FEHBlog

Fedweek has a story that follows up on yesterday’s FEHBP significant changes post

CMS has finalized two big Medicare rules for 2019:

• The CY 2019 physician fee schedule and quality payment program rule.  Becker’s Hospital Review summarizes the rule here, and Healthcare Dive analyzes the rule here, and
• The CY 2019 Outpatient Prospective Payment System rule.  Healthcare Dive analyzes the rule here. The American Hospital Association plans a lawsuit over the rule’s effort to level out the payments between hospital outpatient clinics and other clinics. 

St. Louis Today reports that “Cigna Corp. said on Thursday its $52-billion acquisition of pharmacy benefits manager Express Scripts Holding Co was on track to close by the end of the year.”  (Express Scripts is headquartered in St. Louis.)

MedPage Today expects that Congress will reauthorize the Patient Centered Outcomes Research Institute with “a few tweaks.”

Health Payer Intelligence reports on a Oliver Wyman survey finding increasing consumer dissatisfaction with high deductible plans combined with health savings accounts. The conclusion of the article is striking:

The [Wyman] team said that HDHPs don’t offer the ability to address key consumer satisfaction concerns. Payers trying to tailor benefits to consumers may need to consider new ways to redesign health plan options and to garner trust with beneficiaries. 

The survey found that consumers have extremely little trust in their insurers, rating payers a zero on a scale of 0 to 100.  Consumers are more likely to place their trust with providers.  Eighty percent of consumers said they believe providers work to assist in consumers’ healthcare goals 

“The key lies in understanding the balance consumers perceive between what they already trust, what they might learn to trust, and the incentives – not just in cost and convenience, but in solving pressing concerns health organizations have not addressed,” the team concluded. 

“The new health services landscape becomes much more attractive if it provides new benefits for consumers. We need to spend much more time figuring out what those benefits need to be.” 

Thanks to Fedsmith and surprisingly not to OPM.gov. the FEHBlog ran across this OPM list of significant FEHB Program changes.

OPM’s online organization chart has disappeared from its website, but a reasonable substitute can be found in the agency’s online contact list.

Kaiser Health News offers an interesting article on a large scale allergy test for which Stanford charged a state employee patient over $48,000. The insurer paid around $11,000 to this in-network provider which left the patientwith about $3,000 in coinsurance. She was able to negotiate the coinsurance down to about  $1,500.  The article advises that

Insurers often tell patients to “shop around” for the best price and to make sure they choose in-network providers to avoid surprises. [The patient] did everything right and still got caught out. As a state employee, she had great insurance and Stanford was an in-network provider.  [The patient] said her doctor warned her the test would be expensive, but she never anticipated that could mean close to $50,000. So don’t be afraid to ask for specific numbers: “Expensive” and “cheap” can have hugely different meanings in the high-priced U.S. health system.

Well put.

Drug Store News tells us about a Walgreen’s survey on American attitudes toward the flu shot. 70% of those survey plan to get the vaccination. Get a load of this though —

The survey also found that despite the severity of last year’s flu season — one of the worst in recent years — some 37% of respondents said they had gone to work while suffering from the flu. Additionally, 2-in-5 of those surveyed said they stay home to protect themselves from the flu.

No bueno.

To cap off cybersecurity month, the Department of Health and Human Services today announced  the official opening of the Health Sector Cybersecurity Coordination Center (HC3) at HHS headquarters in Washington, DC.  “The HC3’s role is to work with the sector, including practitioners, organizations, and cybersecurity information sharing organizations to understand the threats it faces, learn the bad guys’ patterns and trends, and provide information and approaches on how the sector can better defend itself.”

Congress remains on the campaign trail this week.

Healthgrades created a national health index ranking major U.S. cities by factors such as access to care, population health, hospital quality, and local specialists. Rochester Minnesota is number one on the index. Healthcare Dive offers its analysis of the index here.

The Health Care Cost Institute created a healthy marketplace index. Healthcare Dive explains that the index “documents variations in healthcare prices across 112 metro areas in the United States found that overall prices are lowest in Baltimore, where rates were 33% below the national average in 2016, and highest in Anchorage, Alaska, and San Jose, California, where rates were 65% above the national average in 2016.” Baltimore ranked fifth on the Healthgrades index.

The FEHBlog has been writing for the American Bar Association’s health law section this year. Here’s a link to his latest article on Association Health Plans.  The FEHBlog is pleased with the Administration efforts to give more healthcare choices to employers and consumers.

On the cybersecurity front:

• The Department of Health and Human Services Office for Civil Rights has rolled out a new version 3.0 of its information technology security assessment tool. 
• The Federal Trade Commission has released cybersecurity tools for non-profits and small and midsized businesses.

On the surveys front —

• OPM released its latest Federal Employee Viewpoint Survey results yesterday. Federal News Radio offers a useful overview of those results here. 
• USA Today reports that the Blue Cross Blue Shield Association released “a first-of-its-kind metric for measuring Americans’ health from birth to age 64: The Blue Cross Blue Shield Health Index. The BCBS Health Index highlights which illnesses — from major depression to substance use disorder —are lowering the quality of life of people across the nation.” Hypertension is the most predominant chronic illness affecting the U.S. population
• Health Data Management informs us that “Artificial intelligence, 3D printing and robotic surgery are among the up-and-coming technologies selected for the Cleveland Clinic’s list of the top 10 medical innovations for 2019.” Keep your sunny side up. 

The Medicare payment for separately payable Part B drugs is typically based on the average sales price (ASP) of a given Part B drug, plus 6 percent of the ASP as an add-on.  For the potential [International Pricing Index or] IPI Model, CMS is considering testing an alternative payment for included drugs that would apply when ASP is higher than an international price. Instead of paying based on ASP, CMS would pay for the drug based on a Target Price derived from international price index and designed to draw down Part B drug prices toward international prices over the course of the model. We estimate that relying on an international price index and setting a Target Price rather than using ASP would result in roughly a 30 percent savings in total spending for the selected Part B drugs in the model. 

CMS would phase-in this Target Price over five years of the model. CMS seeks comment in the ANPRM on several aspects of the model payment, including calculation of the target and the international pricing data.

The comment deadline is December 11, 2018. Most Medicare cost reductions shift costs onto FEHB and private sector plans unless they can implement the same approach.

• The Drug Channels blog tells us

This week, Express Scripts announced an innovative pharmacy benefit contracting model for members of the National Drug Purchasing Coalition (NDPC), a group of 18 large employers. Click here to read the fully-titled press release. You should pay close attention to this b.i.g. news. It is structured so that Express Scripts will not profit from the flow of funds from a brand-name manufacturer to a plan sponsor. What’s more, the PBM’s compensation will be fully delinked from drug list prices. Instead, Express Scripts will earn only fixed management fees plus additional at-risk compensation tied to clinical outcomes. 

Have a good weekend.

On the opioid front —

• The President signed the bipartisan opioid crisis response bill (H.R. 6) into law today. The wide-ranging laws focuses on illegal drug interdiction and treatment of opioid victims. 
• NPR reports that “The American opioid crisis is far from over, but early data indicate the number of deaths are beginning to level off, according to Alex Azar, secretary of the U.S. Department of Health and Human Services, citing ‘encouraging’ results in overdose trends.”
• The Centers for Medicare and Medicaid Services announced “the Maternal Opioid Misuse (MOM) model, an important step in advancing the agency’s multi-pronged strategy to combat the nation’s opioid crisis. The model addresses the need to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce expenditures for mothers and infants.”
• Health Payer Intelligence informs us that “Payers could improve outcomes, increase cost-effectiveness, and reduce opioid use for lower back pain by expanding non-pharmacological coverage such as physical therapy and chiropractic care, according to a new study published in JAMA Network Open.”

The new antiviral, generically known as baloxavir marboxil but sold under the brand name Xofluza, is a single dose [pill] treatment [sold by Genentech]. It is for use only in those aged 12 or more, the F.D.A. said, and should be taken only in the first two days after symptoms like fever, aches and sniffles appear [similar to the existing flu drug Tamiflu].

* * * Xofluza works in a new way, by blocking an enzyme the virus needs to copy itself. So, at least in theory, circulating flu strains resistant to earlier drugs should not have any resistance to it. [That’s the advance over Tamiflu.]

On the Affordable Care Act front —

•  [Yesterday] the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of the Treasury (collectively, the Departments) issued new guidance so states can move their insurance markets away from the one-size-fits-all rules and regulations imposed by the Affordable Care Act (ACA) and increase choice and competition within their insurance markets. 
• Also yesterday, the ACA regulators issued a proposed rule that would permit employer funded health reimbursement accounts (“HRA”) to be integrated with ACA qualified individual health insurance under certain conditions. Currently, under Obama era administration rules HRAs can only be integrated with ACA qualified group health coverage. The 21st Century Cures Act also permits small employers (under 50 full time employees as defined by the ACA) to create QSEHRAs that reimburse employees for individual health insurance premiums. From a 10,000 foot standpoint, the proposed rule would expand this opportunity to large employers. The public comment period on the proposed rule is December 28, 2018. The rule if finalized as proposed would take effect for plan years beginning on or after January 1, 2020. 

Congress remains out on the campaign trail until November 13.

The FEHBlog described the U.S. Justice Department’s approval of the CVS Health / Aetna and Cigna / Express Scripts mergers as a big step but not the final step because the companies still have to deal with state approval. The Hartford Courant reports that New York State is considering blocking parts of the CVS Health / Aetna merger. A final decision is due no earlier than October 26.

Medcity News offers an interesting report on how Blue Cross plans are addressing social determinants of health. For example Blue Cross Blue Shield of Kansas City is using Healthify’s platform.  Healthify claims that it can “help healthcare organizations find community services, track social needs, and coordinate referrals with community partners to radically improve the health of the people we serve.” Interesting.

Healthcare Dive reports that

•     A new Harvard University study casts doubt on the benefits of U.S. hospital accreditation by independent organizations.
•     Researchers looked at patient outcomes at 4,400 U.S. hospitals, 3,337 of which were accredited by the Joint Commission and 1,063 that underwent state-based review between 2014 and 2017. The study included about 4.2 million patients aged 65 and older who were admitted for 15 common medical and six common surgical conditions, as well as patients who completed the HCAHPS patient satisfaction survey.
•     While patients treated at accredited hospitals had slightly lower 30-day mortality rates than patients at state-reviewed hospitals (10.2% versus 10.6%), mortality rates for the surgical conditions were identical (2.4% versus 2.4%). Readmission rates for the medical conditions were significantly lower at accredited hospitals (22.4% versus 23.2%), but were slightly higher for the surgical conditions (15.9% versus 15.6%). The study was published online by BMJ.

Yesterday, the Office of Management and Budget (“OMB”) released the Fall 2018 semi annual regulatory “and deregulatory” agenda. Here are a link to the Office of Personnel Management’s (OPM) current regulatory plan which is not strong on de-regulation in the FEHBlog’s view and a link to OPM’s list of projected regulatory actions.

Govexec.com and Federal News Radio seek to read the tea leaves on the status of the Trump Administration’s federal government reorganization plan as it impacts OPM. In the FEHBlog’s view, an important factor is that OPM’s acting director remains in charge of implementing the White House’s government reorganization plan at OMB. The FEHBlog advises against underestimating Margaret Weichert.

The FEHBlog calls his readers attention to this wide ranging Medpage Today interview with Barbara McAneny, MD, American Medical Association president, and a practicing oncologist/hematologist in New Mexico. Very illuminating.

In other views

• Fidelity Investments offers ideas about how to use health savings accounts over the years. People need education about how to use HSAs.
• Employee Benefit News discusses the current state of implementing bundled payments.
• Healthcare Dive reports on a recent AHIP conference discussing the role of government in healthcare.  
• Health Data Management talks about the importance of personalized incentives in healthcare. 

Washington Post columnist Joe Davidson had an interesting column yesterday on OPM acting director Margaret Weichert’s first week in office.

Also yesterday, the HHS Secretary Alex Azar unveiled a proposed rule that would require televised prescription drug advertisements to include a textual description of the drug’s list price. Health Payer Intelligence offers a useful overview of the healthcare industry’s mixed reaction to the proposal. The FEHBlog thinks that it would be a win for the consumer if the price posting requirement reduces the number of prescription drug ads on TV.

Speaking of advertising, the FEHBlog read a Wall Street Journal article early last month about a California government public nuisance action against Sherwin Williams and other companies that had manufactured lead paint. Part of the evidence was advertising from over a century ago. The defendants had asked the U.S. Supreme Court to review the adverse California state court judgement against them. On Monday the Supreme Court declined to review the judgment.  Governing discusses the Supreme Court’s action here. The lawyers suing the prescription opioid drug manufacturers under this public nuisance doctrine were invigorated by the Supreme Court’s action.

In other litigation news, the U.S. Justice Department announced that it is prosecuting a $1 billion healthcare fraud case the involves compound drug manufacturers and a rogue telemedicine company. Blue Cross of Tennessee allegedly got whacked for $174 million by the fraud.

Healthcare Dive reports that Anthem wrapped up the litigation over a 2015 data breach by agreeing with settle with the HHS Office for Civil Rights for a $16 million HIPAA privacy and security rule fine. On Friday November 2, a panel of the U.S. Court of Appeals for the D.C. Circuit will hear over argument concerning an appeal of the district court’ decision in OPM’s favor in a case seeking to hold OPM accountable for its 2015 data breach.

Finally closing a loop on the opioid crisis response bill, Willis Towers Watson reports that the conference report that both Houses of Congress passed last month did not extend (from 30 to 33 months) the period of time during which primary private sector health plan responsibility for end stage renal disease is primary to Medicare. That hideously expensive pay go was included as a pay-go in the House version of H.R. 6.

The Week in Congress reports that both houses of Congress have left Capitol Hill for the campaign trail. A lame duck session will begin on November 13.