FEHBlog

President Trump announced his blueprint for lowering drug prices today. Here’s a link to a Fierce Healthcare article on the announcement.

The IRS announced 2019 chained CPI-U inflation adjusted amounts for health savings accounts and high deductible health plans. The HSA contribution limit is increased by $50 for self only coverage and $100 for family coverage. There’s no change to minimum HDHP deductible, The out-of-pocket maximum for HDHP coverage is increased by $100 for self only coverage and $200 for family coverage. Fulsome details may be found in this Society of Human Resource Managers report.

Tammy Flanagan writing in Govexec.com discusses changes on the federal benefits horizon here.

Govexec.com separate reports that earlier this week

At a civil service reform town hall hosted by the nonprofit Partnership for Public Service, Office of Personnel Management Director Jeff Pon defended the Trump administration’s plan to freeze the pay of all civilian federal employees in 2019 as needed to “collect data” on compensation and as a chance to “right-size” the pay for different government occupations.

Dr. Pon also defended his agency’s legislative proposal to cut federal employee retirement benefits. And of course, OPM has proposed to cut the government contribution for popular FEHB plans with average quality scores based on OPM’s plan performance system.

Speaking of cuts, BNA reports on the state of health insurer “struggles” to control benefit costs and improve quality of health care.

Healthcare Dive more specifically informs us that

A new Health Care Pricing Project study on employer-based health insurance and hospital pricing found that insurers are paying “substantially different prices for the same services.” Health spending on the privately insured varies by a factor of three across the country, with half of the variation caused by hospital pricing differences and half by quantity.

After all, healthcare is local, as they say.

Beckers Hospital Review reports that

[This week] Bay Area Regional Medical Center in Webster, Texas [which is located outside Houston] * * * officially closed its doors, laid off about 700 employees and plans to seek bankruptcy protection. Also, a lawsuit filed against Bay Area Regional Medical Center this week by a lab testing company revealed the hospital may owe Cigna and Aetna a combined $43 million.

Ouch.

Let’s close with a couple quirky points:

• Health IT Security reports that last Tuesday the House Energy and Commerce Health Subcommittee held a hearing on the topic of aligning privacy protection for certain substance use disorder patients with the HIPAA Privacy Rule. Hopefully that bill will pass Congress this year as the specialized rules, which pre-date HIPAA by 30 years, are unnecessarily complicated for providers and payers. 
• Securityintelligence.com reports that “Malicious crypto-miners have supplanted ransomware as the top healthcare cybersecurity threat.” Que? Here’s a link to a Malwarebytes Labs piece on the #1 threat. 

The Centers for Medicare and Medicaid Services released today its first rural health care strategy. The strategy focuses on the following objectives:

• Apply a rural lens to CMS programs and policies
• Improve access to care through provider engagement and support
• Advance telehealth and telemedicine
• Empower patients in rural communities to make decisions about their healthcare, and
• Leverage partnerships to achieve the goals of the CMS Rural Health Strategy.

Speaking of telehealth, the Society for Human Resource Management offers a helpful article for employers and health plans on how to increase utilization of that service.

CVS Health and Cigna both reported first quarter 2018 financial results. In the context of those presentation, CVS Health CEO Larry Merlo, according to Forbes, said that its merger with Aetna is expected to close later this year, and Cigna CEO David Cordani, according to Beckers Hospital Review, said his company’s merger with Cigna is on the same track to close.

Employee Benefits News offers a pharmacist’s business perspective on these two mergers here.

Finally Fierce Healthcare reports that

Pennsylvania-based Geisinger Health announced Sunday it plans to make [genetic] testing a “routine” part of preventative healthcare at its facilities. [Geisinger is an early if not the first adopter of this approach.] The idea is to make DNA sequencing part of its standard screening tests along the lines of the mammograms, colonoscopies and cholesterol checks that are regularly performed on patients to detect disease earlier. Officials said Geisinger patients will be able to work with their family physician to modify their lifestyle and minimize risks that may be revealed, they said.

Bravo, Geisinger which by the way currently offers FEHB coverage.

Congress is back in town this coming week follow district/state work sessions last week.

This is Public Service Recognition Week. This celebration “is organized annually by the Public Employees Roundtable (PER) and its member organizations to honor the men and women who serve our nation as federal, state, county and local government employees.” Maazal tov to all.

In this regard, Federal News Radio provides a set of slides with demographic background on the federal workforce. Here’s the one that grabs the FEHBlog’s attention. “45% of the federal workforce is over the age of 50.” Bear in mind that the enrollment of the FEHBP is roughly split between employees and annuitants. Consequently, FEHBP carriers face a demographic challenge. The saving grace is the FEHBP’s use of a single risk pool per plan option that includes all age groups paying the same premium.

Warren Buffett chaired the annual Berkshire Hathaway meeting on Saturday. Reuters reports on what Mr. Buffett and his vice chairman said about the “healthcare company being set up by Berkshire Hathaway Inc, Amazon.com Inc and JPMorgan Chase & Co. to lower patient costs” for their employees and eligible family members. Mr. Buffett expects the company’s CEO to be named “within a couple of months.”

Forbes columnist Avik Roy discusses the country’s drug pricing woes in advance of the President’s anticipated speech on that topic which may occur on Tuesday May 6.

The conventional wisdom in Washington is that the only way to reduce drug prices is through price controls. But that’s not true. Competition—especially from unbranded generic drugs—has dramatically reduced prices of most major drugs whose patents have expired. But Congress and the FDA have erected barriers to further competition that deserve to be torn down. 

He presents reform ideas, some of which the FDA has undertake and others of which require Congressional action.

The Hill uses a recent Food and Drug Commissioner speech among other resources to read the tea leaves about the President’s upcoming speech on drug prices.  The FDA Commissioner suggests that the Administration wants to plow manufacturer rebates into lower prices for consumers.

The Wall Street Journal reports that

The opioid epidemic has unfairly increased health insurance costs across the board, not just for those suffering from addiction, plaintiffs allege in five proposed class-action lawsuits filed Wednesday. 

The suits, brought on behalf of people and businesses who have paid for health insurance in California, Illinois, Massachusetts, New Jersey and New York since 1996, represent a new front in litigation seeking to hold corporations accountable for the opioid crisis. 

Already, drug makers and distributors collectively face more than 600 civil lawsuits brought by local and state municipalities trying to recoup costs borne from opioid abuse.

When will the federal government join these lawsuits?

Recent surveys —

•  Becker’s Hospital Review lists 100 “great” U.S. hospitals. 
• The Commonwealth Fund has issued its annual state health scorecard, and the results aren’t pretty. 
• Health Payer Intelligence reports on an interesting employer health care survey. “Sixty-four percent of employees that participated in a new survey said financial incentives helped connect them to necessary healthcare resources and equip them for improved member engagement.” What’s more, “Eighty-two percent of employees said that participating in a high-deductible health plan helped enforce better healthcare decision making.”

Healthcare Informatics reports on Health and Human Services Secretary Alex Azar’s speech to the World Health Congress. The Secretary is keen on making health care pricing transparent to consumers. Why not require doctors to provide a summary of services and prices similar to the summary of benefits and coverage that the ACA requires health plans to produce, e.g., my practice participates in the following networks, if I perform this type of service out of network it would cost $X.

Azar also referenced issues around pharmaceutical pricing. “We also want to lower the high prices of drugs,” he said. “HHS is working with the president to focus on a number of issues, including high-list prices, seniors in government programs overpaying for drugs, and foreign governments getting a free ride on American innovation. We’re working on this. I can assure you the President wants to go further, much further. Action is desperately needed. I believe we can help lower the cost of medicine while still stimulating innovation. We have to do so going forward.” 

Concluding his speech, Secretary Azar said that the potential for change, and the initiatives he had just referenced, are among the reasons “why I’m so optimistic.” Fundamentally, he said, “The time has simply come for this [transformational change] to happen. The status quo just cannot hold. The way we do business in American healthcare, from insurance, to IT, to drug pricing, to patient billing, has got to change.” He said he believes that “The power of informed individuals will deliver high-quality healthcare. Getting to that system won’t be the most comfortable process for some entrenched players,” he warned, but he said the opportunities are many, and exciting, and he added, “I exhort all of you to engage with us on the initiatives we’ve presented today, because the opportunities are [so great]. Change is necessary, change is coming,” he said, and asked the leaders gathered at the conference to be a part of that change.

Healthcare Dive discusses a wide-ranging PwC report on merger and acquisition activities in healthcare.  In the course of discussing tech company involvement with healthcare, the publication observes based on the PwC report that

More than half of consumers surveyed said they believe technology companies can improve the patient experience, reduce costs, simplify healthcare and increase their access to personal health information. But they also expressed concerns about the quality of products and services offered by tech companies and privacy of their information. For example, 36% said they would not be very comfortable getting diagnostic tests through a tech company and 36% were uncomfortable with the idea of a virtual doctor visit.

Consumers are, however, embracing health retailers like CVS Health, Walgreens Boots Alliance and Walmart. Slightly more than half said they would be very or somewhat likely to get a wound treated or get staples or stitches at a retail clinic, and 61% said they would use an at-home strep test purchased at a retail store. Payers like CVS are banking on these loyal retail customers to drive increased use of basic healthcare services at clinics.

Health IT Security offers a very informative report on HHS Office for Civil Rights advice on development of legally mandated electronic protected health information security risk assessments. Definitely worth a gander.

Federal News Radio reports that

In a wide-ranging conversation with reporters Monday morning [April 30],  [OPM Director Dr. Jeff] Pon outlined his vision for OPM and its role in modernizing 40-year-old statutes that govern how agencies recruit, retain, compensate and manage federal employees. 

“We’ve been nibbling around the edges of civil service reform in the [19]90s and also in the 2000s,” Pon said. “We’ve looked at pay systems, but I’m really looking at wholesale change. We’re looking to make sure that the fabric of the civil service is ready for the next 40 years.” 

OPM can push change with four main mechanisms: legislation, executive order, agency-specific authority and OPM authorities. “I’m going to be pushing on all four,” Pon said. “We are going to ask our legislators on ambitious things. We are going to ask for greater authorities for the OPM director to make sure that this position can manage agency-wide HR policies.” 

The ACA regulators, the Health and Human Services Department, the Labor Department, and the Treasury Department, have issued a new Affordable Care Act rule.  Last year, a federal judge here in the District of Columbia ordered the ACA regulators to reconsider an aspect rule that has been standing since 2010. The American College of Emergency Physicians had challenged the way in which the ACA regulators had created a basis for paying out of network emergency care. The ACA regulators stuck with their original and relatively practical approach. The regulators rejected further complications proposed by ACEP which is fine with the FEHBlog. The matter now goes back to federal court.

Health IT Analytics is telling us that

The Blue Cross Blue Shield Association’s network of value-based care programs, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), is outperforming other initiatives in 96 percent of care and cost quality metrics.

The Blue Distinction Total Care Program is the healthcare industry’s largest national network of value-based care programs. Overall, Total Care doctors, hospitals, and clinical care teams are outperforming other healthcare providers in 22 of 23 nationally-recognized industry quality measures.

Members of the program have produced a 10 percent reduction in emergency room visits and a 15 percent decrease in hospitalizations year-over-year.

Impressive.  The FEHBlog appreciates provider-payer cooperation.

Speaking of healthcare metrics, Healthcare Dive reports that “Hospital re-admissions that occur in the first week after a patient is discharged are more likely to be preventable than those occurring later, according to a new study in the Annals of Internal Medicine that suggests it may be time to rethink the association between hospital quality and 30-day readmission rates.” Amen to that. NCQA take note.

The large telehealth provider American Well announced this week that it is acquiring another telehealth company Avizia which focus on providing telehealth services to hospitals and health systems. “Today, Avizia powers over 1,300 hospital deployments and is a leader in comprehensive acute care telemedicine implementation for large health systems. The company has a significant global presence in over 38 countries, with strong clinical use cases across behavioral health, chronic care, stroke, pediatrics and urgent care at over 70 health systems.”

The Wall Street Journal reports that “CareMore, a California-based subsidiary of Anthem that provides health care to 150,000 Medicare and Medicaid patients across the country, is screening its elderly patients for loneliness.”  Evidently, loneliness can adversely affect health, particularly in the elderly. Another social determinant of health. Good luck with that.

Good luck also to the National Institutes of Health which according to Fierce Healthcare “has set [May 6 as the] start date for the full launch of its All of Us precision medicine research project.}

NIH announced that nationwide enrollment in All of Us will begin on May 6 with launch events to be hosted in seven cities: New York City, Chicago, Birmingham, Alabama, Detroit, Kansas City, Kansas, Nashville and Pasco, Washington.  

All of Us seeks to enroll more than 1 million volunteers over the next 5 to 6 years as one of the “most ambitious” research efforts in the country, said Francis Collins, M.D., director of NIH, at a press briefing Tuesday. “Imagine the research we could enable,” he said, with access to “one of the largest and most diverse cohorts” ever made available. 

People who are interested in participating in the study can visit this website.  The FEHBlog enrolled.

The House of Representatives and the Senate are holding district / state work periods this week.

Most employee organization plans participating in the FEHBP hold accreditation from the Accredition Association for Ambulatory Health Care which is based in Skokie, Illinois. Becker’s Hospital Review reports that changed its governance structure after nearly 40 years, from an association structure to a 13-member board of directors. “Arnaldo Valedon, MD, was appointed the first-ever board chair. Ira Cheifetz, DMD, is chair-elect, Timothy Peterson, MD, is secretary and treasurer and Kenneth Sadler, DDS, will serve as immediate past board chair.”

The Wall Street Journal reports that this week closing arguments will occur before federal district judge Richard Leon in the federal government’s lawsuit to block the proposed merger between AT&T and Time Warner.  Why is this relevant to healthcare?

The trial marked one of the biggest antitrust cases in decades and the stakes are high. Should the Justice Department lose, it could embolden companies, including in the media industry, to pursue more transformative deals. A government loss also could prompt it to shy away from future lawsuits against vertical mergers, which combine companies that operate at different rungs of the same industry ladder.

All of the big pending healthcare mergers, e.g., CVS Health / Aetna, Cigna / Express Scripts, and Walmart / Humana also are vertical mergers.

On Friday, the Centers for Medicare and Medicaid Service announced new proposed payment rules to “update [for fiscal year 2019 beginning October 1, 2018] “policies and rates under the Skilled Nursing Facilities Prospective Payment System (SNF PPS), Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS), Hospice Wage Index and Payment Rate Update, and Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).” CMS also released “a Request for Information (RFI) to obtain feedback on positive solutions to better achieve interoperability or the sharing of healthcare data between providers. Specifically, CMS is requesting stakeholder feedback through an RFI on the possibility of revising [Medicare] Conditions of Participation related to interoperability as a way to increase electronic sharing of data by providers.”

Earlier this week according to reports from the Hill and the Washington Examiner, the Senate Health Education Labor and Pensions Committee and the House Energy and Commerce Health Subcommittee each voted out over fifty opioid crisis bills. Health IT Security notes unfortunately that neither package includes a desired provision aligning the privacy laws that protect people with substance use disorders. “Harmonization of [42 CFR] Part 2 with [the] HIPAA [privacy rule] would * * * increase care coordination and integration among treating providers and other entities in communities across the nation.”

Fierce Healthcare tells us that HHS and the American Society for Nephrology are “launch[ing] an accelerator for kidney care innovation. The Kidney Innovation Accelerator, or KidneyX, will begin accepting applications for its first round of funding this summer, HHS announced. In addition to providing funding to back new approaches to kidney care, KidneyX will coordinate with federal agencies to bring the innovations to market more quickly.”

EHR Intelligence reports a positive stakeholder response to the HHS inpatient prospective payment system rule released earlier this week. That rule is chock a block full of policy changes as discussed in the article.

Finally, a couple of items of interest to payers:

• AHRQ released  a “Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families.” [The publication]  is a resource to help primary care practices partner with patients and their families to improve patient safety. The Guide is composed of materials and resources to help primary care practices implement patient and family engagement to improve patient safety.” The guide may help payers convince their members about the importance of selecting and using a primary care provider in the payer’s network.
• Employee Benefit News offers guidance on how to help plan members / employees avoid wasting their health savings account dollars. The FEHBlog expects this guidance will be well received by high deductible plan members. 

While the FEHBlog is a fan of personalized medicine, the Wall Street Journal reports today that

The emergence of genetics-based medicines is pushing the cost of treating certain diseases to new levels, forcing hospitals and health insurers to reckon with how to cover total costs per patient approaching a million dollars. 

The therapies deliver new genes or genetically altered cells to tackle some of the hardest-to-treat diseases, including in children. They come at a high price: Novartis AG listed its newly approved cell therapy for cancer at $475,000, while Gilead Sciences Inc. priced its rival drug at $373,000. 

But the price of the drugs is just the beginning, hospitals and insurers say. Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy hospital stays and use of other services and medicines.