Tuesday’s Tidbits

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

GEHA, the largest employee organization sponsored plan in the FEHB, has a new President and CEO, Arthur A. Nizza, DSW. According to GEHA’s press release, “Dr. Nizza has more than 25 years of leadership experience in the health care industry and has held senior leadership roles at major integrated delivery systems in the Midwest and Northeast. His experience includes roles as Chief Executive Officer, Chief Operating Officer and Chief Information Officer at for-profit and non-profit companies, academic medical centers and faith-based institutions. Most recently, Nizza served as the Executive Vice President and Chief Operating Officer of UnityPoint Health (UPH) in Des Moines, Iowa.” Good luck, Dr. Nizza.

In the tidbits department for this Tuesday —

  • The Agency for Health Research and Quality issued a study of diagnoses causing U.S. hospitalizations in 2018. For example, “Of the 10 most common principal diagnoses among nonmaternal, nonneonatal inpatient stays in 2018, septicemia was the most frequent and accounted for the highest aggregate costs ($41.5 billion). The mean cost per stay was also higher for septicemia than for the other top 10 conditions, with the exception of acute myocardial infarction (AMI).” Healthline explains that “Septicemia is a serious bloodstream infection. It’s also known as blood poisoning. Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream. This is dangerous because the bacteria and their toxins can be carried through the bloodstream to your entire body. Septicemia can quickly become life-threatening. It must be treated in a hospital. If left untreated, septicemia can progress to sepsis.
  • Becker’s Hospital review tells us that “The pandemic led to a dip in emergency room visits, and the numbers may not recover, UnitedHealth CEO Andrew Witty said during the company’s July 15 earnings call. * * *While still speculative, Mr. Witty said urgent care centers may see the patients who turned away from the emergency room.”
  • The National Institutes of Health (NIH) informs us at a glance that “By combining parts of spike proteins from different coronaviruses, researchers developed an mRNA vaccine that protected mice against a range of coronaviruses. The results point the way toward a universal coronavirus vaccine that could prevent future pandemics.” Keep hope alive.
  • NIH Director Dr. Francis Collins discusses in his weekly blog research into genetic reasons for a person’s susceptibility to COVID-19 illnesses and more specifically to severe COVID-19 illnesses.
  • The Drug Channels blog discusses the state of the 340B program market in our country. According to HRSA, the HHS agency that runs the 340B program,

The 340B Program enables covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

  • Drug Channels observes that “The 340B Drug Pricing Program continues to expand far more quickly than the overall pharmaceutical market—and some channels are benefiting more than others. [M]ail and specialty pharmacies’ purchases of products that are eligible for 340B discounts have grown by an incredible 56% per year since 2017. That’s about six times faster than the overall mail and specialty market. 

No Surprises Thursday

Photo by Josh Mills on Unsplash

The federal regulators, including the Office of Personnel Management, achieved their statutory deadline today for issuing the first round of No Surprises Act implementing rules. Here’s the regulators’ output, compliments of the Labor Department:

There is no doubt in the FEHBlog’s mind that the regulators did a fine job of making a silk purse out of sow’s ear / the poorly drafted statute. This rule will help carriers and providers meet the January 1, 2022, launch date. This law, if properly implemented, and signs are looking good now, will protect consumers from surprise medical bills, which was clearly Congress’s objective, but without creating an IT nightmare.

The regulators plan a second round of No Surprises Act rules for October 1, 2021. The second round will focus on the independent dispute resolution process.

From the COVID-19 front —

  • The New York Times reports that “The Johnson & Johnson coronavirus vaccine is effective against the highly contagious Delta variant, even eight months after inoculation, the company reported on Thursday — a finding that should reassure the 11 million Americans who have gotten the shot. The vaccine showed a small drop in potency against the variant, compared with its effectiveness against the original virus, the company said. But the vaccine was more effective against the Delta variant than the Beta variant, first identified in South Africa — the pattern also seen with mRNA vaccines.”
  • Medscape informs us that “The White House on Thursday announced it will send “strike teams” to 1000 counties where the COVID-19 Delta variant is spreading rapidly. The teams will be made up of health and logistics experts from several federal agencies and will conduct coronavirus testing, distribute medicines designed to fight the virus, and boost local and state efforts to increase vaccinations.”

In Thursday Miscellany —

  • GoodRx is tracking prescription drug manufacturer price changes which typically are made effecting January 1 and July 1.
  • The Centers for Medicare and Medicaid Services “is proposing actions that aim to close health equity gaps by providing Medicare patients battling End-Stage Renal Disease (ESRD) with greater access to care, through the ESRD Prospective Payment System (PPS) annual rulemaking. This proposed rule would update ESRD PPS payment rates, make changes to the ESRD Quality Incentive Program (QIP), and modify the ESRD Treatment Choices (ETC) Model.  The proposed changes to the ETC Model policies would aim to encourage dialysis providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model the agency’s first CMS Innovation Center model to directly address health equity.”
  • The Aetna Foundation and U.S. News and World Report released their 2021 healthiest U.S. communities rankings this week.

2021 Healthiest Communities- Top 10

*See the full rankings here

Top 10 Counties

  1. Los Alamos County, New Mexico
  2. Douglas County, Colorado
  3. Falls Church, Virginia
  4. Loudoun County, Virginia
  5. Broomfield County, Colorado
  6. San Miguel County, Colorado
  7. Pitkin County, Colorado
  8. Howard County, Maryland
  9. Morgan County, Utah
  10. Routt County, Colorado

2021 Key Measures

Top 5 Communities for Health Outcomes

  1. San Juan County, Washington
  2. Marin County, California
  3. Carver County, Minnesota
  4. Stevens County, Minnesota
  5. Hunterdon County, New Jersey

Top 5 Communities for Access to Health Care

  1. Olmsted County, Minnesota
  2. Montour County, Pennsylvania
  3. Suffolk County, Massachusetts
  4. Johnson County, Iowa
  5. Perry County, Kentucky

Top 5 Communities for Mental Health

  1. Honolulu County, Hawaii
  2. Pitkin County, Colorado
  3. Fairfax County, Virginia
  4. Santa Clara County, California
  5. San Mateo, California

Memorial Day Weekend update

Thanks to Justin Casey for sharing their work on Unsplash.

Congress is on a State / district work break this coming week. The Supreme Court has over thirty cases to decide, including the latest Affordable Care Act constitutionality case, before adjourning for the summer in late June / early July.

The federal employee news organizations have highlighted portions of the President’s fiscal year 2022 budget proposal which was released last Friday.

  • The Federal Times reports that “President Joe Biden’s fiscal year 2022 budget anticipates a more than 50,000 full-time-equivalent employee increase to the federal payrolls next year, as part of concerted efforts to attract young and expert workers to federal service. * * * ‘The Federal workforce continues to become older on average. Almost 30 percent (635,397) of employees are older than 55, while 8.1 percent (176,805) of employees are younger than 30. By comparison, in the private sector, 23 percent of the workforce is younger than 30. Every single agency has fewer employees younger than 30 today than they had in 2010,’ the budget proposal’s analytical perspectives state.
  • Govexec informs us that “President Biden on Friday formally proposed an average 2.7% pay increase for federal civilian employees in 2022 as part of his fiscal 2022 budget proposal. * * * It was unclear Friday how Biden’s proposal would be divvied up between an across-the-board boost to basic pay and increases in locality pay. In recent years, pay raise provisions have included a 0.5% average increase in locality pay, although it was frozen at 2020 levels this year. * * * The proposal also marks a return to the principle of pay parity between the civilian and military workforce, as service members would also receive a 2.7% pay raise in 2022. 

Federal News Network offers three brief stories on the U.S. Postal Service

The Postal Service sent its first reduction in force notices to non-union management employees Friday [no indication of how many notices were sent out], and is planning to set higher prices on its mail products well above the rate of inflation [first class stamp would increase by 5% from 55 cents to 58 cents].

The Senate, meanwhile, voted [by unanimous consent] to confirm [Anton Hajjar] President Joe Biden’s third nominee to serve on the USPS Board of Governors. The board is now fully staffed for the first time since 2010, and will help the agency get its 10-year reform plan off the ground.

Thus the Senate has confirmed all three of the President’s Postal Governor nominees who shared a confirmation hearing with OPM Director Kiran Ahuja while Ms. Ahuja waits for a confirmation vote.

In healthcare news —

  • Bloomberg tells us that “The U.S. reported the lowest level of infection since the early days of the pandemic and welcomed back sports fans to stadiums. The Indianapolis 500 was run before 135,000 fans, the largest crowd for a sporting event since the pandemic began [but 1/3 of capacity].  * * * The world needs the cooperation of the Chinese government to trace the origins of Covid-19 and prevent future pandemic threats, two leading U.S. disease experts said Sunday.
  • NPR reports that “For children in particular, the risk of serious consequences from COVID-19 is the same magnitude as the risk they face from the flu, she says. But many parents seem more worried about the new and less familiar disease. * * * [E]xperts urge parents to try not to worry too much.
  • Because many FEHB plans provide hypertensive members with at home blood pressure monitor, the FEHBlog wants to share the American Medical Association’s views on what doctors wish their patients knew about home blood pressure measurement.

Finally, the FEHBlog’s eyes were drawn to the weekend Wall Street Journal’s Heard on the Street column which discusses the efforts of Walmart and Amazon to enter the healthcare business.

Weekend update

FEHBlog opening note — The FEHBlog goofed by posting this May 7 COVID-19 charts in the May 14 Friday Stats and More post. The FEHBlog corrected his error on Saturday after the Friday post email went out. You can check out the website if you want to see the May 14 charts which are encouraging. In contrast, check out the Wall Street Journal’s charts on the COVID-19 situation in India which is still struggling with virus. Whereas 37% of the U.S. population is fully vaccinated, less than 5% of the much larger and younger Indian population has reached that status. In this regard, the Rome (N.Y.) Sentinel offers an Excellus Blue Cross consulting pharmacist’s valuable guidance on why people in the age 18 to 34 bracket should received the COVID vaccination.

Q: Katie [Abbott, Pharm.D.], you are in that age group. Why did you choose to get vaccinated? 

I trust the science behind the vaccines and believe they will help bring us back to how life was before the pandemic.

Q: Some, or most cases of COVID-19 in younger people are not severe. Why would a younger person get vaccinated if younger people aren’t really dying from COVID-19?

The younger population may not be seeing as many severe cases or deaths, but they are still at high risk of long COVID. Long COVID is when those who have recovered from COVID-19 experience lasting effects, including a range of symptoms such as fatigue, brain fog, chest pain, shortness of breath, cough, joint or muscle pain, depression, anxiety, and so much more. Long COVID can develop weeks or months after infection. It can happen to anyone who has had COVID, even if they had mild or no symptoms. Getting the vaccine remains a safe way to protect yourself, along with your community, family members, and those who cannot be vaccinated.

Returning to the regular weekend update, both Congress will be in session this week for Committee work and House and Senate floor votes. The House Oversight and Reform Committee will hold its third recent hearing on prescription drug costs on Tuesday morning. It’s worth noting that although the House Oversight and Reform Committee approved the Postal Reform bill (HR 3076) last week, the House Energy and Commerce and Ways and Means Committees also have jurisdiction over the bill. So we don’t know right now, when the bill may reach the House floor.

In OPM news, the Federal Times reports that

In anticipation of more employees returning to the office and in the spirit of May’s Mental Health Awareness Month, the Office of Personnel Management issued a tip sheet for agency human resource staff to better support employees at a vulnerable time. * * * In addition to communicating with employees about the usual resources available to them – such as the Employee Assistance Program and mental health treatments offered through Federal Employee Health Benefit plans – OPM encouraged agency work-life coordinators and HR professionals to be as communicative as possible about office safety procedures and available work schedule adjustments to ease any potential employee anxiety.

In other healthcare news,

  • mHealth Intelligence discusses the work of University of West Virginia researchers who are seeking to determine the best mix of in-person and virtual care. “With telehealth use skyrocketing over the past year and a half due to the coronavirus pandemic, some have wondered if there’s a limit to its effectiveness. Is there a certain number of virtual visits that a patient – especially one with a chronic condition – should get, after which the technology outlasts its value? The answer, according the researchers at the University of West Virginia, is … uncertain.” While that outcome is surprising to the FEHBlog, the researchers have gone back to the drawing board.
  • Fierce Healthcare reports that “GoodRx, a telehealth and drug-pricing comparison software company, acquired competitor RxSaver for $50 million in cash. The company closed the deal in late April, GoodRx reported during its first-quarter 2021 earnings call Thursday. RxSaver, which was owned by Vericast Corp., the payment and marketing company controlled by billionaire Ronald Perelman, operates a price comparison platform to provide discount offerings through partnerships with pharmacy benefit managers (PBMs). The acquisition will expand GoodRx’s business capabilities and consumer reach, particularly with respect to its prescription offering, the company said in its first-quarter 2021 earnings report.”
  • Health Payer Intelligence informs us that ” To help combat racial care disparities in communities of color, Blue Shield of California (Blue Shield) provided $300,000 to 12 different nonprofit organizations in California that promote the mental health and well-being of youths in their communities.   This act supports the health equity strategy of Blue Cross Blue Shield Association (BCBSA), Blue Shield’s parent company, as it seeks to improve racial care disparities by collaborating with local community leaders. By contributing $25,000 to each organization, Blue Shield is providing opportunities for youths of color that can improve their mental health.”
  •  Healthcare Dive reports that “Piedmont Healthcare signed a non-binding letter of intent to acquire Augusta, Georgia-based University Health Care System, which operates three hospitals as well as skilled nursing facilities and urgent care clinics along Georgia’s eastern border with South Carolina. * * * Just last week, the 11-hospital system announced plans to buy four additional hospitals from HCA Healthcare for $950 million. The sale is expected to close in the third quarter of this year. The hospitals in the HCA deal circle the outskirts of the Atlanta region. * * * Altogether, the two most recent deals would give Piedmont a total of 18 hospitals in Georgia, in addition to more ancillary services.” Healthcare Dive adds that the two deals are likely to face regulatory scrutiny.

Weekend update

Photo by Michele Orallo on Unsplash

Happy Mothers’ Day.

Congress will be engaged in Committee business and floor votes for the next two weeks. The Hill reports on what we can expect from Congress in the near term.

From the COVID-19 front, Bloomberg informs us that

The share of U.S. hospital beds occupied by Covid-19 patients fell to 5.37%, the lowest since Oct. 5, according to the U.S. Department of Health & Human Services. Michigan had the biggest percentage of beds occupied by Covid patients at 13.3% followed by Maryland at 10.8%, according to the latest HHS data, which reflect the situation on Thursday. Florida had 3,504 hospitalized Covid patients, the most of any state, followed by Texas with 3,080.

The U.S. added fewer than 35,000 cases on Saturday, sending the seven-day rolling average of new infections to the lowest since the end of September. While reporting often lags on weekends, the data collected by Johns Hopkins University and Bloomberg is the latest sign that the pandemic in America is easing.

Another 625 people nationwide died of Covid-19, bringing the toll to more than 581,000 since the outbreak began. Detroit and New York City had the most deaths per capita among major metro areas in the week through Wednesday, according to a Centers for Disease Control and Prevention report dated May 6.

According to the CDC’s website, nearly 7.5 million doses of COVID-19 vaccine were administered over the past three days. Approximately 43% of the U.S. population over age 18 and 71% of that population over age 65 is fully vaccinated against COVID-19. All of these facts are clearly related.

Govexec reports on the Postal Service’s first quarter 2021 financial results.

USPS lost just $82 million in the second quarter of fiscal 2021, a marked improvement over the same quarter the previous year. When excluding inflationary adjustments to the agency’s workers’ compensation liabilities that are outside of management’s control, however, the agency experienced $1.7 billion in losses from January through March compared to $1.9 billion in that period of fiscal 2020. 

Total revenue jumped 6% over the same period last year, led by a 34% spike in package business. The shift from regular mail—where plummeting volume persisted—to packages continued to add costs to the postal system, as packages entail additional personnel and transportation costs. * * *

The Postal Service’s costs jumped by 4% in the most recent quarter, which management attributed to package delivery and paid leave related to the pandemic. The agency’s total net loss of $82 million was down from $4.5 billion in the same period last year. 

Joe Corbett, the USPS chief financial officer, speculated the agency would break even by fiscal 2023 or fiscal 2024, provided DeJoy’s plan is implemented. USPS is relying in large part on Congress to pass reforms that would remove much of its liabilities for retiree health care costs from its balance sheets.  

Fredric Rolando, president of the National Association of Letters Carriers, said the postal revenue increases demonstrate those retiree health care reforms are the primary change needed.  The uptick in business drives home “how much the American people and their businesses rely on the essential work of the Postal Service,” Rolando said

If the the Postal Service’s healthcare reforms would save money and the Medicare Part D integration would create a gusher of savings, why not just apply those reforms across the entire FEHB which would avoid the additional administrative cost of creating a new Postal Service Health Benefits Program within the FEHB Program?

Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

Today is the first day of National Nurse’s Week. The well-deserved celebration begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday. What a marvelous profession.

Meanwhile Healthcare Dive reports that

  • Last year marked a historic shift in the organization of medicine, with fewer than half of U.S. doctors working in a private practice, according to the latest American Medical Association Physician Practice Benchmark Survey. And among those private practices that continue to operate, many are trending toward a larger size.
  • According to the report, 50.2% of physicians were employees, up from 47.4% in 2018 and 41.8% in 2012. The proportion of doctors working in a private practice was 49.1% last year.
  • Hospitals are one of the largest employers of physicians, with the proportion increasing nearly 50% between 2012 and last year. And with the vast majority of doctors under the age of 40 now employees rather than employers, it suggests the trend will continue over the long term.

The Raleigh (NC) News-Observer reports that

CVS [Health] announced Wednesday it’s joining the list of pharmacies offering people the coronavirus vaccine without requiring an appointment, spokesperson Matt Blanchette told McClatchy News. Same-day scheduling as soon as one hour ahead of time is also available.  Walk-ins are available at 8,300 CVS locations across the country, Blanchette said. The company has more than 9,900 locations across 49 states, Washington, D.C., and Puerto Rico. 

The New York Times adds that “Chains like Walmart, Walgreens, Safeway and Stop & Shop have said that they are now offering vaccines to walk-in clients at some locations or in mobile clinics. Other pharmacies preceded the president’s announcement. Rite Aid said that it would accommodate walk-ins on a limited basis last week, for example.” Let’s go.

Forbes reports that Pfizer-Biontech and Moderna will apply for full FDA marketing approval of their respective COVID-19 vaccines later this month.

The FDA authorized the Moderna vaccine under an EUA on Dec. 18, after granting the same authorization to the Pfizer Covid-19 vaccine. The FDA can grant emergency use authorizations when a panel of experts determine the “known and potential benefits outweigh the known and potential risks,” and when the secretary of Health and Human Services determines a health crisis deems emergency use of unapproved products “appropriate.” Pfizer announced Monday it would file for full FDA approval, and it’s likely Johnson & Johnson, manufacturers of the only other Covid-19 vaccine authorized for emergency use in the U.S., will file for full FDA approval as well. Emergency use authorizations can be revoked when public health crises subside, and FDA approval would allow companies, like Moderna and Pfizer, to directly market their vaccines to consumers. 

FLASH: Politico reports that Pfizer/BioNTech applied for full FDA approval on Friday May 7.

Errata: The FEHBlog included in a post last month an erroneous report that Moderna had filed for FDA approval. He had understood that the application was overdue. Whoops.

Forbes further informs us

Moderna announced Wednesday its booster shot showed a positive immune response against the Covid-19 variants found in South Africa and Brazil. Moderna is testing booster shots in individuals who already received their two-dose Moderna vaccine regimen. [Moderna CEO Stephane] Bancel has said he expects booster shots will be necessary, and Pfizer CEO Albert Bourla said it’s “likely” vaccinated individuals will need a booster within a year of being fully vaccinated. 

From the healthcare business front —

  • According to the Wall Street JournalWalmart Inc. said Thursday it purchased telehealth provider MeMD and plans to offer nationwide virtual healthcare services, another sign of the retail behemoth’s healthcare ambitions. The acquisition will allow Walmart to expand its Walmart Health service around the country, the company said. The retail giant didn’t disclose the financial details of the transaction.
  • The Journal further reports that ‘The MeMD deal opens another front in which Walmart and Amazon will compete, as Amazon recently announced plans to provide its telehealth service, Amazon Care, to its nearly 1 million U.S. employees by summer. Amazon Care, which now serves company workers in Washington state, will also be offered to other employers.” STAT News informs us that “Amazon Care signed its first enterprise customer this week, a significant milestone as the virtual-first health care platform looks to expand its footprint. The client, Precor, is a fitness business that was recently acquired by fitness technology company Peloton for $420 million in cash. Although small financially, the deal is a significant opener for Care.”
  • Healthcare Dive adds that “Nearly two out of three healthcare leaders say they’re currently prioritizing investment in telehealth as the pandemic continues, but that could change over the next few years, when investing in artificial intelligence shoots up the list of priorities, according to a new report from health tech giant Philips.”

Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

Govexec reports that “the Senate voted 81-13 on Tuesday to confirm Jason Miller to be deputy director for management for the Office of Management and Budget. Miller is a former Obama administration economic adviser and most recently a nonresident senior fellow at the Brookings Institution and CEO of the Greater Washington Partnership, a nonprofit civic alliance.”

Julie Appleby of Kaiser Health News writes on the gradual rollback of COVID-19 treatment coverage with no member cost sharing in 2021.

Anthem, for example, stopped them at the end of January. UnitedHealth, another of the nation’s largest insurers, began rolling back waivers in the fall, finishing up by the end of March. Deductible-free inpatient treatment for covid through Aetna expired Feb. 28.

A few insurers continue to forgo patient cost-sharing in some types of policies. Humana, for example, has left the cost-sharing waiver in place for Medicare Advantage members, but dropped it on Jan. 1 for those in job-based group plans.

Not all are making the changes.

For example, Premera Blue Cross in Washington and Sharp Health Plan in California have extended treatment cost waivers through June. Kaiser Permanente said it is keeping its program in place for members diagnosed with covid and has not set an end date. Meanwhile, UPMC in Pittsburgh planned to continue to waive all copayments and deductibles for in-network treatment through April 20.

 Healthcare Dive reports

U.S. hospitals continue to struggle under the ongoing weight of the pandemic and its financial pressure, reporting a mixed performance in March, according to a new report from Kaufman Hall.

Volumes continued to decline, while revenues and expenses generally rose compared to the same time last year. Margins increased on both a year-to-date and year-over-year basis, but that’s largely due to measuring performance this year with last March, when hospitals were hit hard by the effects of state lockdowns and a pause in non-essential procedures, the consultancy said.

Researchers expect continued margin and revenue gains in the next few months, especially in comparison to record-poor performance in the first few months last year. Some gains are due to returning patient volumes, but the report warns the impacts of COVID-19 on providers are far from over.

Here is a link to today’s Centers for Disease Control’s “Interim Public Health Recommendations for Fully Vaccinated People.” The AP reports that “Some experts portrayed the relaxed guidance as a reward and a motivator for more people to get vaccinated — a message President Joe Biden sounded, too.” The FEHBlog honestly see the new guidance as too complicated and he will maintain his current mask wearing practices for a couple more months.

From the government contracting front

  • Here is a link to the President’s executive order raising the minimum wage on federal contracts for services and construction to $15 per hour. FEHB contracts do not fall into these classifications in the FEHBlog’s opinion.
  • The Equal Employment Opportunity Commission is revving up the EEO-1 reporting process. “The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees, and federal contractors with 50 or more employees meeting certain criteria, to submit demographic workforce data, including data by race/ethnicity, sex and job categories. * * * After delaying the opening of the 2019 EEO-1 Component 1 data collection because of the COVID-19 public health emergency, the EEOC has announced that the 2019 and 2020 EEO-1 Component 1 data collection is NOW OPEN.  Eligible employers have until Monday, July 19, 2021 to submit two years of data.”

OPM Director Hearing / End of the Carrier Conference / Thursday Miscellany

The virtual OPM AHIP FEHB Carrier Conference ended today. For a good chunk of the conference, Kiran Ahuja, the President’s nominee for OPM Director contemporaneously had her confirmation hearing before the Senate Homeland and Government Security Committee. Here are the Federal Times, Govexec , and Federal News Network articles on that hearing which reportedly went smoothly for the nominee.

At the carrier conference today, the FEHBlog learned about the many things including the following:

  • The Blue Cross Blue Shield Association has released a strategy to help bring about healthcare equity. “The strategy is centered around improving racial health disparities in maternal health, behavioral health, diabetes, and cardiovascular conditions [by] “measuring racial health disparities, forming community and clinical partnerships, scaling effective programs, and influencing local and federal policy decisions.”
  • The American Pharmacists Association has produced a report on promising practices for pharmacist engagement in tobacco cessation interventions. 
  • OPM now has a list of documentation that enrollees must furnish to the employing office or the FEHB carrier to verify family member eligibility in FEHB.

Thanks OPM and AHIP for a great conference.

In Thursday Miscellany —

  • As promised here is a link to the Internal Revenue Service guidance making “tax credits [available to certain employers] for providing paid leave to employees who take time off related to COVID-19 vaccinations.
  • The AP reports on encouraging “new data reassuring for COVID-19 vaccination in pregnancy.”
  • The Secretary of Health and Human Services has extended the COVID-19 public health emergency for another 90 days from yesterday.
  • The American Hospital Association is touting Hospital-at-Home Innovation During COVID-19 and Beyond. “What was once a small but mighty contingent of health care systems providing “hospital-at-home” care before the pandemic has grown into a larger movement. With this model, hospitals across the country are “admitting” patients to their own homes for acute care with excellent results. As highlighted in AHA’s recent issue brief on hospital-at-home, patients receiving this care have a 20% reduction in mortality, were three times less likely to be admitted to an emergency department than usual care patients and have higher satisfaction with their care. And these results are achieved at a 25% lower cost of care.”
  • Fierce Healthcare reports that [Blue Cross licensee] Highmark Health and ChristianaCare are launching a new joint venture that aims to harness data to accelerate value-based, equitable care. The joint company, which has yet to be named, will take advantage of the strengths of both companies to drive toward more accessible and affordable care. Karen Hanlon, chief operating officer at Highmark Health, said on a call with reporters Wednesday that the venture aims to disrupt the traditional dynamic between payers and providers for greater collaboration.” Here’s hoping.
  • AHIMA reports that the ICD-10 coding authorities are considering releasing new codes for October 1, 2021 (as usual) and April 1, 2022 (special supplement.)

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

Fedweek reports that

A Senate [Homeland Security and Governmental Affairs] Committee hearing is set for Thursday April 22 [at 10:15 am] on Kiran Ahuja’s nomination to become OPM director, potentially setting the stage for her confirmation in the near future.

No opposition has emerged to Ahuja, who was OPM’s chief of staff for part of the Obama administration and who most recently led the Biden transition team for the agency. She also has experience as a Justice Department attorney and with the White House Initiative on Asian Americans and Pacific Islanders under Obama, among other roles.

The FEHB Carrier Conference’s keynote speaker today was Dr. Garth Graham who spoke on social determinants of health issues. Dr. Graham who is Director and Global Head of Healthcare and Public Health at Google/YouTube published a 2018 study finding that

In this cohort study of 6402 patients from 2 acute myocardial infarction registries, self-identified black patients and white patients differed in several clinical and socioeconomic characteristics. The higher the prevalence of characteristics associated with being a black patient, the higher the 5-year mortality rate, but no differences were observed between black patients and white patients with similar characteristics.

These findings illustrate social determinants of health concerns in a nutshell. MedCity News discusses how healthcare providers and payers are addressing these concerns.

Another speaker Dr. Mark Fendrick from the University of Michigan discussed value based insurance design which focuses on paying more for high value care by identifying and excluding low value care.

The alignment of clinically nuanced, provider- facing and consumer engagement initiatives is a necessary and critical step to improve quality of care, enhance patient experience, and contain cost growth.

That’s easier said than done, but you have to start somewhere as OPM points out in its 2022 call letter.

In COVID-19 tidbits

  • ABC News reports that as of yesterday, “All adults in the United States are eligible for COVID-19 vaccines starting Monday, with all 50 states and Washington, D.C., meeting the April 19 deadline President Joe Biden had set for opening eligibility.” The minimum age for the Pfizer vaccine is 16 years old. The minimum age for the Moderna and currently paused Johnson and Johnson vaccine is 18 years old.
  • STAT News informs us about the “many key questions about SARS-2 and the disease it causes, Covid-19, [that] continue to bedevil scientists.” “There was surprising diversity in the questions, though many cluster around certain themes, such as the nature of immunity or the impact of viral variants. Knowing what scientists still want to learn shows us how far we’ve come — and how far we have left to go to solve the mysteries of SARS-2 and Covid-19.”

In telehealth tidbits:

  • More news comes out of last week’s United Healthcare first quarter 2021 earnings report. Becker’s Hospital News reports that “UnitedHealth Group subsidiary Optum has deployed a new telehealth product across all 50 states, company leaders said April 15. The new virtual care product, dubbed Optum Virtual Care, is now live in all 50 states, said OptumHealth CEO Wyatt Decker during UnitedHealth Group’s Q1 2021 earnings call transcript, which was transcribed by the Motley Fool. With the new offering, Optum aims to integrate physical care, virtual care, home care and behavioral care. Optum Virtual Care offers virtual health services but also, if necessary, can connect patients to a bricks-and-mortar facility for more complex care or identifying and triaging both physical and behavioral healthcare needs, Mr. Decker said.
  • Fierce Healthcare reports that “Cigna’s Evernorth has completed its acquisition of virtual care provider MDLive. Cigna first announced the deal in late February, with the expectation it would close in the second quarter. The deal, the insurer said, will enhance the Evernorth subsidiary’s efforts to lower healthcare costs.
  • The upshot of the FEHB Carrier Conference’s discussion of telehealth today was that health plan payments for virtual care should reflect the quality and efficacy of care relative to in-person care. For example, the Insurance Journal reports that

Published in the April issue of Health Affairs, the [University of Michigan] study finds that patients who had an on-demand virtual care visit for an upper respiratory infection in the three years before the pandemic began were slightly more likely to receive additional follow-up care than similar patients who had their first visit in person.

The study compared data from more than 28,700 virtual visits with data from more than 57,400 in-person visits for acute respiratory infections in 2016 through 2019. Those visits, and any follow-up care, were all covered by a large insurer. All the virtual visits were done through a direct-to-consumer telehealth company with which the insurer had partnered.

The authors say it’s important to note that the vast majority of the patients did not require any further care for their infections, which included ear infections, bronchitis, laryngitis, sore throat and pneumonia.

But 10.3% of the patients first seen through a direct-to-consumer telehealth visit ended up having an in-person visit in the next week, compared with 5.9% of those who had their first visit in person. This includes second telemedicine visits or visits to clinics, urgent care centers and emergency rooms.

In other tidbits, Healthcare Dive discusses what to watch as public traded providers and payers report their first quarter 2021 results and CVS Health announced a new joint CVS Health / Aetna benefit design.

The Pause plus Tuesday Tidbits

Photo by Patrick Fore on Unsplash

Here is a link to the joint Food and Drug Administration / Centers for Disease Control statement on the recommended pause in administration of the Johnson and Johnson single dose COVID-19 vaccine that the agencies issued this morning. Becker’s Hospital Review reports that pharmacies and State governments administering the vaccine have implemented this recommendation.

Next steps —

CDC will convene a meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday to further review these cases and assess their potential significance. FDA will review that analysis as it also investigates these [six] cases. Until that process is complete, we are recommending a pause in the use of this vaccine out of an abundance of caution. This is important, in part, to ensure that the health care provider community is aware of the potential for these adverse events and can plan for proper recognition and management due to the unique treatment required with this type of blood clot.

STAT News adds

Experts applauded the decision as the right thing to do.

“The pause is a prudent step to take, because when very serious adverse events occur that are also very rare, what matters most is ‘very serious,’” said John Moore, an immunologist at Weill Cornell Medicine. “Not only are individual members of the public at some risk, but so is the wider confidence in the Covid-19 vaccines.”

“It’s a reasonable but unproven assumption that the J&J and AstraZeneca vaccine safety concerns are linked by being related to an immune response against an adenovirus component,” he said. “So, FDA and scientists need time to better understand what is going on, which means a pause is the right course of action.”

And now for the tidbits

  • Modern Healthcare reports that the House today joined the Senate in delaying otherwise required 2% cuts in Medicare payments for the remainder of 2021. The means that CMS will be giving the Medicare Administrative Contracts its approval to resume paying Medicare claims once the President signs the bill into law.
  • Healthcare Dive reports that “Salt Lake City-based Intermountain [which sponsors an FEHB HMO] is acquiring air ambulance company Classic Air Medical in a bid to better coordinate virtual and physical care for rural patients. Snapping up Classic, which operates aircraft in eight western states and has a significant overlap with Intermountain’s telehealth footprint, is meant to make it easier to transport high-need patients to the closest medical facility equipped for their needs, the nonprofit system said in a Monday statement.”
  • The Department of Health and Human Services “have published several new resources to help states, vaccination providers, and others leading COVID-19 response activities improve access to vaccines for people with disabilities and older adults. These resources clarify legal requirements, illustrate some of the barriers to vaccine access faced by people with disabilities and older people, and provide strategies – and examples of how the aging and disability network can help employ them – to ensure accessibility.”
  • FedSmith explains “the Difference Between Postponed and Deferred FERS Retirement While postponed and deferred retirement sound similar, there are big differences for FERS federal employees who retire early with these options.” You only receive lifetime FEHB coverage in retirement with a postponed FERS retirement.
  • The trade association of prescription drug manufacturers Phrma has launched a new public relations campaign about its patient centered agenda while the Campaign for Sustainable Rx Prices “launched [its own] campaign Tuesday encouraging policymakers to act on campaign promises to hold Big Pharma accountable and lower prescription drug prices.” And so it goes.