Tuesday, June 14, 2011

Tuesday Tidbits

Happy Flag Day! OPM Director John Berry spoke to the Society of American Indian Government Employees today. His remarks included the following points about the FEHB Program:
OPM's Director of Healthcare and Insurance, John O'Brien, is up in Milwaukee at National Congress of American Indians this week to engage in meaningful consultations about how we bring tribal employees into our Federal Employee Health Benefits Family, and I'll say more on that in a moment.
We've launched a new innovation era in the Federal Employees Health Benefits Program, which is nine million members strong - and growing. We're excited to add Tribal employees - even before the state-operated insurance markets, for the general public, go live. We have a real opportunity here to provide Tribes and their employees with a vital service. Our presence at NCAI is just one part of our process of meaningful consultation. And of course, any member can get self and family coverage for children up to age 26.
We're getting FEHBP's insurance companies to cover preventive care with no co-pay and introducing other far-sighted reforms. Nudging them to make these investments in the long term health of their members will also benefit the government as an employer.
It's worth adding that according to a Twin Cities bizjournals.com report, Congress has just created a Wellness Caucusthat will investigate and share ways for companies to support employee health and wellness.

America's Health Insurance Plans today released its annual health savings account / high deductible health plan survey finding that HSA / HDHP coverage among large employers jumped 26% last year. 11.4 million Americans are now covered by these consumer drived plans. AHIP warned that the Affordable Care Act could impair future growth.
  • Restrictions on Over-the-Counter Medications: Starting this year, HSA funds can no longer be used to purchase over-the-counter (OTC) medications without a prescription.  This requirement reduces consumers’ access to common OTC drugs, such as allergy medications, and instead provides an incentive to use higher-cost prescription drug alternatives.

  • Medical Loss Ratio: The medical loss ratio (MLR) regulation is particularly problematic for HSA-eligible plans.  By Congressional design, these plans are intended to provide consumers with a high-deductible, low-premium coverage option along with the ability so save for health care expenses through an HSA.  While these plans typically have lower benefit costs, they are not necessarily less costly to administer on a per-enrollee basis, and, as a result, naturally have lower loss ratios.  Policymakers should recognize the unique nature of HSA plans to preserve consumers’ access to this important coverage option.

  • Minimum Actuarial Value Requirement: Effective in 2014, insurance coverage sold in the individual and small-group markets must meet certain minimum actuarial values for each level of coverage provided: bronze, silver, gold, and platinum.  The lowest level, bronze, must have a minimum 60 percent actuarial value, which is the dollar value of the average expected benefits paid out by the plan.  The ACA directs the HHS Secretary to establish the process for determining actuarial values and states that the Secretary “may” include the amount of the annual employer HSA contributions toward the actuarial value calculation.  Including employer HSA contributions in the actuarial value calculation significantly increases the likelihood that HSA plans will meet the minimum requirement and will help ensure consumers continue to have access to the high-quality, affordable coverage they rely on today. 
The AMA News reports this week on a new study confirming that adverse drug events "send millions back for care."
Ensuring that patients understand their prescribed drugs and how to take them, and monitoring their medication lists for potential drug-drug or drug-disease interactions, are just two ways to prevent adverse drug events, experts say. The challenge for physicians is to do these things reliably when time and payments are tight, Dr. Sarkar [the study's author] said. Meanwhile, patients and their caregivers often struggle to track medications. "The question ... how do we change the health care delivery system to promote safe medication use?" she said. "Let's stop putting the burden on the individual patient and the provider and take a larger perspective."
The article suggests that while electronic medical records / prescriptions may reduce the size of the problem, doctors need to take the time to perform medication reviews with older patients in particular. Doctors reasonably expect to be paid for this service. Perhaps costs could be reduced by involving pharmacists in the process.

The AMA News also had a fascinating article about how health insurers, such as UnitedHealthcare, Humana, and Blue Cross of Florida, are now offering their members mobile phone / tablet applications that provide all sorts of information.
Although their members are their first priority, health plans have determined that their mobile strategy isn't complete without offerings for network physicians, particularly because physicians' embrace of smartphones and tablet computers has been so rapid and enthusiastic. A survey released in May by Manhattan Research found 81% of physicians using a smartphone, and various surveys find 25% to 30% of physicians using a tablet, with many more ready to buy one.

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