The FEHBlog

Tuesday Tidbits

Fierce Healthcare’s reporters fill us in on the day 2 doings at the JP Morgan healthcare conference in San Francisco.

In the same vein, Healthcare Dive informs us that “Cigna is partnering with tech-savvy payer startup Oscar Health to jointly sell commercial health plans to small businesses as the Bloomfield, Connecticut-based payer looks to capitalize on Oscar’s simplified strategy to expand its footprint in the small group market.”

About five years ago, the FEHBlog heard the American Medical Association’s then president elect explain that he takes heart disease death statistics with a grain of salt because doctors historically have listed heart disease as the default cause of death for older patients when no autopsy is ordered. This Wall Street Journal article, however, suggests that our country has a serious problem with heart disease.

Americans are dying of heart disease and strokes at a rising rate in middle age, normally considered the prime years of life. An analysis of U.S. mortality statistics by The Wall Street Journal shows the problem is geographically widespread. Death rates from cardiovascular disease among people between the ages of 45 and 64 are rising in cities all across the country, including in some of the most unlikely places.

NPR Shots discusses the current state of concierge medicine and is younger cousin direct primary care in the U.S.

Monday Musings

This week the 38th annual JP Morgan healthcare conference is being held in San Francisco. Fierce Healthcare’s reporters provide us with an interesting pastiche of conference presentations.

Beckers Hospital CFO Review reports on a recent Health Affairs analysis on the value of bundled payment arrangements.

Twenty studies reviewed show that the bundled payment models maintained or improved quality while lowering costs for lower extremity joint replacement. This didn’t hold true for other procedures and conditions. Study others added that a significant number of studies didn’t find any effect on healthcare spending, although this varied by clinical episode.

Buyer beware.

The FEHBlog wishes to caveat a point made in his December 2019 “Santa Claus” post. The post accurately explained that Congress has repealed the Affordable Care Act’s medical device, health insurer and high cost plan excise taxes (the latter colloquially known as the ACA’s Cadillac tax.) Katie Keith points out in the Health Affairs blog that

Repeal of the health insurance tax would not take effect until 2021, meaning the tax—which has already been built in to many premiums for the 2020 plan year—will remain in effect for 2020. The Cadillac tax and medical device tax are repealed beginning in 2020.

Weekend update

Congress remains in session this week on Capitol Hill.

The Wall Street Journal offers two articles of note:

  • An in-depth article about Google Health’s data analysis arrangements with large health care providers.
  • An article about a new prescription drug manufacturer EQRx, Inc. which claims it plans to offer generics at below market price. The article notes that

The new business is the latest example of how high drug costs have prompted hospital groupsstates such as Californiaand now drug-industry insiders to explore alternative models for making drugs at lower prices. 

Govexec.com reports that

The White House is calling on federal agencies to develop new strategies to reduce injuries in the federal workplace and to help those who are hurt to get back to work more quickly, creating a new, governmentwide push to help accomplish the goal. 

The Protecting Employees, Enabling Reemployment (PEER) Initiative will task each agency [including the Postal Service][ with developing specific strategies and goals to slash injuries on the job and time off of work due to injuries, Office of Management and Budget acting Director Russ Vought said in a memorandum dated Thursday. He noted that 107,000 federal employees filed new workers’ compensation claims in 2018 and received $3 billion in payments. 

Health Payer intelligence brings us up to date on budding payer efforts to provide senior members with ride sharing services to healthcare appointments. In the FEHlog’s view, this is a dandy idea.

TGIF

Yesterday, the Employee Benefits Research Institute (“EBRI”) issued its annual report on the use of health savings account in the U.S. Here’s the key in the FEHBlog’s view:

“As individuals become more familiar with HSAs, they are more likely to take advantage of the benefits of the account. Account balances are growing over time, enabling longtime account holders to withdraw larger sums when unexpected major health expenses occur and saving and investing for retirement expenses”, said Paul Fronstin, director of EBRI’s Health Research and Education Program and coauthor of the report. “Plan sponsors that value employee financial wellness can work with administrators and advisors to take a long-term view of HSA account balance growth.”

Here is a link to HR Dive’s take on this report.

Earlier this week, CMS announced the appointment of Brad Smith to “serve as Director of the Center for Medicare & Medicaid Innovation at CMS and Senior Advisor to Secretary Azar for Value-Based Transformation.” Becker’s Hospital Review adds that “Mr. Smith, a former Rhodes scholar and Nashville, Tenn.-based entrepreneur, comes to the leadership position after serving as COO of Anthem’s Diversified Business Group. He also co-founded and was CEO of palliative care provider Aspire Health.” Good luck, Mr. Smith.

Health Leaders Media reports that America’s Health Insurance Plans has offered a defense of the value of health plan administrative costs in the U.S.

“Study after study continues to demonstrate the value of innovative solutions brought by the free market. In head-to-head comparisons, the free market continues to be more efficient that government-run systems,” AHIP said.

They cited a MedPAC report which showed that Medicare Advantage plans deliver benefits at 88% of the cost of traditional Medicare, including administrative costs.

Supreme Court update

As anticipated, the parties challenging the Affordable Care Act’s constitutionality of the Affordable Care Act filed papers opposing the motion of the law’s defenders to expedite a Supreme Court decision in the case. The Supreme Court case number for the States’ cert. petition is 19-840 and the case number for the House of Representatives cert. petition is 19-841. If you care to read the motion papers, search for the case number(s) in the docket search feature found in the upper right hand corner of the Court’s website. In contrast to PACER the general online service to retrieve federal court papers, this Supreme Court feature is offered at no additional cost. We may hear the Court’s decision on the motion to expedite as early has next Friday January 17.

Photo by Allie Smith on Unsplash

Re-admission Study

The Affordable Care Act (“ACA”) directed a lot of attention on avoiding unplanned hospital re-admissions. Who can argue with that? The ACA rules and the NCQA measures have scrutinized readmissions within 30 days of discharge. The FEHBlog has noticed at least one study concluding that hospitals should not be held responsible for readmissions that occur more than seven days after discharge.

Over the past couple years, health insurers have begun to take into account social determinants of health. It is undoubtedly true that people without a strong social support system are likely candidates for hospital readmission. Therefore, focusing on SDOH considerations should be helpful in avoiding readmissions.

A friend of the FEHBlog shared with him this Tradeoffs podcast story about a random study of the “sickest of the sick” to see whether providing social services for an extended period following discharge would avoid unplanned readmissions within 180 days following discharge. Not surprisingly, to the FEHBlog, the study was not successful.

Researchers tested whether pairing frequently hospitalized patients in Camden, New Jersey, with nurses and social workers could stop that costly cycle of readmissions. The study found no effect: Patients receiving extra support were just as likely to return to the hospital within 180 days as those not receiving that help.

This was the lead story on Police Pulse this morning. But what does the study mean beyond Camden? If the study had had a positive result, then the findings should have been transferable across most populations. However, while this particular negative finding does mean it is back to the drawing board for the Camden patient, those findings are not necessarily transferable to other healthier populations. Also it may be that the 180 day readmission free period was a bridge too far. Health plans and healthcare providers should not be discouraged.

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Midweek Update

Good news! The Wall Street Journal reports today that

The cancer death rate in the U.S. dropped 2.2% from 2016 to 2017, the largest single-year drop ever recorded, according to the latest report from the American Cancer Society, continuing a longstanding decline that began a quarter-century ago.

The drop is largely driven by progress against lung cancer, though the most rapid declines in the report occurred in melanoma. Advances in treatment are helping improve survival rates in the two cancers, experts say.

More good news from Health Data Management

America’s Health Insurance Plans (AHIP) and several member health insurers pilot tested the program, called the Fast Prior Authorization Technology Highway (Fast PATH), to improve the [physician-detested prior authorization] process. The initiative will rely on technologies of Availity and Surescripts to accelerate the exchange of prior authorization requests, responses and information exchange.

Healthcare Dive informs us about a Kaiser Family Foundation study finding that the Affordable Care Act health insurance marketplaces have stabilized even though the individual mandate has been zeroed out. That doesn’t surprise the FEHBlog because the FEHB Program has waived pre-existing conditions without any individual mandate for over 60 years. What’s more the Administration’s individual coverage health reimbursement accounts should feed more people into the marketplaces over time.

The FEHBlog’s favorite podcast, Econtalk, features an interview with computer scientist Melanie Mitchell, who discusses her book about the state and future of artificial intelligence. It’s a helpful discussion for lay people like the FEHBlog who hear artificial intelligence bandied about.

Supreme Court scheduling action

Healthcare Dive reports that “The Supreme Court on Monday set a Friday [January 10] afternoon deadline for challengers of the ACA to respond to the blue state coalition’s motion to expedite the case.” The lead coalition member State of California has requested that the Court calendar to case for oral argument this Spring so that a Supreme Court decision may be issued before the end of the current term in late June / early July. This scheduling order allows the Supreme Court to consider the motion to expedite at its Friday January 17, 2020, conference. Approval of the motion would require the support of at least five justices. If the Court decides the motion on January 17, the decision would be announced that Friday afternoon or the following Tuesday morning. Stay tuned.

Fascinating charts

Check out the Peterson-KFF series of charts on how U.S. healthcare spending has changed over time, which was posted on December 20, 2019. The website explains

This chart collection explores recently released National Health Expenditure (NHE) data from the Centers for Medicare and Medicaid Services. These data offer insight into changes in health spending over time as well as the driving forces behind spending growth.

Yes indeed. 

Weekend Update

As Americans return to full work weeks following the holiday season, Congress begins the second session of the current 116th Congress here in the Nation’s capital.

On Friday, according to the Volokh Conspiracy, the intervenor defendant, appellant States and House of Representatives filed separate requests for expedited review of the Fifth Circuit’s decision in the Texas v. United States decision holding the Affordable Care Act’s individual shared responsibility provision / mandate unconstitutional.  As you will recall, the Fifth Circuit directed the lower court — Northern District of Texas — to carefully reevaluation its December 2018 decision that the ACA is inseverable from the unconstitutional individual shared responsibility responsibility. The petitioners seek to short circuit this step by taking the case to directly to the Supreme Court. For what it’s worth, the FEHBlog expects the Supreme Court to decline this request in order to allow the record to more mature before high court review.

Govexec.com reports that

In a report dated Dec. 19 and released on the Office of Personnel Management’s website last week, the President’s Pay Agent, which is a board comprised of Labor Secretary Eugene Scalia, Office of Management and Budget Acting Director Russell Vought and OPM Director Dale Cabaniss, greenlit a series of recommendations from the advisory Federal Salary Council. Chief among them were the creation of a new Des Moines, Iowa, locality pay area, and the addition of Imperial County, Calif., to the Los Angeles locality pay area.

The inclusion of these new regions is “subject to rulemaking,” meaning OPM must act over the course of the next year to finalize the additions. The pay agent also approved the salary council’s recommendation that officials should consider human capital indicators when weighing regions’ requests to be granted a locality pay area despite not meeting the established criteria for inclusion.

The Wall Street Journal reports today that while antibiotic manufacturers have adequate government funding to research superbug antibiotics, the commercial market for these drugs is insufficient to support manufacture.

Washington has taken notice of the problem, but near-term action remains unlikely. The Disarm Act, short for Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms and introduced in Congress in 2019 (HR 4100 and S 1712), would have Medicare pay for certain antibiotics in full. Despite bipartisan support for the bill, executives worry its progress could be hindered by impeachment proceedings and the coming election.

Disappointing.