Health care provider price and quality transparency is a major Administration goal and a component of the President’s August 22, 2006, Executive Order. The U.S. Office of Personnel Management which administers the Federal Employees Health Benefits Program has explained its Executive Order implementation approach:

Transparency in pricing. OPM will work with carriers to make available to
FEHBP enrollees information about the cost of services delivered by various
providers. This information will be combined with quality information so that
enrollees can see quality and price information together in single, easy-to-use
sources.

Transparency in quality. OPM will work with carriers to make available
information on the performance of doctors, hospitals and other health care
providers. They will use quality measures that have been developed
collaboratively with the health care sector, to help ensure accuracy and
fairness.

OPM announced this week the FEHB plans which were the first to meet its transparency standards:

Aetna Health Plans, American Postal Workers Union consumer-driven, Av-Med,
Blue Choice for Ohio and Missouri, Blue HMO of Ohio, CaliforniaCare,
CareFirst BlueChoice, Foreign Service Benefit Plan, HealthNet of California,
HMO Health of Ohio, Humana Health Plans, Independent Health, Kaiser for
California, Colorado and Northwest regions, M-Care, Rural Letter Carriers
Health Plan, SuperMed HMO and United Healthcare.

As you know, OPM released 2007 FEHBP, supplemental dental, and supplemental vision premiums yesterday. Many more details about 2007 premiums are now available on OPM’s website – www.opm.gov and www.opm.gov/insure

Naturally, there are several news articles on the 2007 FEHBP premiums press release this morning, including the Washington Post, the Federal Times, and Govexec.com .

A multi-disciplinary group organized as Prometheus Payment Reform, Inc. is proposing a new health care provider payment model using “Evidence-Based Case Rates” that seek to tie the payment to compliance with evidence based medical guidelines. “The initial focus of the model is on five specific clinical areas: cancer care (starting with lung and colon cancers), chronic care (starting with diabetes, depression, hypertension and hyperlipidemia), interventional cardiology, orthopedic care (in particular joint replacements) and routine and preventive care.” The group which includes executives from Bridges to Excellence, the Leapfrog Group, the Blue Cross and Blue Shield Association, and the American Hospital Association, currently is preparing to conduct pilot tests of the model in several regions.

As I earlier blogged, the U.S. Institute of Medicine strongly recommends electronic prescribing to reduce medication errors and related health care costs. In his September 1, 2006, testimony before the House Federal Workforce and Agency Organization Subcommittee, OPM Deputy Associate Director Dan Green advised the members of OPM’s plan to conduct an e-prescribing pilot program in the Federal Employees Health Benefits Program. More details are to follow.

Today is a big day in the Federal Employees Health Benefits Program (FEHBP) contract cycle, which began when OPM released its 2007 benefit and rate proposal call letter in April 2006. OPM announced 2007 FEHBP premiums!

The average premium increase is 1.8%, the lowest increase in a decade. “On average, employees will contribute 2.3 percent more to their health care, while the government contribution (roughly 72 percent) will increase by 1.6 percent.” 63% of enrollees will see no increase at all.

“The FEHBP will offer 284 plan choices in 2007, up from 279 in 2006; 29 HDHPs will be offered, an increase of two over 2006. Similarly, the number of Health Maintenance Organizations increases to 209, up from 205.”

For the first time, OPM also announced premiums for the new enrollee-pay-all supplemental dental and vision programs. “Three enrollment categories are available for dental and vision coverage: self only, self plus one, and self and family. Bi-weekly dental premiums, based on the employee’s place of residence, range from $7.29 for self coverage, to $56.77 for self and family coverage; bi-weekly vision premiums range from $2.63 for self coverage, to $16.21 for self and family coverage.”

The next step in the cycle is the Open Season.

A single Open Season for the FEHB Program, FSAFEDS Program and Dental/Vision coverage will be held governmentwide from November 13 through December 11. During this period, individuals can review printed and online materials to compare the coverage and costs of each program, as well as enroll or make changes based on their personal needs. Current FSAFEDS enrollees must re-enroll for 2007 if they wish to continue coverage. Additional information on FEDVIP benefits and costs, along with health plan brochures, will be available at agencies for review by employees; employees and retirees can view the information online at www.opm.gov/insure/health/index.asp. Information on FEDVIP can be obtained online at www.opm.gov/insure/dentalvision; information on FSAFEDS can be found at www.fsafeds.com.

It’s a reoccuring story. My name never shows up in the annual list of MacArthur “genius” grants. Then again, I don’t see any lawyers in this year’s list.

Bristol Myers Squibb took another one in the chops yesterday when a federal judge in New York City invalidated a key Imclone System’s patent associated with its colon cancer drug Erbitux (in favor of three Israeli scientists). BMS is the co-marketer of Erbitux, sales of which are expected to be around $1 billion this year. (It is worse news for Imclone as Erbitux is its only marketed drug, and Amgen is poised to receive FDA approval of a competitor drug. Which company is more snake bit — BMS or Imclone (founder Sam Waksal in prison for securities fraud, etc.)?

September 17 is Constitution Day, the day on which in 1787 the members of the Constitutional Convention, chaired by George Washington, signed our Constitution, subject of course to ratification by the states. OPM has produced a website about its Constitution Initiative project to educate federal employees about the Constitution. I would like to have Constitution Day capped off with a Redskins win over the Cowboys.

According to a study published in the New England Journal of Medicine and its UK cousin The Lancet, a large clinical trial called DREAM indicates that a GlaxoSmithKline drug called Avandia (rosiglitazone) may prevent Type 2 diabetes in high risk individuals. Avandia is labeled for use to treat Type 2 diabetes, which is considered an epidemic in the U.S. and many other parts of the world. However, the study also raised a concern that preventive use of Avandia may cause heart failure. A Lancet editorial cautioned that “The high cost of therapy and the lack of long-term data mean that healthcare funders are unlikely to see rosiglitazone as an appropriate agent” particularly when diet and exercise programs also are effective prophylatics for this population.

The study also revealed that another drug thought to prevent Type 2 diabetes — ramipril — has a minimal impact on the disease.

Forbes.com observes that

Still, the results are a scientific win because they show that it is possible to develop drugs that prevent diabetes. An entirely new class of treatments is racing to market in the form of Januvia and Galvus, experimental pills developed by Merck and Novartis, which work in a new way. The FDA is expected to approve or reject Januvia in mid-October and Galvus in November. It’s possible that Merck and Novartis could find a way to walk through the door that Glaxo has already opened.