Friday, June 28, 2013


The FEHBlog has noticed a couple of recent articles about the use of reference pricing in health plan coverage. The Wall Street Journal explains that 
The idea has been tested for years by a limited number of large employers. But the new option from [Wellpoint] the second-biggest U.S. insurer, which will be available for coverage that kicks off next January, will be offered broadly to any client with at least 100 employees.
Under the approach, workers are supposed to be given choices among hospitals, doctors or other providers to be used for a procedure—such as an imaging scan or even a surgery—each with pricing and quality information. If they pick one that costs more than the employer offers, they pay the difference. If workers opt for a provider that costs less than the employer's price, an employer could choose to offer them a credit, WellPoint said.
Wellpoint is offering the reference pricing option in conjuction with "Castlight Health Inc., which has an online tool that gives pricing and other information about health-care providers.'

The Boston Globe meanwhile reports on the use of reference pricing with prescription drug coverage, e.g.. median price for the drug is $100 if you choose a version of the drug priced in excess of $100 you pay the difference.. The article notes that
GoodRx is a website that allows consumers to compare local prices for just about any prescription drug you can think of. This is not a site for employers or governments -- though they can help by pointing their enrollees in this direction. This is a site for consumers.
Indeed, GoodRx has an smartphone app!

Last year, OPM urged FEHB plans to take steps to reduce C sections before the 39th week of the pregnancy, which has been a major public health campaign lead by the March of Dimes. The New York Times reports that
From 1996 to 2009, the Caesarean delivery rate soared by 60 percent, accounting for a record 33 percent of births nationwide.
The trend alarmed health officials and medical societies because many of these were early-term C-sections, performed at 38 weeks of gestation or earlier, when the risk of complications to the infant is greater.
But from 2009 to 2011, the rate leveled out at 31 percent, according to the Centers for Disease Control and Prevention. The rate of C-section deliveries fell by 5 percent among women at 38 weeks of gestation and rose by 4 percent among those at 39 weeks of gestation.
In more good news, the Washington Post reports that momentum is gathering on Capitol Hill to repeal the onerous health insurer fee imposed by the ACA effective next year. The burden of the tax will fall principally on small businesses and individuals who buy fully insured coverage. Of course there are few sure things when it comes to changing this law.

CMS has updated its Physican Compare website.  The CMS press release explains that
Physician Compare was improved based on user and partner feedback, as part of improvements in the Affordable Care Act. The redesign includes new information on physicians, such as: Information about specialties offered by doctors and group practices;
Whether a physician is using electronic health records; Board certification; and
Affiliation with hospitals and other health care professionals.
Finally, HHS moved full steam ahead today with the final rule on its contraception mandate which already has been implemented in the FEHBP.

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