FEHBlog

The FEHBlog is outside the Beltway this weekend.  It’s a lovely day in Chicago.

The Delaware chancery court judge denied Anthem’s motion for a 60 day long extension of its merger agreement with Cigna late yesterday afternoon. The judge allowed Anthem until Monday to notice an appeal to the higher state court according to this Bloomberg article.

HHS Office for Civil Rights added another scalp to its belt this week.  This one is worth bearing in mind. A large Texas hospital system is paying a $2.4 million settlement and entering into a compliance plan because the hospital publicized the fact that a patient was arrested for presenting a fraudulent identification. It was OK under HIPAA to blow the whistle to the police but not to name the patient in its press release. Expensive lesson.

In an interesting development, the Blue Cross Blue Shield Association announced a nationwide partnership with Lyft to transport certain members to medical appointments at no additional cost to the members. It looks like the arrangement will be an additional tool in the case manager’s toolbox.

Fierce Healthcare reports on last Monday’s Delaware chancery court hearing concerning the Anthem – Cigna merger agreement.  Anthem has asked for a 60 day preliminary injunction barring Cigna from terminating the merger agreement while Anthem seeks U.S. Supreme Court review of last week’s D.C. Circuit decision against the merger. The Delaware judge promised a quick decision on this request.

CBS News reports on a new initiative called Inside Rx that was announced on Monday. The initiative involves Express Scripts, several drug manufacturers, and Good Rx. Inside Rx allows people to pay the PBMs price for many brand name chronic care drugs.  Because of anti-kickback laws, the program can’t be used with insurance, but may be used with flexible spending accounts. People on Medicare, Tricare, etc. can’t use the product. It’s a useful gap filler.

Studies and reports —

• CAQH which does a good job attempting to streamline health benefits, issued its annual report. 
• Health Affairs published a study on affordable care organizations. Fierce Healthcare discusses the study which has some useful findings. 
• TechTarget tells us about BitGlass’s 2016 report on healthcare data breaches. The trend is finally moving in the right direction. 

Congress is out of town this coming week. Here’s a link to the Week in Congress report on last week’s actions on Capitol Hill.

Forbes columnist Avik Roy has a valuable column with three recommendations on changes that the Senate should make to the House of Representative’s American Health Reform Act.

The Wall Street Journal reports that the opioid crisis also has struck college campuses.

Colleges around the U.S., spurred by fatal student overdoses and grieving families, are distributing lifesaving medication and adding on-campus recovery programs as the nation’s opioid epidemic worsens.
Some 33,000 people in the U.S. died of opioid overdoses in 2015, according to the Centers for Disease Control and Prevention. College students are as likely as others to abuse the narcotics, according to a survey of 1,200 college-aged adults commissioned that same year by the Hazelden Betty Ford Institute for Recovery Advocacy and the Christie Foundation.

Last week,  the IRS issued Rev Proc 2017-37 with the inflation adjusted 2018 minimums and maximums for high deductible plans with health savings accounts.  The ACA OOP maximums for all non-grandfathered plans for 2018 are $7,350 for self only coverage (up $200 over 2017 and $14,700 for other than self only coverage (up $400 over 2017).

For weekend reading —

• The Congressional Research Service’s May 4 report on the American Health Care Act. The report is filled with easy to comprehend tables and timelines. No mention of our beloved FEHBP. Thanks CRS.
• An HHS task force on healthcare cybersecurity issued its report this week. The report specifies six imperatives. 

The HIMSS analytics research, presented in two separate studies that analyzed inpatient and outpatient telemedicine, highlighted a jump in growth of usage over a three-year period. “Adoption of telemedicine solutions or services has surged since this study was first conducted in 2014 from roughly 54 percent in 2014 to 71 percent in 2017,” said the reports. “After consistently growing 3.5 percent annually, based on study results adoption has increased roughly 9 percent since 2016.”

It looks like we are now past the tipping point for telemedicine.

Finally, Reuters tells us about a recent U.S. Centers for Disease Control study on American death rates over the period 1999 to 2015.  

“The disparity in deaths between the white and black populations is closing. Even so, critical disparities remain,” Leandris Liburd, associate director of CDC’s Office of Minority Health and Health Equity, said in a conference call.

 The death rate, which is usually calculated as deaths per 1,000 people per year, fell 25 percent for African-Americans during the 17-year period, mostly for those aged 65 and older, the CDC said.

In 2014, life expectancy was 75.6 years for blacks and 79 years for whites, which was an increase since 2000 of 3.8 years for blacks and 1.7 years for whites, the CDC said.
However, the study also said “blacks have the highest death rate and shorter survival rate for all cancers combined compared with whites in the United States.”

The Washington Examiner reports that the Senate Republican majority is working on its own repeal and replace bill that may incorporate parts of the American Health Care Act bill that the House passed this afternoon.  A 12 member work group including members of the three Senate Committees with jurisdiction over healthcare are leading the drafting effort. The group has been meeting for a few weeks and its work has been spurred by the House action. The Wall Street Journal offered a concurring report this evening.

According to the Journal and this comes as no surprise, the Senate will work at its own pace. Of course, both the House and the Senate ultimately must agree to the same bill language in order for the bill to become law. Frequently, a conference committee of the two bodies can resolve disputes on sticky legislation like this in order to push the bill over the finish line. But the Senate has to act next.

The Senate today followed the House of Representatives by passing the $1.1 trillion omnibus appropriations bill that funds the federal government through the end of the current fiscal year on September 30, 2017. The BNA report on the action is here. The President is expected to sign the bill.

Speaker of the House Paul Ryan (R Wisc) finally had the votes today for the House to pass the American Health Care Act (H.R. 1628) by a narrow 217-213 margin.  All of the Democrats and 20 Republicans voted against the bill. (The Republicans have a 22 seat majority in the House; four House seats currently are vacant.) The House Energy and Commerce Committee’s section by section analysis of the bill (only 15 pages) is here.

If this were a Medicaid blog the AHCA discussion would continue at length. But this is the FEHBlog and in the FEHBlog’s view the law would not have a significant effect on the FEHBP.

The bill focuses on reforming Medicaid and attempting to stabilizing the individual market, both heavy lifts. It also lifts the individual and employer mandates and virtually all of the ACA taxes. (The Cadillac tax effective date is pushed back to 2026).  The law leaves the large group market alone. It’s up to the Administration to inject more flexibility in the group market by sensibly loosening ACA regulations and sub-regulatory guidance.

The bill goes over to the Senate now. The bill is structured as a reconciliation measure so that it can be enacted with 51 votes. The Senate Parliamentarian plays a role in determining reconciliation status but the Parliamentarian must report to the Senate leadership. The Republicans have a two seat majority in the Senate so the Republicans could afford to lose two of its own assuming that the Democrats and independents who caucus with the Democrats remain united against the bill. Of course, Vice President Pence is the Senate President who can cast a tie breaking vote.  

Notwithstanding the fact that federal courts blocked two health insurer mega-mergers, hospitals system mega-mergers continue apace according to Modern Healthcare. 

Last night, the Congressional leadership announced a funding deal for the last five months of the current federal government fiscal year.  Here’s a link to the Washington Post’s report.

Congress continues its work on Capitol Hill this week. Here’s a link to the Week in Congress report on last week’s efforts.  The short term continuing resolution funding the federal government expires on Friday May 5.  The House also may vote on the American Health Care Act this week.

The FEHBlog ran across a couple of articles from last week’s Health DataPalooza.  The first article from FCW.com concerns a speech by HHS Secretary Tom Price, and the other from Healthcare IT News concerns a speech by HHS Office for Civil Rights Director Roger Servino. These were their first speeches to the healthcare IT community.

The Wall Street Journal reports that large prescription drug manufacturers are ripping a page out of the Hollywood producer’s playbook by arranging for third party financing of the expensive final stage of their new drug projects — the clinical trials required for FDA approval.  “The drawback: sharing risk also involves sharing the rewards. Such collaborations involve the company in question agreeing to relinquish some of the drug’s profit to its partners.”   This innovation may add more new drugs to the pipeline but the FEHBlog doubts that it will lower the cost curve. 

Also as expected (the act of the deciding, not the outcome), the U.S. Court of Appeals for the D.C. Circuit issued its decision in the Anthem / Cigna merger case. By a 2-1 vote, the panel upheld the lower court decision to block the merger on anti-trust grounds as the Justice Department has sought.  The fate of the merger agreement now lies in the hands of the Delaware chancery court, which will hear Anthem’s motion to block Cigna from terminating the merger agreement on May 8.

Yesterday, the Senate confirmed the President’s nomination of Alexander Acosta to be Secretary of Labor by a 60-38 vote. President Trump’s cabinet finally has been filled. Before long we should have an OPM Director nominee.

The Pharmacy Times reports that Prime Therapeutics, a Blue Cross related prescription benefits manager, and Walgreens recently closed on the formation of “a combined central specialty pharmacy and mail services company, as part of a strategic alliance first announced by the companies last August. The company, AllianceRx Walgreens Prime, is headquartered in Orlando, Fla.”

AllianceRx Walgreens Prime will manage several consolidated mail service and central specialty pharmacy operations. Its workforce of approximately 3,000 employees nationally will be comprised of current Walgreens and Prime employees, including those currently working at the existing Prime location in Orlando. The AllianceRx Walgreens Prime brand will be rolled out in the marketplace over the coming months.
While Prime’s pharmacies will now be part of the combined company, Prime will continue its core function of providing pharmacy benefit management services from its locations in Minnesota, Nebraska, New Mexico and Texas. Similarly, Walgreens will continue to operate its more than 230 specialty pharmacies throughout the U.S., in addition to its retail pharmacies.

Also this week the FEHBlog ran across the website of Amino, Inc.   The company was co-founded by David Vivero, a former executive of Zillow, the online real estate company.  The company’s objective is to provide health care consumers with insights on healthcare pricing and quality at no charge.  The company relies on a database of de-identified medical bills. Interesting.