Weekend Update

Congress is teleworking this week. Both the House and Senate are having home district work sessions. Before leaving and in furtherance of the kerfluffle discussed in last Thursday's post, Rep. Bill Cassidy (R La.) introduced a bill (H.R. 1735) that would require the President, Vice President, and Cabinet Secretaries to join members of Congress and their personal staff members in the exchanges next January. The Hill reports that House Ways and Means Committee Chairman Dave Camp (R Mich.) introduced a bill (H.R. 1780) that would require not only the executive branch leaders but also all of the executive branch employees to leave the FEHBP and join the exchanges. The bills were referred to the House Oversight and Government Reform Committee and the Energy and Commerce Committee.

Last week, the House Energy and Commerce Health Subcommittee held a hearing on the impact that the HIPAA Privacy Rule has on mental health care. The Des Moines Register has an interesting background story on the hearing.

Ron Honberg, legal director for the National Association on Mental Illness, attended Friday’s hearing. In a phone interview afterward, he said the stories told there showed how frayed the country’s mental health system is. Honberg said that too often, care providers use HIPAA “as a crutch” to avoid talking to patients’ families. “I call it hiding behind the veil of HIPAA,” he said. “It’s kind of like, ‘Wow, I’d really like to talk to you, but HIPAA won’t let me.’ ” Honberg said he could see tweaking the law to make clear that talking to families is encouraged. 

The FEHBlog has heard the director of the agency responsible for enforcing that rule say that the rule is "a valve, not a blockage."  Perhaps the valve should be opened further so that families can more easily participate in the mental health care of loved ones.

Modern Healthcare reports that "After sifting through 2,000 pages of public comments, staff members for the Senate Finance Committee say the healthcare industry wants clearer rules, fewer redundant audits and more focus on proactive healthcare fraud prevention." Ah, common sense rears its lovely head.

OPM has been encouraging FEHB plan carriers to adopt value based benefit design.  The National Business Group on Health explains that

Value-Based Benefit Design is the explicit use of plan incentives to encourage enrollee  adoption of one or more of the following:
• appropriate use of high value services, including certain prescription drugs and  preventive services;
• adoption of healthy lifestyles, such as smoking cessation or increased physical  activity, and
• use of high performance providers who adhere to evidence-based treatment  guidelines.
Enrollee incentives can include rewards, reduced premium share, adjustments to  deductible and co-pay levels, and contributions to fund-based plans, such as a Health  Savings Accounts.
VBBD grew out of the recognition that some medical services are of greater value to specific individual enrollees than to others when three factors are considered: 1) medical  evidence of the effectiveness of a particular treatment, 2) the cost of the treatment, and  3) the resulting benefit of the treatment. 

Business Insurance reports that employer adoption of value based health plan design is low due to insufficient price transparency and lagging health management accountability. Indeed, measures of value based plan adoption receded last year.  Business Insurance notes that "A key obstacle providers and employers said they must overcome is the widespread lack of consumerism and accountability for health management among individual employees."  Of course, Rome was not built in a day, but the Affordable Care Act does not greatly encourage such consumerism and accountability.