated: “Racial disparities in vaccination coverage could decrease further with consistent provider offers or referrals for vaccination, in combination with culturally competent conversations with patients.” Specifically, this data found approximately 20 percent of pregnant women reported not receiving a provider recommendation for these vaccinations.

On the COVID-19 front, STAT News informs us that Eli Lilly reports good results with its synthetic antibody treatments for COVID-19. Lilly is seek emergency authorization use approval from the Food and Drug Administration as it continues to clinical trials on the treatments.

In other news —

The Department of Health and Human Services (“HHS”) announced today that

Surgeon General VADM Jerome M. Adams, M.D., M.P.H., issued a Call to Action urging Americans to recognize and address hypertension control as a national, public health priority. The Surgeon General’s Call to Action to Control Hypertension provides strategies for those on the frontlines of health care and public health to address this costly, dangerous and far too common chronic health condition.

According to Fierce Healthcare, Express Scripts has added new tools to its digital formulary that address “women’s health needs, tobacco cessation, muscle and joint pain, caregiver care and COVID-19 workplace support. The formulary’s goal is to assist employers and other plan sponsors in finding the digital health solutions that best fit their worker’s needs, and which have been vetted by experts at Express Scripts for key concerns like effectiveness, value, user experience and security.”

Healthcare Dive lets us know that

Doctors and consumers expect to use virtual care more often after COVID-19 than they did before, according to a new survey from telehealth vendor Amwell, hinting at the long-term potential of the virtual care model in healthcare. Prior to the pandemic, the majority of virtual visits were for on-demand urgent care. But this year, the volume of virtual specialty and scheduled visits outpaced urgent care, suggesting telehealth is becoming normalized across more fields and use cases. Only about 21% of consumers had a virtual visit for on-demand urgent care visit this year. By comparison, 54% had a scheduled visits with their primary care physician.

HHS’s Office for Civil Rights announced another HIPAA scalping of a healthcare provider that failed to provide individual access to their medical record, a top OCR priority at this time. “Dignity Health, doing business as St. Joseph’s Hospital and Medical Center (“SJHMC”), has agreed to take corrective actions and pay $160,000 to settle a potential violation of the HIPAA Privacy Rule’s right of access provision. SJHMC, based in Phoenix, Arizona, is a large, acute care hospital with several hospital-based clinics that provide a wide range of health, social, and support services.”

Tuesday Tidbits

The Wall Street Journal reported this afternoon that the President has “endorsed the U.S. Food and Drug Administration’s [“FDA”] plans for assessing whether a Covid-19 vaccine should be given to the public, making it likely that a shot won’t be cleared until after the election, people familiar with the matter said.” Here is a link to that FDA guidance which was issued today. The FEHBlog also has confidence in the FDA.

The Journal also reports that the President has called off further COVID-19 relief bill negotiations between the Speaker of the House and the Treasury Secretary until after the November 3 election which is four weeks away.

Mr. Trump said he had instructed Senate Majority Leader Mitch McConnell (R., Ky.) to focus his efforts on confirming his Supreme Court nominee Amy Coney Barrett, whose Judiciary committee hearings start Monday, rather than the stimulus effort.

Mr. McConnell said that he agreed with Mr. Trump’s decision.

“I think his view was that they were not going to produce a result and that we needed to concentrate on what’s achievable,” he told reporters.

In other inside the Beltway news, the FEHBlog this morning listened to the oral argument before the U.S. Supreme Court in the ERISA preemption case involving an Arkansas law governing prescription benefit manager pricing practices. Rutledge v. PCMA (No. 18-540) — the recording of the argument is available here.

At issue is a U.S. Court of Appeals decision holding that ERISA preempted this Arkansas law. The counsel for the State of Arkansas, supported by the U.S. Solicitor General, argued that ERISA does not preempt a state law that regulates health care pricing. However, the counsel for PCMA countered, successfully in the FEHBlog’s view that the Arkansas law was not merely a pricing requirement. Rather it was loaded with administrative requirements. If the Supreme Court were to reverse the Eight Circuit, then there are forty states at last count that would be able to impose their pricing and procedural requirement on employer-sponsored health plans, which outcome likely would wind up encompassing the FEHBP.

PCMA’s counsel described that outcome as an administrative nightmare for ERISA plans. He directed the Court’s attention to the amicus brief filed by a nationwide employer based in Arkansas, J.B. Hunt.

For example, if an over-the-road truck driver for J.B. Hunt maintains two separate residences in Arkansas and California, which state PBM law applies? Many Arkansas communities straddle border states (e.g., West Memphis, Texarkana, Ft. Smith, Rogers). What if a J.B. Hunt employee resides in a border state but fills prescriptions across the border in Arkansas— or vice-versa? What if a Minnesota-based over-the- road truck driver needs to fill a prescription while passing through Arkansas, and now the Plan has to process and pay the claim under two different sets of laws?

ERISA and FEHBA state law preemption are in place to permit uniform nationwide administration of these employer sponsored plans. The Supreme Court will issue a decision before the end of June 2021.

Monday Round-up

Photo by Sven Read on Unsplash

For fun, the FEHBlog went down the OPM.gov rabbit hole to find the dates on which the the following year’s FEHB and FEDVIP premiums were announced. Since 2004 (the FEHBlog could not find the 2009 and 2010 press releases), the announcement was made eleven times in September and four times in October. The latest date was October 7 in 2014. Since that date the release dates range from September 28 (in 2015 and 2018) to October 7. So OPM has not set a new record yet.

In this regard, the Society for Human Resources Management reports today that

Employers expect a moderate health plan cost increase next year of 4.4 percent, on average, compared to this year, according to early results from HR consultancy Mercer’s National Survey of Employer-Sponsored Health Plans 2020.

The increase, based on 1,113 employer responses since early July, is marginally lower than a recent forecast by the nonprofit Business Group on Health, which in August expected a 5.3 percent increase in health plan premiums for 2021. But Mercer’s projection is within the broad range of 4 percent to 10 percent forecast by consultancy PwC’s Health Research Institute over the summer.

Mercer projects that 2020 will end with a 3.3 percent health benefit cost increase, which is still largely in line with the average annual cost growth over the past several years. Still, health benefit cost growth is now far outpacing the consumer price index and wage growth, both of which have slowed significantly.

The President, who returned to the White House from Walter Reed National Military Medical Center this evening, signed an executive order on Saturday. The executive order concerns “Saving Lives Through Increased Support For Mental- and Behavioral-Health Needs. It establishes a “Coronavirus Mental Health Working Group (Working Group) is hereby established to facilitate an ‘all-of-government’ response to the mental-health conditions induced or exacerbated by the pandemic, including issues related to suicide prevention. The Working Group will be co-chaired by the Secretary of Health and Human Services, or his designee, and the Assistant to the President for Domestic Policy, or her designee.”

It’s a bit of surprise to the FEHBlog that as Federal News Network reports the federal government has not yet given affected employees the option to decline the Administration’s temporary payroll tax deferral.