FEHBlog

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.

NPR discusses efforts in the Senate to join the House of Representatives in passing a bill to repeal the ACA’s excise tax on high cost health plans a/k/a the Cadillac tax.

Health Data Management reports that Senate Health Education Labor and Pensions Committee Chairman Sen. Chuck Grassley (R IA) is promoting telehealth as a means to maintain the viability of rural hospitals.

Grassley said he—along with other senators—has reintroduced a bipartisan bill that would allow rural diabetic patients to receive regular vision screening using telemedicine.

More broadly, the Rural Emergency Acute Care Hospital (REACH) Act would create a new “rural emergency hospital” classification under Medicare. Many rural hospitals are currently designated as critical access hospitals under Medicare and as a result have to maintain a certain amount of inpatient beds and provide emergency care services 

However, the REACH Act calls for the creation of a rural emergency hospital designation under the Medicare program that would enable facilities in rural areas to provide emergency medical services without having to maintain inpatient beds. In addition to providing emergency care, rural emergency hospitals could convert the space previously used for inpatient services to provide other medical services, including telemedicine.

Last month, the FEHBlog discussed PBM efforts to create curated wellness apps for their members. CNBC reports that BlueShield of California has rolled out its own curated wellness app called Wellvolution.

[Wellvolution provides] an online portal for members to login via a mobile app or the web. Members will then beasked to answer some basic survey questions about their health goals. From there, they’ll get a recommendation for an app or a service they can use as a wellness perk. If they don’t like it, they can change it up at any time. That way, suggests [BlueShield’s Bryce]Williams, “the best tools that our members really like can rise to the top.  The insurer teamed up with a health-tech start-up called Solera Health to develop the service.

Health Payer Intelligence reports on the merger plan of two large New England non-profit health care systems, Harvard Pilgrim Health Care and Tufts Health Plans.  Subject to federal and state regulatory approval, “The [combined] company will offer plans to consumers across the spectrum of socioeconomic and demographic backgrounds, from employer-sponsored insurance and quality health plans to Medicare and Medicaid and dually eligible plans.” But not FEHBP.

Healthcare Dive discusses a New England Journal of Medicine analysis of U.S. hospital ranking programs. U.S. News and World Report received the top (but not the highest possible) grade of B. CMS’s Hospital Compare website received a C.

Healthcare Dive is reporting that “Average monthly premiums for marketplace plans nationwide are expected to increase 0.6% for 2020 coverage — the lowest increase since the launch of the Affordable Care Act plans, according to an analysis of insurer rate filings submitted to all 50 states and D.C.” The FEHBlog is glad that ACA marketplace premiums are stabilizing. It’s noteworthy that although ACA marketplace plans are subject to the resumption of the ACA’s onerous health insurer tax, the premium don’t show a big bump for that event. At this point this hefty tax has been imposed on health insurers, including insured FEHB plans, from 2014 through 2016 and 2018. FEHB premiums didn’t jump precipitously in those years due to imposition of the tax. FEHB premiums grew very slowly for this year when the tax is suspended. Will there be an FEHB premium boomerang for 2020? Time will tell. Nevertheless, the FEHBlog continues to believe that this tax and the ACA’s medical device tax are misguided.

Following up on the report of a Novartis data manipulation scandal last week, the Boston Globe’s STAT reports that

The company previously said it was “in the process of exiting” scientists who were responsible for the scandal but did not identify them. In a statement on Wednesday, Novartis (NVS) said that it had appointed a new chief scientific officer for AveXis and that other scientists, Brian and Allan Kaspar, “have not been not been involved in any operations at AveXis since early May 2019,” without elaborating.

The person familiar with the situation, who spoke on condition of anonymity, confirmed that the departure of the Kaspars, who are brothers, was connected to the disclosure of data manipulation related to the gene therapy Zolgensma.

Consumer health technology company Ciitizen reports launching a scorecard grading healthcare providers on the level of their cooperation with HIPAA’s individual right to access their medical records. Citizen explains

We plan to refresh the scorecard every few months based on the most recent record requests sent to a particular provider - so improvement and consistency in good performance can be rewarded (and consistency in poor performance can also be brought to public attention).

In conjunction with the scorecard, we also released survey of 3003 hospitals and healthcare systems who responded to anonymous questions about their record release processes. Their responses suggest that 56% of health care providers are out of compliance with one or more aspects of the HIPAA Right of Access.

Here’s a link to the HHS website that explains this individual right.  This right also is discussed in your healthcare provider or your health plan’s HIPAA notice of privacy practices.

The National Business Group on Health issued its 2020 Large Employers’ Health Care Strategy and Plan Design Survey today.

The 2020 Large Employers’ Health Care Strategy and Plan Design Survey found employers project the total cost of health benefits will rise 5% in 2020, taking cost management initiatives into account. That increase is identical to 2019’s projected increase – but actual costs are coming in lower. Large employers reported the actual increase in 2018 was 3.6%. Including premiums and out-of-pocket costs for employees and dependents, the total cost of health care is estimated to be $14,642 per employee this year, and projected to rise to an average of $15,375 in 2020.  Employers will cover nearly 70% of costs while employees will bear about 30%, or nearly $4,500.  Forty-four percent of employers ranked musculoskeletal issues as the top condition impacting their costs while 85% ranked it among the top three conditions. One in four (25%) employers ranked cancer as the top condition.  

“One of the challenges employers face in managing their health care costs is that health care is delivered locally and change is not scalable.  It’s a market-by-market effort,” said Brian Marcotte, President and CEO of the National Business Group on Health. “Employers are turning to market-specific solutions to drive meaningful changes in the health care delivery system.”

Good point.

Speaking of which, Kaiser Health News reports on 29 Hepatitis A outbreaks across the United States which often follow the path of the opioid crisis.

Dr. Monique Foster, a medical officer in CDC’s Division of Viral Hepatitis, said vaccinating those at highest risk remains the best strategy. “Outbreaks will stop when we have effectively vaccinated the vulnerable people,” she said.

Although the federal government isn’t recommending universal vaccination, several experts said the more people vaccinated, the better. 

“The risk is there. The disease is circulating,” said the University of Kentucky’s Winter. “It’s good for the general public to be vaccinated.” 

With the virus continuing its advance, Penn State’s Haeder said, “it won’t be long before we have it everywhere.”

Meanwhile according to the Wall Street Journal, the U.S. Preventive Services Task Force today “released a draft [“B” level] recommendation that doctors ask their patients about illicit drug use, including opioid painkillers, so they can be directed to treatment.” Health plans must cover with enrollee cost sharing final “A” and “B” recommendations when carried out by in-network provider. New USPSTF “A” and :B” level recommendations will be required to be covered without cost-sharing starting with the plan year (in the individual market, policy year) that begins on or after the date that is one year after the date the recommendation is issued / finalized. The Journal’s report explains

The group’s draft recommendation, which reverses its previous [2008] stance of not asking about illicit drug use, said it is taking the step in part because 7.5 million people 12 years old and older in the U.S. have been diagnosed with dependence or abuse of illicit drugs in the past year, according to the task force. 

Healthcare Dive reports on healthcare provider suggestions to the Centers for Medicare and Medicaid Services on how to reduce the Medicare administrative burden on them.

Companies took the request for information as an opportunity to air perennial grievances about the highly regulated environment, including inequitable quality measures and reporting requirements, prior authorization that slows down care delivery for patients and problems with interoperability and telehealth.

The FEHBlog dearly wishes that OPM would take a page out of this CMS playbook and apply it to the FEHBP.

Last week, the FEHBlog attended the American Bar Association’s annual meeting in San Francisco. Here is a link to an ABA story about an opioid crisis presentation by the American Medical Association’s President-elect, Susan Bailey, MD.  Dr. Bailey encourages the FEHBlog’s profession to sue health insurers for adequate treatment coverage.

The doctor highlighted three recent legal cases that focus on opioid issues. These cases, she said, show “how legal and medical experts can work together to make sure there is evidence-based care for opioid use disorder patients in correctional settings, and that health insurance companies must use medical evidence to evaluate claims, not just financial evidence. We must work together to hold them to that standard.”

Sigh. Why can’t physicians and health plans work together on these important issues?

A UnitedHealth Group report finds that

The annual cost of hospital inpatient services for privately insured individuals exceeded $200 billion in 2018 and is projected to exceed $350 billion in 2029.1 Hospital inpatient spending growth is in luenced by several factors, including prices charged by hospital facilities (hospital prices), prices charged by physicians practicing within these hospitals (physician prices), and patients’ utilization of inpatient services

United notes that hospital prices increases materially exceed physician price increases.  United opines that “Slowing the growth of hospital inpatient costs – by reducing hospital price increases to the level of physician price increases – would make health care more a ordable for consumers and employers.” That’s easier said than done, of course. Hopefully, S. 1895, the bipartisan bill to lower healthcare costs, will help if enacted.

In the same vein, Healthcare Dive reports that

The frequency and price tags on surprise medical bills for emergency and inpatient services at in-network hospitals is on the rise, according to a study published Monday in JAMA Internal Medicine.

The percentage of emergency department visits resulting in a surprise bill jumped from 32.3% in 2010 to 42.8% in 2016 while the increase for inpatient admissions went from 26.3% to 42%. The cost of the bill in both categories nearly doubled in that time period, with the top 10% of ED visits resulting in a bill of more than $1,000, and the top 10% of inpatient visits costing more than $3,000.

Patients at some hospitals were far more likely to receive a surprise bill. For inpatient, the chance was less than 10% at about half of the nearly 3,300 hospitals included, but the chance was more than 90% at about 15% of hospitals. For ED visits, it was a greater than a 90% chance at 23% of at the more than 4,000 hospitals studied.

For this reason, the FEHBlog’s principal goal last week as he travelled through the California sub-acute care system was to avoid the emergency room.

Here’s a link to an interesting  Signal story about “8 Emerging Healthcare App Development Trends to Follow in 2019.” Check it out.

The FEHBlog is in the San Francisco airport waiting for his flight back to DC.  He enjoyed the American Bar Association meeting and side trips to the Napa Valley and Yosemite (spectacular).

While in San Francisco, the FEHBlog realized that he had a bacterial infection. He located and visited a walk in clinic. It turned out that treating this particular infection was outside the walk in clinic’s scope so he had to visit an urgent care center, which he did. The FEHBlog got the antibiotic prescription that he needed and filled the prescription at Walgreen’s, The FEHBlog was surprised by the distinction between walk in and urgent care centers. It strikes the FEHBlog that these types of rather arcane distinctions (from the patient’s perspective at least) could push patients to the emergency room. Perhaps the FEHBlog should have checked with insurer first.

Congress remains on state work periods until after Labor Day. Congressional staff comes back early to work in DC on FY 2020 appropriations and big legislation such as S. 1895, the bipartisan bill to lower healthcare costs.

As you know, in the fourth quarter of 2018, CVS Health acquired Aetna, and Cigna acquired Express Scripts, The FEHBlog thought that both PBM / health insurer mergers made sense from a improving health care quality perspective. Healthcare Dive reports that CVS Health and Cigna each reported strong 2nd quarter 2019 earnings earlier this month.

The Boston Globe’s STAT reports

The Trump administration finalized late Wednesday [in a Medicare national coverage decision] long-sought rules for when Medicare will cover CAR-T treatments, the cutting-edge, often curative therapies that harness patients’ own immune cells against their cancer. 

Under the new policy, Medicare will pay for CAR-T therapies so long as they’re administered in health care facilities that follow the Food and Drug Administration’s special safety rules, known as risk evaluation and mitigation strategies, or REMS. Medicare will also pay for CAR-T even when it’s used to treat conditions that aren’t FDA-approved. The two CAR-T treatments on the market, Gilead’s Yescarta and Novartis’ Kymriah, are approved to treat non-Hodgkin lymphoma and acute lymphoblastic leukemia, respectively. The policy is likely a positive development for hospitals . . . .

Greetings from San Francisco where the FEHBlog is attending the American Bar Association’s annual meeting.

The AP reported on Wednesday that

The government is clarifying a policy change that will limit the prescribing of opioid painkillers to federal workers. The Labor Department issued a statement Tuesday saying the limitations will apply to employees injured on the job and covered under the government’s workers’ compensation program. Last week at a White House briefing a senior administration official suggested the change would apply to the federal [employees] health plan, which is a much bigger program.

The FEHBlog thinks its safe to say that the FEHBP is already on top of this issue.  Keeping pace with concerns about opioid restrictions and proper coverage of opioid addiction treatment are the issues at the heart of the ongoing opioid use crisis for FEHBP carriers.

The Government Employees Health Association (“GEHA”) announced yesterday that the Office of Personnel Management has awarded GEHA the government-wide indemnity plan contract. This statutorily mandated FEHB plan slot has been vacant since 1990. GEHA will flll the vacancy with two new options effective January 1, 2020.  GEHA is calling its new plan “Elevate.”

“The Elevate plans are specifically designed to help members achieve the health they need to live the lives they want,” said Darren Taylor, GEHA president and CEO. “We are excited to enhance our collaboration with OPM and continue to partner with our federal employee members on their health and wellness journeys.”

Good luck to GEHA.

Fierce Healthcare reports on Blue Cross of Illinois opening wellness centers for its members on the south side of Chicago. The FEHBlog likes the idea of insurers opening these facilities for members.

Healthcare Dive discusses at length the issue of whether low government prices cause hospitals to charge higher prices to commercial payers.  Because there’s no doubt that the pricing gap exists, the real issue is whether or not the gap can be reduced.

• Interesting USA Today editorial board interview with AHIP’s CEO Matt Eyles. 

• Troubling New York Times article about a Food and Drug Administration report alleging that Novartis “concealed manipulated data from the Food and Drug Administration while applying for approval of an extremely expensive gene therapy treatment and then delayed reporting the issue.”  This data concerned the $2.1 million per treatment gene therapy drug that the FDA approved last May.  “The F.D.A. said patients were not at risk, and that the treatment could still be sold. But the news that a drugmaker had manipulated or mishandled data is an unsettling moment for the pharmaceutical industry. Many companies are racing to develop breakthrough gene therapy treatments for rare and intractable diseases.”

• Equally troubling is this Washington Post article about a 27 year old man with Type 1 diabetes who ran out of his parent’s coverage and switched from a prescription insulin to an over the counter insulin. The young man died as a direct result. The article explains the public health crisis created by the following factors —

The more affordable form of the medication — sold by Walmart since 2000 under its ReliOn brand — is known as “human insulin.” It predates the genetically altered “analogue” insulin doctors routinely prescribe. While human insulin can require as many as four hours to take effect, with varying levels of success, analogue insulin is more precise and takes as little as 20 minutes to regulate blood sugar levels, patient advocates say. [Analogue insulin prices nearly tripled since 2002,  Human insulin is useful for Diabetes 2 but not Diabetes 1}.

• Finally, the Journal of the American Medical Association / Internal Medicine  offers an  editorial on whether there is hope of a pancreatic cancer screen test. The need for such a test is illustrated by the fact that “It is estimated that in 2019, about 57, 000 people will be diagnosed with pancreatic cancer in the United States and that it may soon overtake colon cancer to become the second-most common cause of cancer-related death.1 Based on recent progress in the treatment of colon cancer, the best hope for reducing the cancer-specific mortality of pancreatic cancer may be early diagnosis and treatment.” Good luck.

Congress is on recess until after Labor Day.

The FEHBlog was taken with Peggy Noonan’s Medicare for All discussion in her latest Wall Street Journal column about last week’s Democrat Presidential candidate debates —

I never minded the phrase “Medicare for All” because I figured it meant this: “We would like Medicare or some other governmental entity to be available to all who need it, and will come up with ways to ease them in and give people in trouble a break. What everyone wants is the plastic card in the wallet that says you’ve got coverage, so the ambulance isn’t turned away and the kids are treated. We can work this out. We’re America.” 

America would respond to that. A great nation must take care of its stressed, its incapable, its unlucky. 

But I don’t think that the American people understood, at least until the first debates, that Medicare for All means this: “All private insurance is abolished, we’re taking it away, you’re going to be forced into a program we’ll run, we’re going to squish this down on your head, the hospitals will have to conform with our directives whether they bankrupt it or not, and the health-insurance industry and its jobs will be extinguished.” 

And on top of that we will all have to pretend the cost of this will come from savings due to reduced paperwork, or a tax on the wealthy. 

It’s all so crazy. I heard no one in the debates say, “Guys, you are making a mistake to give the state all the power in this area. The government can rarely make things dramatically better in huge and complicated matters like this, but it is always capable of making it worse.” 

I would be very surprised if most people watching didn’t think that’s exactly what they’ll do, make it worse. 

I didn’t hear anyone say, “As you revolutionize the entire health sector, you have to be leery of upsetting all the things that make American medicine, for all its flaws, the most advanced and cutting-edge system in the world, with the greatest doctors and scientists.”
Some candidates pointed out that such sweeping plans were impractical, unrealistic, unworkable. I didn’t hear any philosophical or historical reservations.

Amen to that. It certainly would make more sense to provide needy people with better access to government funded health centers combined with good catastrophic insurance protection.