Govexec.com reports that the OPM Inspector General has advised OPM to create a formal contingency plan for the Federal Long Term Care Insurance Program because the market has shifted since the Program was created 2000.

“In 2000, there were 125 insurers in the long-term care insurance marketplace,” auditors wrote. “By 2014, there were only 12 insurers that were issuing at least 2,500 individual policies and only five insurers sold group policies.”

Additionally, only one firm still offers a group plan in the mold of FLTCIP. John Hancock discontinued the sale of new group policies in 2010, and it shuttered new individual long-term care plan sales in 2016. Instead, many insurance companies now offer a hybrid product that provides long-term care insurance along with either life insurance or an annuity.

The Inspector General’s advice makes sense to the FEHBlog but OPM asserts that it has the situation under control via regular contacts with John Hancock. Congress needs to take a look at this Program.

Today, the chairman and ranking minority member of the Senate Health, Labor, Education and Pensions Committee announced a bipartisan bill (S. 2680) including a series of forty measures to address the opioid crisis. The measures are described in this summary of the bill.  Some form of legislation directed at this crisis is bound to pass Congress before the August recess.  As this is an election year, there won’t be many legislative days left for Congressional action after the August recess.

Becker’s Hospital Review discusses Amazon Business’s decision to shelve its plan to become a major pharmaceutical distribution to major hospitals and other large heath care facilities. Instead, “the e-commerce giant will focus on beefing up its less sensitive medical supply offerings to smaller hospitals and clinics, sources familiar with the matter told CNBC.” The FEHBlog thinks that more competition at the distribution level could help control health care costs.

Health Data Management reports that CVS Health is moving full steam ahead with its strategy.

CVS Health is hiring a senior executive from a startup that specializes in primary-care clinics, a sign that the drugstore chain is serious about providing more medical services directly to consumers as it moves toward acquiring health insurer Aetna. 

Marc-David Munk will become CVS’s chief medical officer for its MinuteClinics and will oversee “expanded healthcare services across the CVS Health enterprise,” the pharmacy and drug-benefits manager said in a statement Friday. Munk was previously chief medical officer at Iora Health, a startup that operates about two dozen physician practices. 

In a 2015 blog post, Munk wrote about what he called “primary care 2.0” that should be “consumer-focused, well-managed and with a move toward higher-acuity, in-clinic diagnostics and treatment. Delivered by people you know, in a system you know.”

Forbes reports on an important advance in chemotherapy.

Adding Merck’s Keytruda to a standard chemotherapy regimen halved the odds that previously untreated patients with advanced non-small cell lung cancer would die, meaning that at the end of 21 months an extra 2 patients out of every 10 were still alive. 

The results set the stage for Keytruda to become a standard treatment for patients with non-small cell lung cancer, and herald another advance for the field of cancer immunotherapy, which uses drugs like Keytruda to harness the immune system to attack tumors. 

“I do think that improvement of overall survival is quite striking,” says Alice Shaw, a Harvard professor who has done leading research in lung cancer.

Healthcare Finance News tells us about a recent AHIP survey finding that the number of enrollees in high deductible health plans coupled with health savings accounts jumped 8% last year.  The article also discusses a number of pending bills in Congress intended to improve this arrangement. The FEHBlog who is enrolled in such an arrangement thinks it’s pretty, pretty good already. OPM did a good deed in the most recent call letter by permitting FEHBP carriers who offer these arrangements to make a higher contribution to the HSA for enrollees.

Finally Health IT Analytics reports that the American Medical Association and Google are holding a competition open to “technology developers who offer streamlined tools and standards-based methodologies to import, extract, and transfer patient-generated health data between mobile devices and clinical interfaces.”

Congress remains in session on Capitol Hill this week. Here’s a link to the Week in Congress’s report on last week’s actions there.

The FEHBlog noticed that last week the House Ways and Means Committee held a roundtable discussion with hospital leaders about how to reduce red tape in Medicare.  Unquestionably, Medicare is an unnecessarily complex program, but all healthcare programs, including the FEHBP, are also bound up in too much red tape.  Congress, HHS, CMS, OPM, and the Labor Department need to let the health care providers and the insurers focus on doing their respective jobs, rather than on regulatory compliance and reporting, in the FEHBlog’s view. There needs to be a better balance.

Health Data Management reports on how health information technology seeks to tackle the top ten causes of death in the U.S.  Heart disease is listed as the number one cause of death. The FEHBlog recalls an AMA president explaining a few years ago that internists often default to heart disease on the death certificate when an autopsy is not performed. The top two causes, heart disease and cancer, lead to more deaths than the other eight combined.

Yesterday, the President issued an executive order creating a task force on the U.S. Postal System. The task force is chaired by the Treasury Secretary and its membership includes the OPM Director. The task force is expected to evaluate the Postal Service and present a report with “recommendations for administrative and legislative reforms to the United States postal system” no later than August 10, 2018, which allows the task force 120 days to complete its work. The creation of the task force no doubt will cause Congress to place its postal reform legislation (S. 2639 and H.R. 756) on the back burners for now.

Altarum reported today that

In March 2018, the Health Care Price Index rose by 2.2% compared to the previous year, fractionally higher than in February, and the highest rate since January 2012. Driving overall price acceleration is high hospital price growth of 3.7%, barely down from 3.8% in February—a more than 8-year high. This was driven by continuing high hospital price growth for Medicare (4.6%)—the highest Medicare rate since November 2009. 

In that regard, Reuters reports on a recent study concluding that price of cancer drugs does not reflect value of those drugs.

“The cost [of cancer drugs] is going up very steeply, and the improvements tend to be much more incremental, that’s really the fundamental issue,” Dr. Richard Schilsky, senior vice president and chief medical officer at ASCO, said in a telephone interview. 

Cost increases are similar regardless of whether a drug is a “true game changer that revolutionizes the approach to treating a kind of cancer, or the drug just produces a small incremental improvement over an otherwise available therapy,” he added. 

“Cost is not connected with benefit, and cost is going up quickly, and benefit is highly variable,” Schilsky said. “I think that as a society and as a healthcare system we need to introduce and experiment with some strategies that try to restore more normal market forces.” 

ASCO and other groups are supporting efforts to make cancer drug costs relate to their effectiveness, he added. “We clearly need to do something,” he said. “We can’t just allow the continued escalation in pricing and cost without making any effort to tie it to the benefits the treatment delivers.”

Good luck with that.

Becker’s Hospital Review and Healthcare Dive offers interesting perspectives on United Healthcare’s Optum division. Beckers points out that

Andrew Hayek, a leader in UnitedHealth’s care delivery operation, told Bloomberg the company has “been slowly, steadily, methodically aligning and partnering with phenomenal medical groups who choose to join us.” In the future, OptumCare hopes to expand its 30-market operation to 75 markets, including the nation’s most populous states: California, Texas, Florida and New York.

Whether it’s hospital- or insurer-employed physicians, Ken Marlow, an attorney with Waller Lansden Dortch & Davis, told the publication, “The smartest participants in the system are the ones who are going to be able to provide quality care at the lowest cost setting. Whoever gets there first, and whoever is able to do that, I think will be the winner.”

It’s hard to argue with that logic.

The Senate “read” the bipartisan Postal reform bill (S. 2629) a second time on Monday and placed the bill on the general orders calendar (item no. 366). The next step will be for the Senate leadership to bring up the bill for a vote.

The House Ways and Means Committee released a bipartisan staff report on stakeholder suggestions on how to address the opioid crisis.   The legislative themes that attracted majority stakeholder approval were opioid prescription limits, better data tracking, and increasing public access to medication-assisted treatment and non-opioid based pain remedies.

Healthcare Dive provides us with expert opinions on whether the U.S. can cope with a physician shortage and steps that are and can continue be taken to increase the number of physicians.. For example,

Edward Salsberg, director of health workforce studies at George Washington University’s Health Workforce Institute, does not share the concern that the nation is facing a severe shortage, pointing to how the industry is redesigning service delivery to enhance utilization. 

“While the number of new physicians is growing slowly, the number of NPs and PAs is growing very rapidly as is a whole host of other professions,” he told Healthcare Dive. “Making better use of the workforce we have through innovations in service delivery and modifications in scope of practice laws/regulations can help increase access, improve quality and constrain the growth in health care costs.”

 More recommendations —

• Revcycle intelligence.com discusses three strategies to reduce low value health care, and

• Health Affairs discusses two approaches that payers can take to improve the efficacy of accountable care organizations.  

The Department of Health and Human Services has finalized the Affordable Care Act 2019 benefit and payment parameter notice.  There is one item in this massive notice that applies to the FEHBP. On pages 332-334, HHS announced that it is finalizing as proposed the 2019 maximum annual limitations on cost-sharing for essential health benefit coverage at $7,900 for self only coverage and $15,800 for other than self-only coverage. This represents an approximately 7% increase above the current 2018 parameters of $7,350 for self only coverage and $14,700 for other than self only coverage.  The CMS press release provides other details on the notice, which loosens restrictions on insurers operating in the individual and small group markets.

Govexec.com reports that the Trump Administration is considering moving 25% of OPM’s responsibilities to other government agencies. “The White House * * * is reportedly weighing the option to move the entire [security] background investigations program to [the] Defense [Department].” What’s more,

“There’s another proposal to move OPM’s Human Resources Solutions, which provides HR services to agencies on a consulting basis, to the General Services Administration. The organization includes a federal staffing center and leadership development program, among other resources.”  

Finally, some actual tidbits

•  The American Hospital Association is encouraging Congress to align a dated federal law (almost 25 yrs older than HIPAA which was enacted in 1996) that protects substance use diagnoses from disclosure (42 CFR Part 2) with the now customary treatment, payment, and health care operations uses and disclosures permitted by the HIPAA Privacy Rule. The AHA explains that  

“Clinicians treating patients for any condition need access to their complete medical histories, including information related to any substance use disorder (SUD), to ensure their patients’ safety, and delivery of the highest quality care. Partitioning a patient’s record to keep SUD diagnoses and treatments hidden from the clinicians entrusted to care for the patient, as required by 42 CFR Part 2, is dangerous for the patient, problematic for providers and contributes to the stigmatization of mental and behavioral health conditions”

• The Alzheimer’s Association has proposed a new approach to drug research for that disease. Focus drug testing on patients who have been diagnosed with the disease using biomarkers rather than on patients with Alzheimer’s symptoms, such as cognitive impairment which can have many causes. The work stemming from mapping the human genome has lead to the discovery of many such biomarkers. ” The authors envision that defining Alzheimer’s disease as a biological construct will enable a more accurate understanding of the sequence of events that lead to the cognitive impairment associated with Alzheimer’s disease, as well as the multiple causes of the disease. This will enable a more precise approach to therapy trials including focusing more specific targets and including the appropriate people.” Evidently this approach has worked successfully with other complicated diseases.

The FEHBlog wraps up a pleasant long weekend with family in Minneapolis tomorrow.  Like the FEHBlog, Congress returns to Capitol Hill tomorrow following a two week long recess. Modern Healthcare reports that Congress is nearing the finish line on legislation to address the opioid crisis that goes beyond funding.

Health Payer Intelligence tells us about new payer approaches to incorporating preventive care and wellness initiatives into their holistic health programs intended to help people avoid or control chronic disease. Good luck with that worthy effort.

The Associated Press reports that last week a federal judge in Alabama issued a ruling in an antitrust case against the Blue Cross Blue Shield Association, The federal judge “agreed to let plaintiff lawyers move ahead with allegations that some actions by 36 [Blue Cross] state insurance operations could amount to an automatic violation of antitrust laws.”  The Wall Street Journal adds that

The case has a long way to go. [The lawsuit was filed in January 2013.] The judge left open at least one potential defense for the insurers’ actions, and the lawsuits against the Blue insurers haven’t yet been certified to proceed as class actions, an issue that could take several more months to resolve.

The AP story notes that “An attorney for the Blue Cross Blue Shield Association, Scott Nehs [actually the Association’s general counsel], says the organization will appeal.” Furthermore, according to the Journal,

the new ruling also held some positive aspects for the insurers. The judge ruled that another aspect of the Blue companies’ cooperation, a program that involves working together to offer national insurance plans [e.g., the Blue Cross Federal Employees Plan] wasn’t an automatic antitrust violation. He also said it wasn’t yet clear whether the Blue insurers effectively operate as a single entity, which could shield their actions against the antitrust allegations.

It’s not easy being a health insurer.

The FEHBlog is out in chilly Minneapolis for a family event. Brr.

Yesterday, the U.S. Surgeon General, Dr. Jerome Adams, issued an opioid crisis related advisory, the first Surgeon General advisory since 2005.  The Surgeon General is encouraging wider distribution of naloxone a life saving medicine which can reverse the effects of an opioid overdose until EMTs arrive. OPM had a session on this topic at the recent carrier conference. Naloxone is dispensed as a nose spray. The Surgeon General explained that

Naloxone is already carried by many first responders, such as EMTs and police officers. The Surgeon General is now recommending that more individuals, including family, friends and those who are personally at risk for an opioid overdose, also keep the drug on hand.

All states have passed laws to increase access to naloxone and, in most states, you can walk into a pharmacy and request naloxone even if you don’t already have a prescription. In addition, most states have laws designed to protect health care professionals for prescribing and dispensing naloxone from civil and criminal liabilities as well as Good Samaritan laws to protect people who administer naloxone or call for help during an opioid overdose emergency. 

Naloxone is covered by most insurance plans and, for those without coverage, may be available at low or no cost through local public health programs or through retailer and manufacturer discounts. It is easy to use, safe to administer and widely available. 

The Kaiser Family Foundation issued a large employer survey on the opioid crisis. Prescriptions are down significantly but treatment costs are skyrocketing. Here’s a link to a Healthcare Dive report on the KFF report.

Fierce Healthcare reports that CVS Health, which has been holding a client forum this week, “kept price growth at only 0.2% for pharmacy benefit management clients despite 10% inflation, according to a report (PDF) the company released on Thursday. The lower cost growth was due in part to utilizing low-cost generic drugs, which were dispensed to 86% of pharmacy benefit management (PBM) clients. ”  Maazal tov.

Employee Benefit News suggests three ways to boost health savings account participation. The best tidbit is to “don’t just talk about HSAs around open enrollment. Reach out consistently, whenever your employees are best primed to care: at the beginning of a new plan year; in March and April when tax savings are front of mind; or after a pay raise or promotion.”

Finally, the Departments of Health and Human Services and Justice released today that “a fiscal year (FY) 2017 [which ended September 30, 2017) Health Care Fraud and Abuse Control Program report showing that for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4. Additionally, the report shows that the departments’ FY 2017 Takedown event was the single largest healthcare fraud enforcement operation in history.”

The FEHBlog enjoys tracking healthcare trends. Here’s the latest:

• Good trend — Kaiser Health News reports that the Centers for Medicare and Medicaid Services is authorizing Medicare Advantage supplemental coverage for services and supplies that help Medicare Advantage plan beneficiaries live happier, more independent lives. 

“CMS is catching up with the rest of the world in terms of its understanding of how we keep people healthy and well and living longer and independently, and those are all positive steps,” said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans, which represents nonprofit health insurance plans. Some offer non-emergency medical transportation, low-cost hearing aids, a mobile dental clinic and a “grocery on wheels,” to make shopping more convenient, she said. 

UnitedHealthcare, the largest health insurer in the U.S., also welcomes the opportunity to expand benefits, said Matt Burns, a company spokesman. “Medicare benefits should not be one-size-fits-all, and continued rate stability and greater benefit design flexibility enable health plans to provide a more personalized health care experience,” he said.

Given the older demographics in the FEHBP, the FEHBlog expects such extra benefits to appear in the FEHBP before long.

• Good trend –The HHS Office of National Coordinator for Health Information Technology released the ONC Guide to Getting and Using your Health Records, a new online resource for individuals, patients, and caregivers. Check the site out.

• Bad trend — Fierce Healthcare reports that “New nationwide surveillance discovered hundreds of antibiotic-resistant ‘nightmare bacteria,’ officials from the Centers for Disease Control and Prevention warned this week as they urged local governments to help in the effort to fight superbugs.”  What’s more — “Antibiotic-resistant superbugs are an expensive problem—with costs topping $2 billion per year based on some estimates—and are deadly, on track to kill more people than cancer by 2050. In addition to the containment strategies outlined by the CDC, providers can hinder the spread of these bugs by being more judicious with antibiotic use.” Ruh roh. 

OPM’s recently installed Director, Dr Jeff Pon, and Deputy Director, Michael Rigas, posted a video for civil servants last week. For people like the FEHBlog who are involved with OPM, it was useful to watch the video to get a flavor for their respective management philosophies.

Thanks to Fortune Magazine, the FEHBlog ran across this eclectic Opioid Watch news feed from the Opioid Research Institute.  One of the articles promotes the study of human waste to identify neighborhoods with high opioid use, known as hotspotting. According to the article this investigative technique which is already popular in Europe has made its way across the pond. Hotspotting is considered more reliable than personal surveys.

In this regard, it’s worth adding that this is National Public Health Week in the U.S.

Forbes reports on the technology front that

An effort to apply blockchain technology to improve inaccurate doctor directories of health plans is the goal of a new partnership between UnitedHealth Group and its Optum unit, Humana, Quest Diagnostics and MultiPlan. 

The healthcare companies have no plans to develop bitcoin or a form of cryptocurrency. Rather, healthcare companies involved in a pilot program announced Monday are going to use blockchain’s ability to secure data and distribute it in an encrypted way to make sure the most current information is available in health plan provider directories.

Good luck.

Last Thursday, the U.S. Centers for Disease Control issued its latest report on opioid overdose deaths:

Drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people ages 15 and older, all races and ethnicities, and across all levels of urbanization. 

CDC’s new analysis confirms that recent increases in drug overdose deaths are driven by continued sharp increases in deaths involving synthetic opioids other than methadone, such as illicitly manufactured fentanyl (IMF). 

“No area of the United States is exempt from this epidemic—we all know a friend, family member, or loved one devastated by opioids,” said CDC Principal Deputy Director Anne Schuchat, M.D. “All branches of the federal government are working together to reduce the availability of illicit drugs, prevent deaths from overdoses, treat people with substance-use disorders, and prevent people from starting using drugs in the first place.” 

CDC’s analysis, based on 2015-2016 data from 31 states and Washington, D.C., showed:
Across demographic categories, the largest increase in opioid overdose death rates was in males between the ages of 25-44. 

• Overall drug overdose death rates increased by 21.5 percent.
• The overdose death rate from synthetic opioids (other than methadone) more than doubled, likely driven by illicitly manufactured fentanyl (IMF).
• The prescription opioid-related overdose death rate increased by 10.6 percent.
• The heroin-related overdose death rate increased by 19.5 percent.
• The cocaine-related overdose death rate increased by 52.4 percent.
• The psychostimulant-related overdose death rate increased by 33.3 percent.
• IMF is mixed into counterfeit opioid and benzodiazepine pills, heroin, and cocaine, likely contributing to increases in overdoses involving these other substances.

The report further notes that “Eight states had significant increases in death rates involving prescription opioids. West Virginia, Maryland, Maine, and Utah had the highest rates.”