FEHBlog

10 days are left in the current Federal Benefits Open Season which ends on December 11.

Congress is in session this coming week. Here’s a link to the Week in Congress’s report on last week’s activities on Capitol Hill.  The report does not reflect the approval of the Senate’s tax reform bill which occurred overnight on Friday. The leadership in the House of Representatives and the Senate now will appoint members of Conference Committee that we seek to reconcile the House and Senate tax reform bills. If successful, the Conference Committee will produce a report that will be sent to the House and Senate for their approval.

The Senate Health Education Labor and Pensions Committee will hold two hearings this week on the implementation of the 21st Century Cures Act which was voted into law last December.

The current continuing resolution funding the federal government expires on this coming Friday December 8. The FEHBlog has every expectation that Congress will extend the resolution for two weeks or into January. There will be no government shutdown.

In an encouraging development,

The U.S. Food and Drug Administration [on Friday November 30] approved the FoundationOne CDx (F1CDx), the first breakthrough-designated, next generation sequencing (NGS)-based in vitro diagnostic (IVD) test that can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type. The Centers for Medicare & Medicaid Services (CMS) at the same time proposed coverage of the F1CDx. The test is the second IVD to be approved and covered after overlapping review by the FDA and CMS under the Parallel Review Program, which facilitates earlier access to innovative medical technologies for Medicare beneficiaries. 

“By leveraging two policy efforts aimed at expediting access to promising new technologies, we’ve been able to bring patients faster access to a breakthrough diagnostic that can help doctors tailor cancer treatments to improve medical outcomes and potentially reduce health care costs,” said FDA Commissioner Scott Gottlieb, M.D. “The FDA’s Breakthrough Device Program and Parallel Review with CMS allowed the sponsor to win approval for this novel diagnostic and secure an immediate proposed Medicare coverage determination within six months of the FDA receiving the product application.” 

Compared to other companion diagnostics previously approved by the FDA that match one test to one drug, the F1CDx is a more extensive test that provides information on a number of different genetic mutations that may help in the clinical management of patients with cancer. Additionally, based on individual test results, the new diagnostic can identify which patients with any of five tumor types may benefit from 15 different FDA-approved targeted treatment options. Its results provide patients and health care professionals access to all of this information in one test report, avoiding duplicative biopsies.

The Wall Street Journal just reported that

CVS Health Corp. has agreed to buy Aetna Inc. for about $69 billion in cash and stock, a landmark deal that would change the health care landscape in the country by bringing a large [health] insurer and a big provider of pharmacy services under one roof. 

In an agreement that has been months in the making and is likely to be announced later Sunday, Aetna stockholders are to receive $207 per share, $145 in cash and $62 in stock, according to people familiar with the matter.  As part of the deal, CVS plans to use its nearly 10,000 pharmacy locations to provide consumers with more local care options.

 More details to follow.

The FEHBlog is up in Manhattan with Mrs. FEHBlog watching their grandson for the weekend. The FEHBlog has found something more enjoyable than this blog!

There are 10 days left in the Federal Benefits Open Season.

The Washington Post reports that the CVS / Aetna merger agreement may be inked on Monday.  Bloomberg offers some interesting observations on financial aspects of the anticipated merger, which of course must clear government anti-trust scrutiny. Also the Chicago Tribune reports that Express Scripts CEO Tim Wentworth noted at a Forbes conference yesterday that while his company would be open to health insurer merger or partnering with Amazon, his company is not actively pursuing such a deal.

Meanwhile at the Office of the National Coordinator for Healthcare Technology conference, the National Coordinator discussed next steps in achieving interoperability in healthcare technology according to the MedPage Today report.. Of course, the government missed the boat by approving free distribution of non-interoperable electronic medical records to providers earlier this decade to the tune of over $30 billion. But better late than never.

Fierce Healthcare reports on HHS Secretary nominee Alex Azar’s confirmation hearing before the Senate Health Education Labor and Pensions Committee earlier this week. The focus of the hearing was on controlling prescription drug costs.

Yesterday CMS cancelled the Obama Administrations mandatory hip fracture and cardiac bundled payment models created for Medicare patients.  The FEHBlog is not a fan of such mandatory programs.  The shift to value based reimbursement appears to remain on track.  Fierce Healthcare also reports on a Humana study concerning provider efforts to adapt to valued based reimbursement.

Finally, researchers at UConn, the FEHBlog’s alma mater, are reporting “new evidence suggest[ing] the fatty molecules [or lipids that clog arteries] might come not only from what you eat, but from the bacteria in your mouth. The research may explain why gum disease is associated with heart trouble.” So pay attention to your dental care.

Thirteen days left in the Federal Benefits Open Season.

Healthcare Dive tells us about five payer trends to watch in 2018.  The FEHBlog is encouraged by the fact that

Providers and payers have increasingly worked collaboratively. Payer-provider partnerships vary in type, size, location and model. There are 50/50 joint ventures with co-branding, and less intensive partnerships like pay for performance, accountable care organizations, patient-centered medical homes and bundled payments. Oliver Wyman found the partnerships can be broken down depending on providers’ appetite for risk.
They involve national payers like Aetna, Cigna and various Blues and new players in the payer space like Oscar Health and Bright Health.

In this regard, it’s noteworthy that according to a Forbes report, United Healthcare’s Optum unit has launched a $250 million incubator called Optum Ventures “to develop early-stage healthcare companies.” Optum is another leader in the payer – provider collaboration field.

Fierce Healthcare tries to read the tea leaves concerning Humana’s next M&A deal. Leerink Partners analyst Ana Gupte thinks that

Humana is a possible takeout target after the annual enrollment season for Medicare Advantage concludes. Should a transaction occur, Cigna would be the most likely buyer—though it would need to divest its Health Spring Medicare Advantage plans to satisfy antitrust regulators, Gupte wrote in a research note (PDF).  Other “dark horse acquirers” of Humana could include either Anthem, Walmart or Walgreens, Gupte wrote. While the two retailers might seem like odd candidates to purchase a health insurer, such a deal makes sense considering CVS Health is said to be in talks to acquire Aetna.

Interesting.

Kaiser Health News offers consumer tips on how to avoid surprise ambulance bills.  If you can plan an ambulance trip, e.g., from a hospital to another facility, then you can arrange for an in-network ambulance service. If you can’t plan the trip, it’s a crap shoot because the days of free municipal ambulance service is over.

The FEHBlog hopes that all of his readers enjoyed the Thanksgiving Holiday. Congress is back from its holiday break tomorrow. Federal News Radio discusses bills for federal employees to watch this coming week and The Hill reports on five health care issues that will receive Congressional attention before the Christmas holidays break.  None of bills / issues directly affect the FEHBP.

The Federal Benefits Open Season ends on December 11, which is 15 days away.

Health Payer Intelligence offers its views on how health plans can help high deductible plan enrollees  get the best value out of their coverage. High deductible plan enrollees can contribute to a health saving account that they own as long as they don’t have other health benefits coverage, such as Medicare.  A few years ago a group of federal annuitants demanded in federal court that they be allowed to waive Medicare Part A coverage in order to continue contribute into their health savings accounts.  The federal courts rejected their lawsuit.

The FEHBlog who is under age 65 is enrolled an ERISA governed high deductible plan with a health savings account. The FEHBlog’s birthday is in December which means that he will lose the ability to contribute to his HSA on the first day of December in which he turns 65. If he were enrolled in an FEHB plan he would be entitled to an individual Open Season under 5 CFR Section 890.301(k) at that time:

(k) On becoming eligible for Medicare. An employee may change the enrollment from one plan or option to another at any time beginning on the 30th day before becoming eligible for coverage under title XVIII of the Social Security Act (Medicare). A change of enrollment based on becoming eligible for Medicare may be made only once.

It probably doesn’t make sense to change plans for one month, but it’s the enrollee’s call. Nationwide FEHBP plans that offer a high deductible plan with a health savings account option typically include a health reimbursement account offering for annuitants who can’t contribute to a health savings account.  

First the FEHBlog wants to point out that he has corrected the erroneous KFF.org link in Monday’s post on Medicare Advantage. Lo siento.

Kaiser Health News kicks off this happy season with a recommendation that family discuss end of life planning during the Thanksgiving dinner. It certainly makes sense to discuss this important issue in a family setting, but Thanksgiving?

In this regard Medical News Today reports  “new [American Cancer Society] research examined a total of 1,570,975 cancer cases, 587,521 of which resulted in death. During the analysis, 26 cancer types and 17 risk factors were analyzed.

These 17 risk factors are called “modifiable” because people can take active measures to change them.”

Health Payer Intelligence discusses how data analytics and employee wellness engagement platforms can improve employee health and reduce health plan costs.

Employers that want increased member engagement for wellness services
such as flu shots or other preventive measures need to capture and
leverage data on their employees’ healthcare conditions, preferred
communication tools, and motivating incentives for utilization.

Leveraging analytics to identify high-risk populations helps
employers determine where to direct communications, and who is most
likely to benefit from services.

OPM certainly is an employer that seeks that type of engagement.

The Hartford Courant reports today that “An acquisition of Aetna Inc. by CVS Health
Corp. may meet little resistance from federal regulators under the
Trump administration, speeding the deal toward completion, two analysts
say. A deal between Aetna and CVS could be announced within days, Dow Jones is reporting.”

Last but not least the FEHBlog overlooked that last Thursday OPM’s Healthcare and Insurance Director Alan Spielman blogged about Open Season. Have a look.

In the course of writing about the ongoing Federal Benefits Open Season, the FEHBlog overlooked linking to this Tammy Flanagan article in govexec.com. Ms. Flanagan also discussed Open Season on a Federal News Radio program last Friday.

Healthcare Dive takes a look at why insurers are flocking to Medicare Advantage.

Payers see MA as a stable market. That’s evident in the fact that MA premiums are expected to decrease by 6% next year. Insurance companies like stability. Insurers increase premiums by double digits when there isn’t stability, which is the case with the ACA exchanges.

KFF.org explains that

Since 2006, Medicare has paid plans under a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs). If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees. Payments to plans are then adjusted based on enrollees’ risk profiles [plus some other stuff explained on the KFF.org website] 

FEHBP certainly is stable market but no one is predicting a looming premium decrease. Both MA and FEHBP carriers are subject to a profit limiting 85% medical loss ratio. Under the FEHBP, the government contribution formula works like the MA benchmark but perhaps it’s not as not as efficient as the MA approach. It’s an interesting intellectual exercise.

ICD10 Monitor reports that the American Medical Association has released 2018 changes to its CPT codes and descriptors. HIPAA requires that these CPT codes, which describe outpatient medical services, must be used in HIPAA standard electronic transactions.  The Monitor notes that the 2018 changes amount to 312 edits.

Congress is out of town this week for the Thanksgiving holiday. Here’s a link to The Week in Congress’s account of last week activities.

Following up on last Friday’s posts, here are Fedsmith’s more detailed take on the Medicare Part B premiums and federal annuitant options and the PBM trade association PCMA’s first take on HHS’s proposed 2019 changes to the Medicare Part D program.

We now enter into the second week of the Federal Benefits Open Season. There are twenty two days left to pull the trigger to change plans which is typically only necessary if your current plan has dropped out of FEHBP for 2019. If in doubt check out OPM’s Fast Facts and the Significant Changes list for 2018.

The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017. However, a statutory “hold harmless” provision applies each year to about 70 percent of enrollees. For these enrollees, any increase in Part B premiums must be lower than the increase in their Social Security benefits. After several years of no or very small increases, Social Security benefits will increase by 2.0 percent in 2018 due to the Cost of Living adjustment. Therefore, some beneficiaries who were held harmless against Part B premiums increases in prior years will have a premium increase in 2018.

The 30 percent of all Part B enrollees who are not subject to the “hold harmless” provision will pay the full premium of $134 per month in 2018. Part B enrollees who were held harmless in 2016 and 2017 will see an increase in the monthly Part B premium from the roughly $109, on average, they paid in 2017. An estimated 42 percent of all Part B enrollees are subject to the hold harmless provision in 2018 but will pay the full monthly premium of $134, because the increase in their Social Security benefit will be greater than or equal to an increase in their Part B premiums up to the full 2018 amount. About 28 percent of all Part B enrollees are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase.

Medicare Part B enrollees not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2018, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium. These groups represent approximately 30 percent of total Part B beneficiaries.

The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same annual deductible in 2017. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.

The fact sheet includes the table with the rates for higher income Medicare beneficiaries. With respect to Medicare Part A:

The Medicare Part A annual inpatient hospital deductible that beneficiaries pay when admitted to the hospital will be $1,340 per benefit period in 2018, an increase of $24 from $1,316 in 2017. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay a coinsurance amount of $335 per day for the 61st through 90th day of a hospitalization ($329 in 2017) in a benefit period and $670 per day for lifetime reserve days ($658 in 2017). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $167.50 in 2018 ($164.50 in 2017).

Quadruple aim?? We all have heard about the healthcare Triple Aim of improving the patient experience of care (including quality and satisfaction); improving the health of populations; and
reducing the per capita cost of health care.  Revcycleintelligence.com suggests that no one will achieve the triple aim without including the fourth aim of provider satisfaction.

Reliant Medical Group [located in central Massachusetts] focuses on the Quadruple Aim by implementing team-based care and placing teams in shared spaces.
The medical group, which includes 27 clinical locations, spreads case workloads across teams of caregivers. The team consists of caregivers of all levels and team members share clinical and bureaucratic responsibilities.
Shared spaces is a key component to Reliant Medical Group’s team-based care approach, [Reliant’s CEO] added.

As the FEHBlog is blue skying, he notes that Modern Healthcare is reporting about the development of new quality measures that go beyond outcomes toward overall health and wellness.

The Institute for Healthcare Improvement recently endorsed what are called “whole system measures,” or a limited number of measures that encompass patient experience, health of populations and costs. The 15 measures assess areas like job satisfaction, social support from family or friends, and ability to afford healthcare services. 

To that end, Health Payer Intelligence reports that local health plans are becoming involved with supporting affordable housing initiatives.

Also on the cutting edge, Healthcare Dive reports that the Food and Drug Administration has approved for marketing a digital pill called Abilify MyCite that tracks whether the patient ingests the medication.

Yesterday, the Centers for Medicare and Medicaid Services released proposed 2019 rules for the Medicare Advantage and Medicare prescription drug (Part D) programs. Here’s a link to the CMS Fact Sheet. Reuters reports that the Part D proposals would allow the plans to use limited pharmacy networks for opioid prescriptions and to share rebates more directly with consumers. The latter proposal is likely causing the industry palpitations. Oh and by the way, hey CMS where is the news release on 2018 Medicare cost sharing amounts and premiums??

CHIME announced that it has ended its patient ID challenge unsuccessfully.  Healthcare Dive explains that “Instead, CHIME will focus its efforts on creating a Patient Identification Task Force through its CHIME Healthcare Innovation Trust affiliate.”  That’s disappointing. How about using an intelligence free combination of characters.

Healthcare Dive also reports that “Having a primary care physician (PCP) care for their own patients in hospital settings may result in meaningful differences in care patterns and patient outcomes, according to a new JAMA study.” Well duh. The problem is translated the Dr. Welby scenario to a group practice scenario — see Quadruple Aim.

Finally the FEHBlog ran across this Centers for Disease Control website on cancer statistics across our great land.  Check it out.