FEHBlog

Following up on a number of recent posts:

• Federal News Radio reports that 

The Justice Department jumped the gun in June when it claimed  a Maryland woman pleaded guilty for using data stolen from the 2015 breach of the Office of Personnel Management to obtain fraudulent loans. In a letter to Sen. Mark Warner (D-Va.), Justice Assistant Attorney General Stephen Boyd said DoJ reached a “premature conclusion” that the data only came from the OPM breach.

The Senate and House of Representatives return to work on Capitol Hill this week following a week-long state or district work period combined with the Independence Day holiday.

Federal News Radio reports that tomorrow, OPM will publish in the Federal Register a proposed rule

to establish Birmingham/Hoover/Talladega, Alabama; Burlington/South Burlington, Vermont; San Antonio/New Braunfels/Pearsall, Texas; and Virginia Beach/Norfolk, Virginia, as new locality pay areas. 

Once OPM completes the regulatory process, the president must set locality pay rates for the four new areas, which typically occurs at the very end of each calendar year. 

Federal employees in these four new areas would likely see the locality pay changes on or after Jan. 1, 2019 in their first paychecks of the new year.

The change favorably impacts 62,000 federal employees (out of 2 million) and brings the number of locality pay areas to 51. The FEHBlog had no idea that the number of locality pay areas is that high.

Yesterday, the Health and Human Services Department announced that it is suspending the Affordable Care Act’s risk adjustment program based on a New Mexico federal court decision. The details, including a timeline, are available on the CMS website.  Many are lashing out at HHS over this decision, but in the FEHBlog’s view the root problem is the overreaching and poorly drafted Affordable Care Act. Ironically, the New Mexico case challenging CMS’s method of calculating the risk adjustment was brought by the New Mexico health co-op unnecessarily created by the ACA.

The FEHBlog is a fan of Mondays because he enjoys his work and new episodes of the Econtalk podcast are released that day.  The FEHBlog ran across this academic assessment of the ACA, titled A Cure for our Healthcare Ills, via the Econtalk.org website.  Also check out this Econ Talk interview with Jerry Muller the author of one of the FEHBlog’s favorite books of 2018, The Tyranny of Metrics.

The Society for Human Resource Management calls attention to the fact that the House-passed bill addressing the opioid crisis (H.R. 6) “contains a provision extending the amount of time that employer-sponsored health plans [including FEHB plans] must cover end-stage renal disease under Medicare secondary payer rules from 30 months to 33 months.”  That would be a bitter pill for those plans to swallow on top of the high cost of the opioid crisis itself.

The Washington Examiner reports that several prescription drug manufacturer are continuing their unpopular practice of semi-annual pricing changes.

CNBC, via Becker’s Hospital Review, tells us that telemedicine faces obstacles on its path to reaching the mainstream of healthcare. AHIP points out in this article how telemedicine can be interwoven current focus on social determinants of health. The FEHBlog believes that eventually telemedicine will reach the mainstream.

Meanwhile the International Foundation reports

Onsite [health] clinics are not a new concept, but they are gaining increasing popularity with employers of all sizes. Because these clinics provide primary care and preventative care, onsite clinics are a multifaceted solution used by employers to decrease costs, increase access to care, improve health outcomes for their employees, and create a more productive and satisfied workforce. 

In fact, more than 40 companies on Fortune’s list of the “100 Best Companies to Work For” offer an onsite health clinic for their employees. Additionally, according to the National Survey of Onsite Clinic Operations and Policies Report published in December of 2014, 66% of onsite health center programs demonstrated its ROI in all or some areas.

Federal agencies offer on-site medical clinics but they don’t coordinate care with FEHB plans.

Congress is out of town this week for the Fourth of July holiday. The Supreme Court wrapped up its October 2017 term last week. Of course, the Supreme Court remains in the news because Justice Kennedy announced his retirement from the bench. 

Greeting from Madison Wisconsin whether the FEHBlog and his wife are helping their daughter celebrate her wedding on Friday.  A lot has been happening in the healthcare world so duty calls.

Here are links to Bloomberg Government and FCW.com articles on last Wednesday’s House Oversight and Government reform committee hearing on the President’s federal government reorganization plan. Also here’s a link to the FEDWeek Issues brief on the proposed OPM reorganization.

Amazon is paying “roughly” $1 billion for a company called Pillpack. Pillpack provides chronically ill people with a thirty day supply of various prescribed medicines in daily blister packs. The service is available in the continental U.S and Alaska. The FEHBlog heard about this innovative company a few years ago at an Express Scripts conference. The Wall Street Journal reports that PillPack “has never achieved much retail share,” Raymond James & Associates said in a note to investors. Nevertheless the acquisition shows that Amazon is serious about breaking into the mail order drug business.

The FEHBlog agrees with this Wall Street Journal observation:

[T]he health-care market may be challenging for Amazon to disrupt. It is highly regulated, and depends on a complex web of contracts, interconnected data systems and other relationships with health plans, drug-benefit managers and other health-care players that Amazon may not want to alienate if it wants its pharmacy business to prosper.

For more details on this transaction, check out this Drug Channels blog post.

Health IT Security breaks down the healthcare breach data found in the FBI’s 2017 Internet Crimes report.

Finally here are Fortune and RevCycleIntelligence articles on creating uses to applying social determinants of health. Check them out.  

Here’s a link to the testimony from today’s Senate Finance Committee hearing on prescription drug prices at which HHS Secretary Alex Azar testified.

Tomorrow morning at 10 am, the House Oversight and Government Reform Committee will hold a hearing at which OMB Deputy Director for Management Margaret Weichert will testify about the President’s reorganization plan. Last week, the FEHBlog linked to a commentary from Federal News Radio about how that plan handles OPM. The author of that piece had a follow up article which you can read at this link.

The Wall Street Journal yesterday offered an interview with the new Director of the U.S. Centers for Disease Control Dr. Robert Redfield. Dr. Redfield plans to “address two of the most common ways people take their lives: substance abuse and firearms,” in addition to his agency’s other public health responsibilities.

Noting that the most common means of suicide is firearms, he said the CDC recently expanded the number of states in which it tracks violent deaths, and would conduct research into gun violence if Congress funds it. “We’re authorized to do it,” he said. “We just need a funding mechanism.” 

Dr. Redfield said the CDC is also stepping up its efforts to combat opioid abuse, another common factor behind suicide and one of his top priorities for the agency. “We’re going to continue to expand our efforts,” he said, including developing guidelines for prescribing opioids for acute pain and using a new system that can track opioid overdoses in a timely way using emergency-department data. 

The freshest opioid data used to be months old, Dr. Redfield said. Now, “we’re going to be able to track this epidemic in real time, which I think is really important to be able to respond.”

In another interesting development, Fortune Magazine reports on a venture capital fund called the Dementia Discovery Fund which “makes early stage venture capital investments to develop novel disease-modifying therapeutics for all forms of dementia.”  The DDF completed its initial investor fund raising  of $350 million this week.  AARP, United Healthcare, Quest Diagnostics invested $75 million and Bill Gates invested $50 million. Other initial investors included the NFL Players Association and many prescription drug manufacturers. Hopes springs eternal.

Congress is in session for one more week until it takes time off for the Independence Day holiday. The U.S. Supreme Court ends its October 2017 term this week.

The Senate Finance Committee will hold a hearing on prescription drug costs on Tuesday morning June 26. The scheduled witness is the HHS Secretary Alex Azar.

A few weeks ago, the FEHBlog called readers attention to a PriceWaterhouseCoopers analysis of medical cost trends. The FEHBlog noticed an interesting Health Payer Intelligence article that pulled a couple of nuggets out of that report.  To wit,

Health plans with narrower, high performance networks (HPNs) can help generate cost savings by focusing on improvements in care quality and member satisfaction. HPNs allow payers to invest greater financial resources in a limited number of providers in order to maximize the effectiveness and efficiency of provider care. HPNs also hold providers accountable by measuring their performance with quality measures.

and

Payers and employers are also using health advocates to assist high deductible health plan (HDHP) members with accessing effective and affordable healthcare services. 

HDHPs are a popular employer-sponsored plan offering that can contain costs by shifting greater financial responsibility to health plan members. However, that greater financial responsibility sometimes discourages HDHP members from seeking needed services in order to cut back on personal costs. 

Health advocates are gaining popularity within the employer-sponsored market because they can effectively help HDHP beneficiaries to use affordable healthcare services. 

The New York Times reported today on the journey of a  young primary care provider in her efforts to understand her patients suffering from opioid addiction.  

Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than two million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment. Dr. Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.

Amen to that sentiment.

Finally, the Wall Street Journal reported last week that

Some current and former federal government employees are taking a look at their credit activity after the Justice Department said this week that data stolen by suspected Chinese hackers in 2014 cyberattacks at the Office of Personnel Management may have been used to commit identity fraud.

Federal prosecutors on Monday said a Maryland couple had pleaded guilty to using information stolen in the OPM breach to set up fraudulent car-loan applications with a Langley, Va., credit union.

Here’s a link to the U.S. Attorney’s office press release. It’s clear that two days later U.S. Attorney’s office walked back from the statement that the information had beens stolen in the OPM breach. Here’s the qualification:

As stated in the Statement of Facts for defendants Cross and McKnight, numerous victims of the LFCU identity theft fraud also identified themselves to DOJ as victims of the OPM Data Breach. The Government continues to investigate the ultimate source of the PII used by the defendants and how this PII was obtained.

Time will tell.

Following up on the Whither OPM? posts, the FEHBlog now sees that the OPM HR policy shop would wind up alongside the Office of Management and Budget as part of the Executive Office of the President.  OPM Director Pon has voiced his support for the President’s reorganization plan.  Federal News Radio offers an expert opinion on the proposal to “abolish OPM.”

Yesterday the Senate Appropriations Committee unanimously approved its Financial Services and General Government appropriations bill.  This is the bill that funds OPM and the FEHBP. It allows for a 1.9% civil service raise next year.

Today, according to the Hill, the House of Representatives approved its massive bill to address the opioid crisis by a 396 to 14 vote.

The legislation, passed Friday, includes a range of measures to fight the epidemic, including lifting some limits on prescribing Buprenorphine, a drug used to treat opioid addiction. The bill also requires health-care professionals to write prescriptions for Medicare beneficiaries electronically in order to better track prescriptions and to allow Medicare to cover treatment at addiction treatment clinics.

AHIP held its annual conference in San Diego this week. Healthcare Dive provides three takeaways from that conference.

Oh joy! The World Health Organization released Version 11 of the International Classification of Diseases (ICD-11) earlier this week. 55,000 Version 11 codes vs. 14,400 Version 10 (ICD-10) codes. “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022. This release is an advance preview that will allow countries to plan how to use the new version, prepare translations, and train health professionals all over the country.” Of course the January 1, 2022, effective date does not mean that U.S. health plans and healthcare providers will not begin using the ICD-11 on that date. The FEHBlog expects a five to ten year lag from for U.S. implementation based on the ICD-10 process.

Earlier today, the Trump Administration released its federal government reorganization plan,  As Federal News Radio accurately reported yesterday, the reorganization plan proposes (at page 51) to move OPM’s human resources, healthcare and insurance, and retirement services to the General Services Administration. OPM’s background search service would move to the Defense Department and the remaining employment policy functions would move to the Office of Management and Budget.

The reorganization plan requires Congressional approval. The House Oversight and Government Reform Committee will hold a hearing on the reorganization plan next Wednesday June 27 at 10 am ET.

Here’s the Federal Times article providing its overview of the reorganization plan.

Federal News Radio is reporting as its current lead article that the President’s government reorganization plan scheduled to be announced tomorrow will do away with OPM as we know it. “Multiple sources said the reorganization may also include a move of OPM’s health care and retirement services to GSA.”