Fedweek reports that the OPM Inspector General has issued a report on FEHBP dependent eligibility issues. While the FEHBlog cannot locate it online, Fedweek informs us that the Inspector General

recommended that agency benefit officers verify the FEHB eligibility of dependents at the time of initial enrollment and when a family member is added to coverage by collecting and maintaining documentation such as proof of birth and marriage certificates. OPM would “need to work with its partners (agencies, payroll offices, carriers) to develop and implement a system to verify and maintain supporting eligibility documentation to reduce the aforementioned issues related to unentitled FEHB enrollments,” it said.

About five years ago, OPM added a clause to the standard FEHBP contracts requiring carriers to share the cost of dependent eligibility audits. However, those audits have not yet materialized. In any event, the FEHBlog agrees with the Inspector General’s approach.

Centene which owns an FEHB carrier Health Net closed on its acquisition of Wellcare, which among other things is a Medicare Part D (prescription drug) carrier according to a Healthcare Dive report. “The blockbuster acquisition will make Centene the country’s third-largest publicly traded managed care company and double its Medicare footprint.”

The Centers for Disease Control advises that

the second infection with 2019 Novel Coronavirus (2019-nCoV) in the United States has been detected in Illinois. The patient recently returned from Wuhan, China, where an outbreak of respiratory illness caused by this novel coronavirus has been ongoing since December 2019.

The CDC announcement explains the appropriate steps that the agency is taking to prepare for the disease. Kaiser Health News reminds us

There’s a deadly virus spreading from state to state. It preys on the most vulnerable, striking the sick and the old without mercy. In just the past few months, it has claimed the lives of at least 39 children.

The virus is influenza, and it poses a far greater threat to Americans than the coronavirus from China that has made headlines around the world.

“When we think about the relative danger of this new coronavirus and influenza, there’s just no comparison,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center.

Quite true.


The Supreme Court accepted an Affordable Care Act case for review this afternoon but it was not the one that the FEHBlog has been tracking. The Court granted “cert” in a scope of the contraceptive mandate case (No.s 19-431 and 19-454). The FEHBlog will keep an eye out for action the Texas v. United States case (No. 19-840) over the law’s constitutionality.

The Centers for Disease Control issued a report yesterday on adult physical inactivity prevalence by state and race / ethnicity. .

All states and territories had more than 15% of adults who were physically inactive.

In 4 states (Colorado, Washington, Utah, and Oregon) and the District of Columbia, 15% to less than 20% of adults were physically inactive.

In 24 states, 20% to less than 25% of adults were physically inactive.

In 15 states, 25% to less than 30% of adults were physically inactive.

In 7 states (Tennessee, Oklahoma, Louisiana, Alabama, Kentucky, Arkansas, and Mississippi), and 2 US territories (Puerto Rico, and Guam), 30% or more of adults were physically inactive.

The South (28.0%) had the highest prevalence of physical inactivity, followed by the Northeast (25.6%), Midwest (25.0%), and the West (20.5%).

Ruh roh

Govexec reports that early this month the Postmaster General Megan Brennan has delayed her retirement past the scheduled January 31, 2020 date in order to allow the Postal Service authorities more time to appoint her successor.

Thursday Miscellany

As the JP Morgan healthcare conference closes, Fierce Healthcare’s reports provide a summary of the highlights.

Employee Benefit News informs us about how CVS Health is leveraging its Aetna acquisition to make gene therapies more affordable to patients.

Healthcare Dive reports that the federal government has today released for public comment a health information technology roadmap for the next five years.

The plan will act as a blueprint for federal agencies like the Department of Defense and the Department of Veteran’s Affairs, along with private sector partners, as they work to make it easier for patients to electronically access health data. Much of the plan focuses on proliferating standardized application programming interfaces and stimulating a new “app economy” in healthcare.

Health Payer Intelligence discusses about a new “path forward” for mental health care.

Launched in November 2019 by the National Alliance of Healthcare Purchaser Coalitions (NAHPC), along with other healthcare partners, the Path Forward for Mental Health and Substance Use initiative aims to strengthen mental health parity through stakeholder collaboration.

“What we have developed is an approach that is thoughtful and comprehensive in terms of how we need to approach rebuilding a health system that can support people with mental health and substance use,” says Michael Thompson, NAHPC president and chief executive officer. 

“It’s basically about making sure that we are taking the same rigor in the treatment of mental health as we would with any other health condition collaborative care, which is providing better support and improving the treatment that is provided through primary care physicians and telebehavioral health.”

Midweek update

Fierce Healthcare reporters update us on day 3 of the JP Morgan healthcare conference. CMS Administrator Seema Verma was today’s principal speaker.

Today, about a half dozen groups submitted friends of the court briefs in support of the parties seeking immediate Supreme Court review of the 5th Circuit’s decision on ACA constitutionality. The FEHBlog was impressed by the America’s Health Insurance Plan’s amicus brief.

Over the course of nearly a decade, the ACA has fundamentally reshaped the nation’s health care system. Congress in 2017 chose not to disturb that paradigm shift—including the promise of affordable coverage for those with preexisting conditions—when defanging the individual mandate without repealing any other part of the ACA. Invalidation of the entire ACA would flout Congress’s manifest intent, with profound consequences for our health care system and the hundreds of millions of people it serves. This Court should grant certiorari now to make clear that even if the individual mandate falls, the balance of the ACA will remain in force.


Federal News Network reports that the U.S. Postal Service released to the public their five year strategic plan today. The sooner that Congress considers this report and the legislative issues it raises, and other stakeholder views, the better.

Reg Jones in FedWeek explains in FedWeek on whether deferred and postponed federal annuitants are eligible for FEHBP coverage in retirement. It turns out that postponed annuitants (a CERS feature) can pick up FEHBP coverage in retirement but deferred annuitants (CSRS and FERS feature) cannot.

Tuesday Tidbits

Fierce Healthcare’s reporters fill us in on the day 2 doings at the JP Morgan healthcare conference in San Francisco.

In the same vein, Healthcare Dive informs us that “Cigna is partnering with tech-savvy payer startup Oscar Health to jointly sell commercial health plans to small businesses as the Bloomfield, Connecticut-based payer looks to capitalize on Oscar’s simplified strategy to expand its footprint in the small group market.”

About five years ago, the FEHBlog heard the American Medical Association’s then president elect explain that he takes heart disease death statistics with a grain of salt because doctors historically have listed heart disease as the default cause of death for older patients when no autopsy is ordered. This Wall Street Journal article, however, suggests that our country has a serious problem with heart disease.

Americans are dying of heart disease and strokes at a rising rate in middle age, normally considered the prime years of life. An analysis of U.S. mortality statistics by The Wall Street Journal shows the problem is geographically widespread. Death rates from cardiovascular disease among people between the ages of 45 and 64 are rising in cities all across the country, including in some of the most unlikely places.

NPR Shots discusses the current state of concierge medicine and is younger cousin direct primary care in the U.S.

Monday Musings

This week the 38th annual JP Morgan healthcare conference is being held in San Francisco. Fierce Healthcare’s reporters provide us with an interesting pastiche of conference presentations.

Beckers Hospital CFO Review reports on a recent Health Affairs analysis on the value of bundled payment arrangements.

Twenty studies reviewed show that the bundled payment models maintained or improved quality while lowering costs for lower extremity joint replacement. This didn’t hold true for other procedures and conditions. Study others added that a significant number of studies didn’t find any effect on healthcare spending, although this varied by clinical episode.

Buyer beware.

The FEHBlog wishes to caveat a point made in his December 2019 “Santa Claus” post. The post accurately explained that Congress has repealed the Affordable Care Act’s medical device, health insurer and high cost plan excise taxes (the latter colloquially known as the ACA’s Cadillac tax.) Katie Keith points out in the Health Affairs blog that

Repeal of the health insurance tax would not take effect until 2021, meaning the tax—which has already been built in to many premiums for the 2020 plan year—will remain in effect for 2020. The Cadillac tax and medical device tax are repealed beginning in 2020.

Weekend update

Congress remains in session this week on Capitol Hill.

The Wall Street Journal offers two articles of note:

  • An in-depth article about Google Health’s data analysis arrangements with large health care providers.
  • An article about a new prescription drug manufacturer EQRx, Inc. which claims it plans to offer generics at below market price. The article notes that

The new business is the latest example of how high drug costs have prompted hospital groupsstates such as Californiaand now drug-industry insiders to explore alternative models for making drugs at lower prices. reports that

The White House is calling on federal agencies to develop new strategies to reduce injuries in the federal workplace and to help those who are hurt to get back to work more quickly, creating a new, governmentwide push to help accomplish the goal. 

The Protecting Employees, Enabling Reemployment (PEER) Initiative will task each agency [including the Postal Service][ with developing specific strategies and goals to slash injuries on the job and time off of work due to injuries, Office of Management and Budget acting Director Russ Vought said in a memorandum dated Thursday. He noted that 107,000 federal employees filed new workers’ compensation claims in 2018 and received $3 billion in payments. 

Health Payer intelligence brings us up to date on budding payer efforts to provide senior members with ride sharing services to healthcare appointments. In the FEHlog’s view, this is a dandy idea.


Yesterday, the Employee Benefits Research Institute (“EBRI”) issued its annual report on the use of health savings account in the U.S. Here’s the key in the FEHBlog’s view:

“As individuals become more familiar with HSAs, they are more likely to take advantage of the benefits of the account. Account balances are growing over time, enabling longtime account holders to withdraw larger sums when unexpected major health expenses occur and saving and investing for retirement expenses”, said Paul Fronstin, director of EBRI’s Health Research and Education Program and coauthor of the report. “Plan sponsors that value employee financial wellness can work with administrators and advisors to take a long-term view of HSA account balance growth.”

Here is a link to HR Dive’s take on this report.

Earlier this week, CMS announced the appointment of Brad Smith to “serve as Director of the Center for Medicare & Medicaid Innovation at CMS and Senior Advisor to Secretary Azar for Value-Based Transformation.” Becker’s Hospital Review adds that “Mr. Smith, a former Rhodes scholar and Nashville, Tenn.-based entrepreneur, comes to the leadership position after serving as COO of Anthem’s Diversified Business Group. He also co-founded and was CEO of palliative care provider Aspire Health.” Good luck, Mr. Smith.

Health Leaders Media reports that America’s Health Insurance Plans has offered a defense of the value of health plan administrative costs in the U.S.

“Study after study continues to demonstrate the value of innovative solutions brought by the free market. In head-to-head comparisons, the free market continues to be more efficient that government-run systems,” AHIP said.

They cited a MedPAC report which showed that Medicare Advantage plans deliver benefits at 88% of the cost of traditional Medicare, including administrative costs.

Supreme Court update

As anticipated, the parties challenging the Affordable Care Act’s constitutionality of the Affordable Care Act filed papers opposing the motion of the law’s defenders to expedite a Supreme Court decision in the case. The Supreme Court case number for the States’ cert. petition is 19-840 and the case number for the House of Representatives cert. petition is 19-841. If you care to read the motion papers, search for the case number(s) in the docket search feature found in the upper right hand corner of the Court’s website. In contrast to PACER the general online service to retrieve federal court papers, this Supreme Court feature is offered at no additional cost. We may hear the Court’s decision on the motion to expedite as early has next Friday January 17.

Photo by Allie Smith on Unsplash

Re-admission Study

The Affordable Care Act (“ACA”) directed a lot of attention on avoiding unplanned hospital re-admissions. Who can argue with that? The ACA rules and the NCQA measures have scrutinized readmissions within 30 days of discharge. The FEHBlog has noticed at least one study concluding that hospitals should not be held responsible for readmissions that occur more than seven days after discharge.

Over the past couple years, health insurers have begun to take into account social determinants of health. It is undoubtedly true that people without a strong social support system are likely candidates for hospital readmission. Therefore, focusing on SDOH considerations should be helpful in avoiding readmissions.

A friend of the FEHBlog shared with him this Tradeoffs podcast story about a random study of the “sickest of the sick” to see whether providing social services for an extended period following discharge would avoid unplanned readmissions within 180 days following discharge. Not surprisingly, to the FEHBlog, the study was not successful.

Researchers tested whether pairing frequently hospitalized patients in Camden, New Jersey, with nurses and social workers could stop that costly cycle of readmissions. The study found no effect: Patients receiving extra support were just as likely to return to the hospital within 180 days as those not receiving that help.

This was the lead story on Police Pulse this morning. But what does the study mean beyond Camden? If the study had had a positive result, then the findings should have been transferable across most populations. However, while this particular negative finding does mean it is back to the drawing board for the Camden patient, those findings are not necessarily transferable to other healthier populations. Also it may be that the 180 day readmission free period was a bridge too far. Health plans and healthcare providers should not be discouraged.