FEHBlog

The Hill reports that “Senators left Washington on Thursday for a five-week August recess, capping off a slog of a summer stretch. Before leaving, lawmakers passed a two-year budget deal, which suspends the debt ceiling through mid-2021, and confirmed 13 judicial nominees and other high-profile picks, including Kelly Craft to be the U.S. ambassador to the United Nations.” The Senate did not consider before the break S. 1895, the bipartisan bill to lower healthcare costs, H.R. 748, the House passed bill to repeal the ACA’s high cost plan tax, or Dale Cabaniss’s nomination to be OPM Director.

The Federal News Network brings us up to date on the Trump Administration’s efforts to shift most OPM functions over to the General Services Administration.

The administration recently informed Congress of its plans to move the administrative support functions for two OPM-led councils, the Chief Human Capital Officers Council and the Performance Accountability Council, to GSA, Margaret Weichert, acting OPM director and deputy director for management at the Office of Management and Budget, told reporters Tuesday afternoon [July 30]. 

It’s a relatively small change, as GSA already supports several governmentwide executive councils and organizations, such as the Chief Information Officers Council and the Chief Financial Officers Council.

Following up on the Weekend Update, MedCity News reports that two generic drug manufacturers, Mylan and Pfizer’s UpJohn division merged to form a newco on Monday as the Wall Street Journal predicted. “Pfizer shareholders will own 57 percent of the new company, while Mylan shareholders will own 43 percent.”

The Trump Administration today announced an “action plan” to import lower cost prescription drugs into the U.S. principally from Canada.  Health Affairs blog discusses the action plan here.  Health Affairs observes

Today’s announcement certainly represents a significant shift for HHS on drug importation, but it also does not appear that the agency is eager to implement this plan in the near future. The administration is merely stating its intention to release such plans in the fuHelath ture, rather than actually doing so today. Such plans could then take months or years to implement. Most importantly, the plan relies on others — states, wholesalers, and manufacturers themselves — to do the federal government’s work for it, to demonstrate the potential for importation to be done safely and effectively. Finally, the state-based importation programs would be only demonstration projects, which (in addition to only applying in a geographic subset of the country) would be time-limited and require renewal.

Health Data Management reports that

The Centers for Medicare and Medicaid Services is launching a pilot program that leverages HL7’s Fast Healthcare Interoperability Resources standard to enable clinicians to access claims data directly within their workflow. At Tuesday’s White House Blue Button Developers Conference, CMS announced the Data at the Point of Care pilot, part of the Trump administration’s 2018 MyHealthEData initiative designed to put patients in control of their own healthcare information so they can make informed medical decisions.

Blue Button 2.0 is a FHIR based application that allows Medicare beneficiaries to access their claim information. The new initiative will allow clinicians to use a different FHIR based application to access claims data for the purpose of filling gaps in their records. HDM further reports at this White House conference that “Amazon, Google, IBM, Microsoft, Oracle, and Salesforce once again have pledged to work to advance HL7’s Fast Healthcare Interoperability Resources application programming interface.”  The FEHBlog has high hopes that the FHIR standard will solve the problem of electronic health record interoperability.  In time, the FHIR standard will allow clinicians and health plans to share healthcare quality data.

On a related note, Becker’s Hospital Review offers three things to know that about the growth of blockchain technology in healthcare.

Yesterday, pursuant to the President’s recent health quality and pricing transparency executive order, the Centers for Medicare and Medicaid Services published a proposed hospital price transparency rule for calendar year 2020 that

implements Section 2718(e) of the Public Health Service Act [part of the Affordable Care Act] and improves upon prior agency guidance that required hospitals to make public their standard charges upon request starting in 2015 (79 FR 50146) and subsequently online in a machine-readable format starting in 2019 (83 FR 41144)..  Section 2718 is entitled “Bringing Down the Cost of Health Care Coverage.”  Section 2718(e) requires each hospital operating within the United States to establish (and update) and make public a yearly list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.  In the proposed rule, we propose the following: (1) definitions of “hospital”, “standard charges”, and “items and services”; (2) requirements for making public a machine-readable file online that includes all standard charges [redefined to include both gross charges / rack rate and negotiated rates with health plans] for all hospital items and services; (3) requirements for making public payer-specific negotiated charges for a limited set of ‘shoppable’ services [serves that are scheduled in advance] that are displayed and packaged in a consumer-friendly manner; and (4) monitoring for hospital noncompliance and actions to address hospital noncompliance (including issuing a warning notice, requesting a corrective action plan, and imposing civil monetary penalties), and a process for hospitals to appeal these penalties. 

Modern Healthcare observes that several hospital systems already offer online personalized lookups of out of pocket costs for “shoppable” services.  This approach preserves the confidentiality of the negotiated insurer rates.

Speaking of hospitals, Medpage Today offers a clickable slideshow of U.S. News and World Report hospital rankings which were published this week.  The top three overall are the Mayo Clinic, Mass General, and Johns Hopkins.

Today, CMS announced that “the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, is projected to decline. Over the past three years, average Part D basic premiums have decreased by 13.5 percent, from $34.70 in 2017 to a projected $30 in 2020.”

Speaking of pharmacy benefits, the Associated Press is reporting

The government’s employee health plan [our beloved FEHBP] will tighten its rules for covering prescription opioid painkillers starting this fall, the Trump administration said Monday.The announcement by a senior administration official was part of a White House drug policy briefing. The official spoke on condition of anonymity under the media coverage rules established for the event. *** Under the new policy, initial prescription [for acute pain issues] will be a for 7-day supply, instead of 30 days, the official said. Patients will be able to get up to three refills of 7-days apiece. Formal re-authorization that involves consulting a clinical professional will be required every 28 days.

The FEHBlog expects that these standards generally are in effect in the FEHBP already. 

In other news, Fierce Healthcare informs us that CVS Health announced an expansion of its Transforming Diabetes program that several FEHB plans use.

The Senate remains in session for this final week before its August recess.

The Wall Street Journal reports that the giant prescription drug manufacturer Pfizer “is in talks to merge its off-patent drugs business with generic drugmaker Mylan NV, according to people familiar with the matter, in a deal that would create a giant global seller of lower-priced medicines.” The deal could be announced as early as tomorrow. The article’s description of the complicated nature of the prescription drug manufacturers business structures is quite interesting.

Health Payer Intelligence discusses how Blue Cross of Michigan is using virtual wellness program to successfully drive member engagement.

“The program uses a virtual format, allowing us to be scalable and deliberate,” Bjorkquist explained. “It has separate sessions for members and employers, on the same topic, and delivers content using live webinar capabilities, PowerPoint, and graphics. The intent was always to host the sessions live with audio and video, as opposed to just a podcast or audio webinar, which most people are doing.” 

The sessions are TED style, lasting approximately 13 to 14 minutes and focus on key wellness activities that will ideally improve member health. 

These sessions focus on kindness, mindfulness, financial well-being, emotional health, exercise, nutrition, meditation, social isolation, and other relevant topics. The virtual coordinator offers tips, examples, and promotes opportunities for the members to engage in activities related to the subject of the week.

Fierce Healthcare reports on four recent initial public offering in digital health companies, the most recent being Livongo and Health Catalyst.

Fierce Healthcare also reports on a new CVS Health and Aetna Foundation social derminants of health initiative oriented toward Medical and employer sponsored plan business. .

The initiative also includes the launch of a new tool aimed to help employers with Aetna plans track the impacts of the social determinants on their healthcare costs. The insurer is set to release the tool before the end of the month and add additional functionality early next year. 

Using the tool, employers will gain insights on the health of their workforce, but it will also provide valuable feedback to CVS to determine what interventions may be most useful to specific populations, according to the announcement.

The Hill reports that the U.S. House of Representatives left town today for its summer recess after passing the compromise two year budget deal. The House will return to Capitol Hill on September 9. The Senate will remain in session for the next week in order to pass the budget deal and fingers crossed the House passed bill repealing the ACA’s high cost plan tax (H.R 748).  

Health Leaders Media tells us about the Senate Finance Committee’s 19-9 decision today to approve its bipartisan leadership bill to lower Medicare and Medicaid prescription drug costs.  It is conceivable that some of the bill’s provisions could wind up as amendments too S. 1895 the bill to lower health care costs. The article indicates that the House of Representatives is developing its own bill to lower prescription drug spending.

Healthcare Dive reports that

CVS Health will trial a coordinated care pilot for knee replacements in Aetna beneficiaries later this summer, CVS CEO Larry Merlo said at a Medicare Advantage conference in Washington on Tuesday. 

In the pilot, pre- and post-operative care for Aetna MA and commercial members undergoing a knee replacement procedure will be managed by a clinical team in the home, at CVS pharmacy locations and via telehealth. 

The trial is the first in a series of initiatives CVS and its payer arm Aetna are working on, Merlo said, and will be available for as many patients as possible according to a spokesperson.

The pilot will begin in Houston where CVS Health opened its first Health Hub store late last year.

Stat reports that the Senate Finance Committee leaders, Chairman Chuck Grassley (R Iowa) and Ron Wyden (D Ore.) have introduced a bill to control prescription drug spending under Medicare and Medicaid to the tune of $100 billion in savings over ten years.

The Wall Street Journal discusses health insurer efforts to improve the smartphone apps that they make available to consumers.

Insurers say new services aim to go beyond one-off telemedicine encounters, with personalized doctor recommendations, online appointment-booking and pricing information, as well as a growing array of mental-health offerings. “How do we use technology to guide people to the care that’s best for them?” said Firdaus Bhathena, CVS’s chief digital officer. “We’re working on the actual connected end-to-end experience.”

Cool.

Recently, the FEHBlog pointed out recent Centers for Disease Control statistics finding a 5% drop in opioid crisis deaths from 2017-18.  This ABC News article discusses this and other aspects of this sobering CDC report.

Between 2012 and 2017, the rates for white and black people aged 25 to 44 increased 21% each for both groups, while Hispanic people of the same age range saw a 13% rise. Sally Curtin, a statistician at the CDC’s National Center for Health Statistics and one of the report’s authors, said an uptick in suicides, homicides and drug overdoses contributed to the higher rates for the younger part of the group.. 

Also disturbing is this Reuters report concerting a study finding that sizable numbers of Americans take antibiotics without a prescription.

When people take antibiotics without a prescription, they often take unnecessary medication or choose an inappropriate drug or dose, the study team notes in the Annals of Internal Medicine. People might get sicker when they self-medicate with a drug that’s not effective for their illness, exposing themselves to potentially preventable complications – and they can also make antibiotics less effective not just for their own use but for others who need these drugs. Every time somebody takes antibiotics they don’t need, it contributes to antibiotic resistance, according to the U.S. Centers for Disease Control and Prevention.

There’s a public health issue for you.

The Internal Revenue Service announced today that the employer health coverage affordability percentage for 2020 will be 9.78%, e.g., the employee contribution for self-only coverage is less than 9.78% of W-2 income.  In the FEHBP the calculation is made against the lowest cost nationwide plan available to all employees. That 2020 percentage is down slightly from 2019’s 9.86% figure. The affordability percentage is used along with 60% minimum actuarial value to determine whether an applicable large employer complies with the affordability requirements of the ACA’s employer shared responsibility mandate. While the ACA’s individual shared responsibility provision is kaput, the employer mandate is alive and well.

The Hill reports tonight that the President and Congressional leadership have reached a two year budge deal that also suspends the federal debt ceiling until July 31, 2021.  The House and Senate will seek to pass the budget deal and send it to the President for his signature before the August recess.The faster this legislative act can be completed, the sooner the August recess will arrive.

Healthcare Dive reports on U.S. District Judge Richard Leon’s Tunney Act hearing on the fairness of the Justice Department’s resolution of antitrust issues stemming from last year’s CVS Health acquisition of Aetna. The hearing was held last Friday July 19 in federal court in Washington DC.  Of note,

Several of [Judge] Leon’s questions during oral argument suggested he might consider anticompetitive harms outside the Tunney Act as a basis to reject the settlement.

The judge seemed particularly interested in AIDS Healthcare Foundation lawyer Christopher Casey’s suggestion of additional remedies that could be put into place on top of the divestiture of the PDP plans the companies were already required to complete.

Those proposed remedies included requiring CVS allow all rival pharmacies access to to its pharmacy network, allowing all Aetna plan members to opt out of using CVS mail-order pharmacy and allowing all managed care companies access to the CVS Caremark PBM.

Of course, a district court decision invoking such remedies would send the case up to the U.S. Court of Appeals for the D.C. Circuit for review.

Congress remains in session this week on Capitol Hill. As Politico reports, the Trump Administration continues to negotiate with Congressional leaders on a two year budget and debt limit increase deal as the August recess grows nearer.

Health Payer Intelligence offers some perspective on the House vote last week to repeal the Affordable Care Act’s high cost plan tax. The Stop the HIT Coalition commended the House vote while urging Congress also to further suspend or repeal the ACA’s health insurer tax (“HIY”). Healthcare Dive notes that “Insurers are expected to increase premiums by roughly 2% to recoup the cost of the tax as they face an estimated $16 billion fee next year, according to consultancy Oliver Wyman.”  Here’s a link to the Oliver Wyman report.

Fierce Healthcare informs us that “The National Quality Forum and Blue Cross Blue Shield Association have teamed up to launch a new playbook aimed at growing access to medication-assisted treatment (MAT) for opioid addiction.” Check it out at this link.

U.S. District Judge Richard Leon, who also is hearing the Aetna / CVS merger case, rejected today a legal challenge to a Trump Administration rule expanding the available length of coverage for short term health insurance coverage. The FEHBlog found the opinion to be quite convincing.  The plaintiffs plan to appeal. The FEHBlog is pleased with the outcome because it allows more consumer choice.

The clinical trial of the company’s HemoCare Hemodialysis System for the administration of home hemodialysis will involve up to 70 patients at 10 sites, CVS said. Home hemodialysis helps facilitate longer, more frequent dialysis treatments compared to in-center treatments, according to the company.

Health Payer Intelligence brings us a discussion of CMS initiatives implementing the President’s executive order on improving American kidney health.

The Boaston Globe reports that

A decade-old experiment to put a dent in Massachusetts health care costs by changing the way doctors are paid appears to be working — offering a potential strategy to combat one of the most vexing problems in today’s economy.

In a new study, researchers at Harvard Medical School found that a payment plan from Blue Cross Blue Shield of Massachusetts that rewards doctors who control costs is linked to smaller increases in health care spending and better-quality care.

Blue Cross’s payment program gives doctors a fixed amount of money to take care of their patients. When doctors stay on budget and improve care, they can earn bonuses. If not, they can be penalized.

That’s good news.

In other New England news, the Middletown (CT) News reports that

“Insurers that sell policies on Connecticut’s Affordable Care Act exchange, Access Heath CT, are seeking premium increases for their 2020 policies, basing their requests largely on a new federal tax that will be imposed next year.”

This is not a new federal tax. It’s a resurrected federal tax. The onerous health insurance tax created by the Affordable Care Act applied to insured plans, including most FEHB plans, from 2014 through 2016. Congress suspended the tax for 2017, permitted its resurrection for 2018, suspended it again for this year, and evidently plans to permit the tax to kick in again for next year. The Stop the HIT website has details. That’s bad news.

CNBC reports on an interesting Amazon Pillpack controversy with the “players” in the drug supply chain.

According to two people familiar with the matter, PillPack was informed this week that it will soon be cut off from accessing that data via a third-party entity, ReMy Health — a move that could seriously complicate its business. Amazon is considering legal action against Surescripts to halt those efforts, said the people, who asked not to be identified because the deliberations are confidential. One person told CNBC that PillPack has already sent a cease-and-desist letter to Surescripts.

CNBC reports that the House of Representatives voted by a wide majority of 397-31 votes to repeal the Affordable Care Act’s self-defeating high cost plan tax (H.R. 748).  If the Senate does not quickly approve this clean bill and send it to the President for his signature, the FEHBlog will eat his hat.

The House giveth; the House taketh away. Healthcare Dive informs us that the House Energy and Commerce Committee today cleared for full House consideration an amended version of its no surprise billing act (H.R. 3630) —

The change comes from Rep. Raul Ruiz, D-Calif., and will let either providers or payers appeal to an independent arbiter in cases where the median in-network rate exceeds $1,250. Previously, the bill proposed establishing a benchmark payment rate to resolve any disputes.

This bone thrown to out of network providers destroys the bill’s opportunity for lowering health care costs. The Senate bill (S. 1895) does not include this time bomb.

Today, the Internal Revenue Service took a step to implement the President’s recent executive order on health care pricing and quality transparency by issuing IRS Notice No. 2019-45.  This notice, which took effect immediately, permits certain chronic disease related services to be covered under high deductible health plans before the deductible. This favorable change should make these sensible policies which can be coupled with health savings accounts more appealing to consumers. Time will tell.

The Health and Human Services Secretary Alex Azar issued a statement today on the encouraging news that “the Centers for Disease Control and Prevention’s National Center for Health Statistics released provisional counts of overdose deaths in the United States showed a decline of 5.1 percent between 2017 and 2018.” Still way to high, but moving down.

Check out this Employee Benefit News article based on an interesting study conducted by Optum and the National Business Group on Heath

For decades, employers and benefit managers have thought of well-being programs as one-dimensional with the focus on physical health, only offering benefits like on-site fitness centers, gym discounts or a health program that encourages more movement.

But now, in a highly competitive marketplace where employers are looking to attract and retain motivated and productive employees, the idea of well-being programs is expanding and evolving. Just focusing on physical health won’t cut it anymore. Rather, employers are now seeking out innovative workplace well-being programs that encompass five aspects of health: physical, mental, financial, social and community.

Overall employee well-being matters. Newly released data shows that employees who are offered programs that address most or all of the five aspects of well-being are significantly more likely to say their job performance is excellent, they have a positive impression of their employer and would recommend their company as a place to work.