FEHBlog

The Boston Globe’s STAT reports this afternoon that

The Centers for Disease Control and Prevention [“CDC”] reported a rising number of cases of mysterious pneumonias linked to vaping on Friday. Now, the agency reports 450 people from 33 states and one U.S. jurisdiction have been affected. 

Three deaths have been confirmed, authorities said, and another is being investigated. 

The New England Journal of Medicine and CDC’s online journal, Morbidity and Mortality Weekly Report coordinated the release of case reports and case findings from Illinois and Wisconsin, Utah, North Carolina and California. While the descriptions of the cases were remarkably similar, it is not currently clear why young vapers — the majority of cases are young men — are developing severe pneumonias.

Here’s a link to the CDC’s press release on this investigation.  The CDC recommends

While this investigation is ongoing, people should consider not using e-cigarette products. People who do use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention for any health concerns. Regardless of the ongoing investigation, people who use e-cigarette products should not buy these products off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.

The Wall Street Journal reports today that

Insurers are scrambling to blunt the expense of new drugs that can carry prices of more than $2 million per treatment, offering new setups aimed at making the cost of gene therapies more manageable for employers.

Cigna Corp. announced Thursday a new program that allows employers and insurers to pay per-month fees for a service that will cover the cost of gene therapies and manage their use. CVS Health Corp. says it plans to offer a new layer of coverage specifically for gene therapies, which would handle employers’ costs above a certain threshold. Anthem Inc. said it is looking at special insurance setups to help employers protect themselves from the financial impact of the drugs.

Helpful.

The Internal Revenue Service announced on Tuesday that the agency plans to collect $15,522,820,037 (yes that’s 15 trillion) from health insurers next year based on an Affordable Care Act tax unless Congress acts to further suspend or repeal that levy.  The tax necessarily increases premiums in the FEHBP which the tax heavily impacts. Cost curve up.

Healthcare Dive informs us that

UnitedHealth Group plans to link its network of tens of thousands of physicians in its population health management and care delivery business, OptumHealth, with insights it gleans from its data analytics business, OptumInsights.

• Patients and providers will be able to access health data in real time as part of this new “digital ecosystem,” Optum CEO Andrew Witty, former chief at GlaxoSmithKline, said Thursday at the Wells Fargo Securities Healthcare Conference. It will link all Optum care locations in a particular geography and rely on a risk-based, capitated fee structure to align all participating players together, Witty said.
• Currently, UnitedHealth has bandwidth in about a dozen U.S. cities to implement the program. It plans to partner with health systems where it doesn’t have a strong enough provider presence to advance value-based care and tackle chronic diseases. 

In legal news, the U.S. Justice Department this week petitioned the U.S. Court of Appeals for the D,C, Circuit for a full court rehearing of the recent three judge panel decision to resurrect a federal labor union claim for damages against OPM and its contractor Keystone Government Solutions due to the 2015 data breach. 

U.S. District Judge Richard Leon issued his Tunney Act review decision today approving the antitrust settlement agreement between CVS Health and the Justice Department concerning CVS Health’s acquisition of Aetna.  CVS Health observed

CVS Health and Aetna have been one company since November 2018, and today’s action by the district court makes that 100 percent clear.  We remain focused on transforming the consumer health care experience in America.

Healthcare Dive reports on a new prescription benefit manager, Capital Rx, which is touting its pricing transparency model.

Health IT Analytics informs us that “Having [hospital[ staff pharmacists perform post-prescription audits reduced antibiotic use among patients, suggesting that these professionals can help lead antibiotic stewardship interventions, according to a study published in JAMA Network Open.”

The Washington Post reports that “former [Food and Drug Administration (“FDA”)] agency heads and dozens of health groups urged the White House to nominate acting FDA chief Norman “Ned” Sharpless to become the agency’s permanent commissioner.”

Finally, the Federal News Network reports that

Agencies have achieved some middling progress on their efforts to improve and prioritize federal employee health and wellness, according to the Office of Personnel Management. An evidence-based survey of agency health and wellness initiatives shows progress in some areas but gaps in others, particularly in organizations’ efforts to implement nutrition and other support programs for nursing employees, which are required by law.

CVS Health is celebrating the fifth anniversary of its decision to remove tobacco products from its pharmacies. The FEHBlog frankly is surprised that other pharmacy chains have not followed this lead.

Fierce Healthcare discusses how prescription benefit manager CVS Caremark is carving drugs with “hyper inflated” prices out of its formularies.

The pharmacy benefit manager (PBM) launched its program for “hyperinflation” drug removals in 2017 in which it will take drugs off its template formulary if they have far cheaper equivalents and their high prices aren’t backed by quality metrics. So far, they’ve identified five drugs to remove as the default option for docs.

The Government Accountability Office reports on the importance of educating consumers about the proper disposal of opioid prescriptions.

Available studies suggest that many patients are unaware of federally recommended disposal methods or choose not to dispose of unused prescription opioids. For example, five studies found that between one-quarter and three-quarters of patients stored unused opioids for future use or had misplaced their unused opioids. Further, federal data indicate that 85 percent of intentional misuse occurs with the patient’s knowledge—for example, when a patient sells or gives away unused prescription opioids. To educate and motivate patients to dispose of unused opioids, FDA launched a public awareness campaign called “Remove the Risk” in April 2019. Also, FDA and other stakeholders have created educational materials for patients and providers on safe opioid disposalFina.

Finally, Healthcare Dive informs us that

• Nonprofit hospitals’ operating margins are improving after falling for the last two years, according to an annual report on hospital performance from Fitch Ratings.
• Smaller hospitals are driving the turnaround and it’s a notable trend because they’re not able to command higher rates from payers like their peers the “must-have” hospitals, according to the report. 
• “The fact that [smaller hospitals] saw meaningful improvement is a good indicator that operational strength is returning to the sector, though the highs we saw in 2015 may be an unattainable highwater mark,” Kevin Holloran, senior director for Fitch, said in a statement. 

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.