Tuesday, May 31, 2011

Tuesday's Tidbits

Earlier today, the Department of Health and Human Services announced changes to the federal pre-existing condition insurance plan administered by HHS and the Office of Personnel Management. The changes are intended to make enrollment easier and more affordable. Modern Healthcare reports 
HHS Secretary Kathleen Sebelius told members of a congressional panel May 5 that the program had about 18,000 participants. When it was launched in 2010, HHS officials said they expected it to include 200,000 people at any one time.
Federal officials blamed both the cost of the premiums and a lack of publicity for minimal enrollment in the program, "Cost is always a factor for people buying health insurance coverage," John Berry, director of the OPM, said during the same call with reporters. Berry said there is no cost estimate for the changes but that the federal government will pay for the lowered premiums using the program's original $5 billion appropriation.
USA Today reports on two recent prescription drug manufacturer studies about the unnecessary health care costs (for emergency room and other outpatient visits) created by people who failed to properly take prescribed drugs. The article reports that 
Sen. Kay Hagan, D-N.C., and Rep. Cathy McMorris Rodgers, R-Wash, have introduced bills that would allow Medicare reimbursement for more patients who sit down with therapists for one-on-one help managing their medication. The bills would allow pharmacists to recommend the counseling to patients who have chronic diseases or who take several medications every day.
That strikes the FEHBlog as an interesting idea. I remember working many years ago on a coverage issue involving a belt designed to monitor the health of women with at risk pregnancies. The women sent along the data daily and a nurse called to discuss the results. It was determined that the belt was not helpful but the daily discussions with the nurses were helpful. Coaching compliance with medical orders could pay off.

Today was the deadline for FEHB plan carriers to submit their 2012 benefit and rate proposals to OPM. In the call letter OPM asked carriers to explain their strategy for including gerontologists in their provider networks. I think that the AMA News may have shed light on a 2013 initiative -- creating a strategy for including specialists who will treat obese people. Seriously, this AMA News article reports on Florida OB-GYNs who are refusing to treat overweight patients. What's next?  The AMA News does deserve credit for publicizing this issue, in the FEHBlog's view.

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