FEHBlog

Healthcare Dive reports on today’s Senate Health Education Labor and Pensions Committee hearing on its bipartisan bill to lower healthcare costs. The FEHBlog understands that the next step will be the release of a revised bill.

Health Payer Intelligence informs us about America’s Health Insurance Plans’ Congressional testimony last week criticizing vertical healthcare provider mergers.  AHIP’s “statement emphasizes that one major cause of rising health care costs is vertical provider consolidation—when more and more of a region’s doctors and medical experts work for the same hospital or health system. We highlight research findings showing that when health systems in a region get bigger and squeeze out competition, prices go up for consumers.” Of course, as Health Payer Intelligence points out, the provider associations make similar claims about payer consolidation. In the FEHBlog’s view, there’s no doubt that the Affordable Care Act gave tremendous momentum to provider and payer consolidations.

The Government Accountability Office made public a report on OPM’s retirement application processing delays. On page 7 there’s a chart breaking down the following statistic given in the report:

31.6 percent of federal employees who were on board as of September 30, 2017, will be eligible to retire in the next 5 years. Some agencies have particularly high levels of employees eligible to retire in the next 5 years.

The federal Agency for Healthcare Quality and Research released an updated report on the frequency and associate cost of hospital readmissions occurring within 30 days of discharge. The following bullets caught the FEHBlog’s eye:

• In 2016, blood diseases had the highest readmission rate (25.3 percent), followed by neoplasms (17.9 percent). Pregnancy/childbirth had the lowest readmission rate (3.6 percent).
• The average cost of readmission was higher than the average cost of the index admission for two-thirds of the types of principal diagnoses.

Congress remains in session on Capitol Hill this coming week. On Tuesday, the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs.

This bill seeks to resolve the problem of surprise out of network billing. Kaiser Health News discusses a prime example of this problem — air ambulance billing. The article notes that the current version of the HELP bill does not tackle air ambulance billing, but the bill is expected to be refined over the next weeks.

The FEHBlog was very impressed by this Wall Street Journal essay by a Johns Hopkins University bio-ethicist, Dr. Travis Reider, who became addicted to opioids following a motorcycle crash.  Here’s an excerpt:

Opioids are not only dangerous; they also can be powerfully effective. Perhaps the greatest challenge about them today is to resist the urge to be simplistic or reactionary. America’s current crisis of overuse has led some prescribers to avoid the drugs completely, and it has led politicians to occasionally consider ham-fisted policy solutions, like limiting the lengths or dosages of prescriptions regardless of any individual patient’s needs. But when a medication has both risks and benefits, what we need isn’t one-size-fits-all policies but nuance.

The author goes onto explain what he means by nuanced policies. For example,

Doctors also must provide an exit strategy. In many instances, this would only require a plan for the number of days of use and a modest taper. But the longer a patient is exposed, the more complex the strategy may be. For every patient on opioid therapy, there must be a clinician who sees long-term management and tapering as their job. We cannot allow medical professionals to play hot potato with opioid patients, trying to toss them to someone else before the timer goes off. 

Yesterday, the Trump Administration finalized a rule that will permit large, medium, and small employers to offer individual coverage and excepted benefit health reimbursement arrangements to their employees effective January 1, 2020.  Here’s a link to the FAQs on the new rule. 

The FEHBlog is a fan of Trump Administration rules, such as the association health plan rule, the limited duration plan rule and this rule, that expand consumer choice of health plan coverage in the wake of Congress’s decision to zero out the individual health insurance mandate at the beginning of this year. The new rule can be used by employers who are subject to the ACA’s employer mandate which has remained in effect subject to certain conditions.

Beckers Hospital Review reports briefly on a House Ways and Means Committee hearing on Medicare for All bills held yesterday. Medicare for All would provide no consumer choice at all.

Speaking of Medicare, the Centers for Medicare and Medicaid Services issued FAQs on its expanded Section 111 reporting program for group health plans, including FEHB plans, that kicks in on January 1, 2020.

Healthcare Dive reports on a House Energy and Commerce Health subcommittee hearing held yesterday on the surprise billing issue.  Payers prefer that Congress set a rate for surprise out of network care and providers prefer that Congress requires independent dispute resolution to resolve the surprise billing disputes, such as baseball arbitration in which a third party selects one the parties’ proposals without negotiation. The Affordable Care Act does include a requirement that health plans pay a certain minimum amount for emergency care but that law does not require the out of network provider to accept the payment as setting the patient’s debt. See ACA FAQ #15 at this link.    The payers want that finality.  In any event the new law will have a broader scope than true emergency care. The legislators were warning the industry representatives yesterday that they needed to resolve this issue quickly or legislation will happen. Expect enacted legislation.

Healthcare Dive also discusses how Humana has integrated real time benefit information, e.g., cost sharing, prior authorization, into the popular Epic electronic medical record via a tool called IntelligentRx. Smart move. Expect to see more of this integration.

Fierce Healthcare offers an interesting interview with Walgreen’s Chief Medical Officer.

FH: Going forward, how do you see consumers’ use of digital platforms for accessing healthcare services changing?
PC: We see that the digitization of healthcare has been well received by consumers, but there are some situations where you need to be physically there. For example: lab services. We’re running a full primary care practice at Walgreens and to be able to have that direct face-to-face interface with the provider we also find is valuable. I don’t think those two areas compete; I think they are more complementary than competitive.
As a primary care physician, I find these changes in offerings in terms of different venues of care to be very exciting. We have a challenge in this country in terms of an aging population and the increasing prevalence of chronic disease. I think we need many different ways to approach healthcare and the digital aspect is very exciting.

The Hill reports that the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs next Tuesday June 18. The Committee Chairman, Sen. Lamar Alexander (R TN) plans to move the bill through Committee quickly as he reported “has said he hopes the full Senate can vote on the package in July. It could be combined with another bipartisan health care package aimed at lowering drug prices that the Senate Finance Committee is working on.”

Today, the House Appropriations Committee approved for floor consideration the financial services and general government appropriations bill for the next fiscal year. The vote was along party lines.  The Federal Times reminds us that “Appropriations legislation often goes through thorough changes as it moves from House to Senate consideration and back, making it likely that the general government and financial services bill will likely look different in some ways by the time it is signed into law.”

Following up on Express Script’s roll out of a digital formulary, CVS Health has announced a new vendor management services for employers and other plan sponsors. Healthcare Dive explains that the new program “will allow employers to contract and manage their relationship with third-party vendors that offer employee benefits, which could be both digital and non-digital tools.” Big Health’s Sleepio app is the first available tool. CVS Health advises that “Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits.”

Finally, here’s a Reuter’s report on the state of the measles breakout.

Well yesterday the FEHBlog could not find a relevant Congressional hearing this week. Today FCW.com reports that the House Appropriations Committee will mark up its subcommittee approved financial services and general government appropriations bill tomorrow.  Here’s a link to the Committee’s announcement.

The OPM appropriations discussion begins on page 74 of the Committee report.  FCW.com explains that the Committee “calls on OPM to do a better job on its own, with the $309 million in funding allowed by the bill. Lawmakers want OPM to speed up retirement processing, eliminate delays to federal hiring and improve the user experience at USAJOBS, the only front door for applicants to federal jobs.”

Health Payer Intelligence reports that the large Blue Cross licensee is acquiring Beacon Health Options, a behavioral managed care company that serves millions of people across the country.  Here’s a link to the companies’s press release issued last Thursday.  Health Payer Intelligence explains that

Beacon Health Options is not a payer, but instead contracts with different payers to help manage mental and behavioral health for beneficiaries. It also works with employers to help offer this as a benefit to workers. 

The acquisition by Anthem will allow Beacon Health Options to fully scale its offerings, the organizations said. In combination with Anthem’s existing mental and behavioral health management programs, the pair will be able to promote patient-centered care. 

Fierce Healthcare discusses the American Medical Collection Agency data breach. Because the company connects consumer debts for large laboratory companies, among other heath care providers, the breach is estimated to effect 20 million people.  The FEHBlog found this Krebs on Security post illuminating.

Studies

• Fierce Healthcare informs us that

Individuals who are living with chronic or acute conditions have a much different view of the social determinants of health (SDOH) compared with researchers and the media, according to a new study (PDF) out of the Anthem Public Policy Institute.

Congress remains in session this week on Capital Hill. The FEHBlog does not see any relevant hearings coming up. We continue to await Senate action on the Dale Cabaniss nomination to be OPM Director.

Healthcare Dive has summarized major organizational comments submitted last week on the Senate Health Education Labor and Pensions Committee’s bipartisan discussion draft of a health care reform bill  Not much industry consensus.

Managed Care magazine discusses a Wall Street Journal open by Hoover institution scholar Scott W. Atlas MD.  The piece floated thenFEHblog’s boat.

The FEHBlog as yet can’t find any public comments on the Senate Health Education Labor and Pension Committee’s discussion draft of a health care reform bill. He did gather a potpourri of public comments on the Health and Human Services / Office of National Coordinator proposed rules on electronic health record interoperability and price transparency in a dropbox for your information.

Healthcare Dive reports on the final two days of the evidentiary Tunney Act hearing before U.S. District Judge Richard Leon concerning the consent decree that lead to the Justice Department’s approval of the CVS Health acquisition of Aetna last November. The judge requested post hearing briefs and will hear oral argument from counsel in mid-July.

The FEHBlog has always been a fan of reference pricing. The Health Affairs blog today discusses the success of a CALPers reference pricing initiative for outpatient surgery. Check it out.

Becker’s Hospital Review reports that the Blue Cross Blue Shield Association CEO Scott Serota, who has been in office since 2000, plans to retire at the end of next year.

The same publication further informs us that

OptumCare, the healthcare delivery unit of UnitedHealth Group, won’t own inpatient care or post-acute care services, the health insurer’s CEO said during an annual strategy conference, according to Business Insider. 

When asked by an analyst at the Sanford C. Bernstein 2019 Annual Strategic Decisions Conference in New York City whether UnitedHealth plans to expand OptumCare, CEO David Wichmann and CFO John Rex said they want to build out the company to generate $100 billion in annual revenue by 2028. That’s up from $16 billion last year.  

The executives said they’ll expand their footprint in areas outside of the hospital. These include urgent care practices, surgical centers and primary care offices. 

Mr. Wichmann said while it won’t be building any hospitals, he does see the insurer partnering with health systems for hospital-based services. 

Express Scripts recently announced that beginning next year it will offer plan sponsors a digital health technology formulary that

will help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. Available in 2020, the digital health formulary will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition. 

By adopting a digital health formulary, plan sponsors can confidently deploy a digital health product to their members knowing it has been through a uniform review process to ensure its safety, quality, usability and affordability. The digital health formulary also will:

• reduce the administrative burden for plan sponsors associated with contracting and managing digital health companies,
• help improve affordability by leveraging Express Scripts’ size and scale in the purchasing of digital health products, and
• create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market.

Initially, the digital health formulary will include solutions for diabetes, cardiovascular, behavioral health and pulmonary conditions, and will later expand to include tools for other chronic and complex conditions. 

Healthcare Dive reports on CVS Health’s investor announcements today.  Of note —

• CVS Health plans to open 1,500 HealthHUB stores by the end of 2021 as part of its enterprise growth strategy. By the end of this year, the pharmacy chain will expand on its initial three-store Houston pilot program and open additional locations in Houston, Atlanta, Philadelphia, southern New Jersey and Tampa, Florida.
• HealthHUBs devote about 20% of retail space to health services, focusing on preventive care, wellness activities and education and management of chronic conditions like asthma and diabetes, according to the company. 

Humana broke with company policy to not comment on potential merger and acquisition matters to quell rumors of a possible merger with competitor Centene in a recent filing to the Securities and Exchange Commission. The Louisville-based company stated that it “will not make a proposal to combine with Centene as an alternative to Centene’s proposed transaction with WellCare Health Plans, Inc.” Apparently, the negative impact of speculation on the company’s stock was too much to ignore.

Finally, Healthcare Dive also lets us know that “More than 2,800 comments poured in on two wide-reaching HHS rules to promote interoperability and discourage information blocking in healthcare, with industry groups largely lauding the goal but not the means of achieving it.” If at first you don’t succeed, etc.