FEHBlog

The excitement is palpable. The OPM AHIP FEHBP Carrier Conference begins today. Here’s a link to the full agenda. More to follow.

The FEHBlog believes that few federal laws have spawned more litigation than the Affordable Care Act. Last week, the Health Affairs blog had two posts on that litigation.

Congress returns to Capitol Hill this week.

The Federal Times reports that “The federal government will soon be announcing the award of a contract to study what compensation and reward practices matter most to federal employees and stand the greatest chance of encouraging merit in government service, according to Margaret Weichert, deputy director for management at the Office of Management and Budget and acting director of the Office of Personnel Management.”  The article adds that  “According to Weichert, pay and benefits both received above 60 percent in [Federal Employee Viewpoint Survey] FEVS satisfaction scores, while performance rewards scored between 30 and 40 percent. * * * Those rewards may include practices that improve work-life balance, provide better access to job progression or offer training to transition into more-needed, higher-paying positions.”

The Government Accountability Office issued a report last week finding that

There may be several companies selling health insurance in a given market, but we’ve previously found that most people generally enroll with one of a few companies. When that happens, it can mean less competition and higher premiums for that area.

We updated our work with more recent private insurance data. The overall story is similar: The 3 largest companies held 80% or more of the market in at least 37 states. 

Modern Healthcare reports on an Urban Institute report that builds on the GAO findings.  Any competition is better than Medicare for all in the FEHBlog’s view.

Yahoo Finance offers an interview with Aetna’s former CEO Mark Bertolini.  The FEHBlog values Mr. Bertolini’s insights. Here’s the piece of the interview that struck home with the FEHBlog —

Presently, health care in the U.S. is like a “warranty system” that waits until people are “broken” to fix them, according to Bertolini. “It’s a warranty system today,” Bertolini said. “You get a warranty card when you join a health plan. If you get broke and present yourself to the nearest dealer, we’ll fix you at some cost. It’s not free. And so we have to change that model to what are we doing in the community.”

“This is why we did the CVS deal. We got to do something in the community where we can get people into the stores, have the stores reach out to the community as a way of finding better ways to take care of people, keeping them away from the system,” Bertolini said.

All forms of insurance are warranty systems. The FEHBlog agrees that the old warranty model is outdated. But how can either the new community model work or the old warranty model work with personal responsibility for one’s wellbeing being at the forefront?

The Centers for Medicare and Medicaid Services, which enforces the HIPAA electronic transaction standards and code set rules, announced their findings from a voluntary study of health plan and healthcare clearinghouse compliance with those standards.

Ten organizations met the criteria for participation in the Optimization Pilot. Of these, four clearinghouses and one health plan completed the pilot. All but one of these entities underwent a corrective action plan as part of the pilot. Each participating entity received an acknowledgement stating their participation and compliance. By participating in the pilot, covered entities assisted HHS with streamlining the compliance review process, including review tracking, coordinating and communicating with participating entities, and assessing violations.

CMS advises health plans and clearinghouses to look forward to “a future Information Bulletin for details about full implementation of the Compliance Review Program.”

In Thursday tidbits, the FEHBlog called attention to Choosing Wisely Campaign flyers that can be shared with patients and plan members. The FEHBlog noticed today that the Choosing Wisely campaign also offers a free smartphone app.

The Wall Street Journal reports that while current flu season has not been as severe as last year, it is lasting longer. Thankfully Spring arrived yesterday so the flu can’t hang around much longer.

According to Govexec.com, OPM’s Acting Director Margaret Weichert today provided more insight on the process of folding certain Office of Personnel Management functions into the General Services Administration.

[T]he changes would take place in two broad phases: this year, functions the White House believes can be done administratively, like HR Solutions and OPM’s IT services, will go to GSA, while remaining offices, such as those that work on retirement and administration of the Federal Employees Health Benefits Program, will have to wait for Congress to pass legislation.

“We’re finalizing some of the legal authorities, but we think there’s a huge amount around HR services, IT and many shared services that we will be able to do administratively using a variety of vehicles,” Weichert told reporters. “I think some of the pure statutory elements defined in Title 5 and elsewhere, particularly around the trust funds and pure policy and oversight activities, would require legislation. And we have a forthcoming legislative proposal that will be coming out soon, although I can’t give an exact date.”

The FEHBlog ran across this useful Choosing Wisely Campaign webpage with educational communications for patients / plan members.

This Healthcare Dive article touts the value of electronic prior authorizations of health plan coverage. HHS created standard electronic formats for these transactions long ago. Considering how much the provider organizations complain about prior authorization, the FEHBlog is surprised by the relatively slow provide uptake on electronic prior authorization.

Becker’s Hospital Review discusses the recent release of the Robert Wood Johnson’s rankings of the healthiest U.S. counties. The FEHBlog lives in the healthiest county in Maryland.

The tidbits keep on coming. The International Foundation of Employee Benefit Plans reviews seventeen popular measures that employer sponsored health plans are adopting to control prescription drug cost.

Healthcare Dive reports that “America’s Health Insurance Plans, the BlueCross BlueShield Association and other payer and employer groups sent a letter Monday [March 18] asking Congress to prohibit doctors from sending a surprise bill for emergency or involuntary care.”

Finally, earlier this week the FEHBlog pointed out that Amazon now will let users link health savings account debit cards to their accounts. The FEHBlog should have added that the same feature will allow users to link healthcare flexible spending accounts to their accounts.

The current government contribution toward FEHBP coverage is the lesser of 72% of the enrollment weighted average premium or 75% of the selected plan’s premium. According to Fedweek, the legislative proposals associated with the President’s FY 2020 budget, which the FEHBlog has not been able to find online, would adjust the government contribution based on OPM’s plan performance system. The enrollment weighted average factor would be 76% for plans that score high in that system and 71% for other plans. OPM offered a similar idea but never circulated a draft of the legislative language. As always, the devil is in the details.

The FEHBlog discovered this weekend that he can link his health savings account debit card to his Amazon.com account and Amazon can tell whether or not it’s appropriate to use that card for a particular purchase. Convenient.

Check it out. An irony discovered in the article is that U.S. Justice Department has indicted electronic health record vendors In sum

10 years after President Barack Obama signed a law to accelerate the digitization of medical records—with the federal government, so far, sinking $36 billion into the effort—America has little to show for its investment. Kaiser Health News (KHN) and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials, and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it.

Quite sad.

This morning, the Office of Management and Budget released the second and final phase of the President’s FY 2020 budget proposal. The second phase included agency appendices with their individual budget proposal. The Office of Personnel Management (“OPM”) budget proposal is found beginning on page 1085 of the General Service Administration (“GSA”) appendix. We learn that OPM plans to take another shot at getting Congress to approve incorporating quality measure scores into the government contribution calculation (p. 1094).

Also check out the budget proposal’s analytical perspectives on strengthening the federal workforce, which is chock a block full of federal employment data and reorganization which explains the current approach on folding OPM’s healthcare and insurance unit into GSA.

Happy St. Patrick’s Day. Congress is hold a state work period recess this week. Here is a link to the Week in Congress’s report on last week’s actions on Capitol Hill.

Avik Roy, the Forbes columnist, suggests that the problem of surprise emergency room bills could be resolved if Congress

caps out-of-network [emergency care] prices [in the commercial market, e.g. FEHBP] at the lower of the median privately contracted rate and Medicare’s rates. Not only will such a policy end price exploitation by out-of-network emergency care providers, but also by in-network providers. It will also give market participants the opportunity to do better than Medicare, whether through value-based contracts, simple price competition, or other innovations.

A worthy idea. Health Payer Intelligence offers a report on the status of the issue on Capitol Hill.

Healthcare Dive reports that the Department of Health and Human Services announced that it is actively seeking to resolve a major regulatory headache for payers and providers created by a 1975 law (and implementing rules known as 42 CFR Part 2) that inhibits coordination of caring with patients with opioid addiction, among many substance use disorders. Good luck.

Last week, the Trump Administration announced that “National Cancer Institute Director Norman “Ned” Sharpless will serve as acting commissioner of the Food and Drug Administration,” when Dr. Scott Gottlieb steps down next month. According to MedCityNews

Sharpless has served as NCI director since October 2017, having previously served as director of the University of North Carolina’s Lineberger Comprehensive Cancer Center, since January 2014. He received his medical degree from UNC in 1993, followed by a residency in internal medicine at the Massachusetts General Hospital and a hematology-oncology fellowship at Harvard Medical School’s Dana-Farber/Partners Cancer Care.