Friday, May 25, 2018


We have finally reached the end of the great federal holiday drought which runs from Presidents' Day in mid -February to Memorial Day weekend which starts tomorrow.

Yesterday, the Congressional Budget Office released a report that "examines how budgetary outcomes under those proposals would compare with CBO’s adjusted baseline budget projections." The report finds in its health programs section that OPM's proposed legislative change to the FEHBP government contribution formula would have budgetary savings of nearly $5 billion over the period 2021 through 2028. OPM would work its magic by reducing the government contribution for most plans and raising it by 4% by those plans which in OPM's view offer higher quality. OPM still has not released the legislative language as far as the FEHBlog know. But it appears that OPM will push forward with the plan with Congress.

Speaking of Congress, the Washington Examiner reports that a bipartisan group in Congress has introduced a bill to suspend the ACA's onerous health insurer fee for 2020. It's already suspended for next year, but surprisingly like a vampire it was reactivated for this year.  It's a good idea to start early on this worthy initiative as the health insurer fee only raises premiums, particularly in the FEHBP.

Modern Healthcare reports that a group of health systems are continuing on their joint effort to create a generic drug manufacturer to serve health systems.
Intermountain Healthcare, Ascension, SSM Health and Trinity Health are working with the U.S. Veterans Affairs Department to pool their capital and fight back against drug companies that unexpectedly hike the prices of decades-old off-patent generic drugs. The providers also want to create a more reliable supply of generic drugs like sodium bicarbonate and saline that are vulnerable to shortages.
While the health systems didn't specify what drugs their new venture will make, they want to provide both sterile injectables and oral medications either through their own facility or by contracting with existing manufacturers. 
Eighty percent of nearly 750 providers, payers and pharmaceutical companies polled said they are optimistic or cautiously hopeful that the new endeavor will change the status quo, according to a Reaction Data survey. Ninety percent of 605 hospitals and clinics surveyed said they would buy drugs from the new entity.
The FEHBlog also hopes that the joint venture succeeds.

Wednesday, May 23, 2018

Midweek Update

Retired OPM official Reg Jones reminds us about the impact on life events on FEHBP coverage on

Federal News Radio reports that Congress has sent a Veterans Affairs healthcare overhaul bill to the President's desk for signature. (Just so you know that FEHBlog know, a bill passed by Congress becomes law if the President doesn't sign or veto it within 10 days after receipt as long as Congress is in session. That's in the Constitution.)

Healthcare Finance News tells us about an interesting Milliman study prepared for AHIP. The study allocates an average premium dollar to various purposes.
Prescription drug prices and medical costs, which account for more than 45 percent of the average dollar, continue to rise, AHIP said, forcing premium increases. 
The researchers examined two years of data from commercial plans and from the individual market, from 2014 to 2016.
Cost curve up.

Health Payer Intelligence tells us that "Healthcare payers that wish to be known as innovators need to continually be on the lookout for emerging health plan market opportunities that offer strong profit potential."  The article describes payer strategies.  In that regard, the FEHBlog noticed in Healthcare Dive that Anthem has purchased a palliative care company Aspire Health that really impressed the FEHBlog when he read an article about the company in December 2016.
Aspire, founded in 2013 by former U.S. Sen. William Frist and CEO Brad Smith, focuses on in-home care support for patients with serious illnesses. The model emphasizes care coordination through the use of a care team, including physicians, nurse practitioners, nurses and social workers.
The Nashville, Tennessee-based Aspire currently holds contracts with more than 20 health plans across 25 states. Terms of the deal, which is expected to close in the third quarter of this year, were not disclosed.
Good move, Anthem.

Tuesday, May 22, 2018

Tuesday's Tidbits

The Wall Street Journal reports that the House of Representatives Congress sent to the President's desk the Senate's right to try bill (S.  204).  "The version of the legislation that passed Tuesday is broad and allows patients access to an investigational drug if the patient is diagnosed with a life-threatening disease or condition."  Health plans generally do not cover investigational drugs as the manufacturer usually assumes that cost. The President is expect to sign the bill into law. 

Healthcare Dive informs us that the Government Accountability Office is recommending that the Centers for Medicare and Medicaid Services continue Medicare's prior authorization programs because those programs save money. The American Medical Association has been on a holy war against insurer prior authorizations for the same reason, at least in the FEHBlog's opinion. This GAO report has to be a shot in the arm for all prior authorization programs. 

Two worthy initiatives:

1. Fierce Healthcare reports on a fresh effort to improve patient safety.
Led by the Institute for Healthcare Improvement (IHI), a newly launched steering committee will seek to refocus the industry’s attention on safety and quality goals, such as finding ways to cut down on medical errors. In all, a collection of 24 groups including private organizations like the American Hospital Association and the ECRI Institute will be part of the new committee.
The steering committee held its inaugural meeting today, and

2.  Fierce Healthcare also reports that Kaiser Permanente, which is the carrier with the third largest enrollment in the FEHBP, is investing $200 million in urban housing initiatives through a partnership with the U.S. Mayors and CEOs for Housing Investment.

Finally, the Internal Revenue Service has announced the inflation adjusted percentage that applicable large employers will use to determine whether the minimum essential coverage offered to employees is affordable as required by the Affordable Care Act for plan years beginning after December 31, 2018. The specified percentage is 9.86%, up from 9.56% this year.

Sunday, May 20, 2018

Weekend update

Congress remains in session on Capitol Hill this week.

The Supreme Court issued a significant opinion last week striking down a federal law restricting sports gambling. Invoking a Constitutional law principle called "anti-commandeering," the Court found the law defective because it sought to order around state governments, rather than U.S. citizens and residents (which is OK).   While recognizing that "The Constitution limits state sovereignty in several [significant] ways," the Court remarked that
The legislative powers granted to Congress are sizable, but they are not unlimited. The Constitution confers on Congress not plenary legislative power but only certain enumerated powers. Therefore, all other legislative power is reserved for the States, as the Tenth Amendment [to the Constitution] con­firms. And conspicuously absent from the list of powers given to Congress is the power to issue direct orders to the governments of the States. The anti-commandeering doc­trine simply represents the recognition of this limit on congressional authority. 
You learn something new everyday. (The Court noted that the use of the term anti-commandeering doctrine did not crop up until the 1990s a decade or so after the FEHBlog graduated from law school.)

OPM Director Dr. Jeff Pon reminded us last Friday about a useful OPM website  If you scroll down the home page you will find a lot of useful demographics information about federal employees. If you are a federal employee, you can register to log in and get more details.

The Blue Cross Blue Shield Association issued a Health of America report on major depression. Here are the key findings:

  • Major depression has a diagnosis rate of 4.4 percent in the United States, affecting more than 9 million commercially insured Americans.
  • Diagnoses of major depression have risen dramatically by 33 percent since 2013. This rate is rising even faster among millennials (up 47 percent) and adolescents (up 47 percent for boys and 65 percent for girls).
  • Women are diagnosed with major depression at higher rates than men (6 percent and nearly 3 percent, respectively).
  • People diagnosed with major depression are nearly 30 percent less healthy on average than those not diagnosed with major depression. This decrease in overall health translates to nearly 10 years of healthy life lost for both men and women.
  • A key reason for the lower overall health of those diagnosed with major depression is that they are likely to also suffer from other health conditions. Eighty-five percent of people who are diagnosed with major depression also have one or more additional serious chronic health conditions and nearly 30 percent have four or more other conditions.
  • People diagnosed with major depression use healthcare services more than other commercially insured Americans. This results in more than two times higher overall healthcare spending ($10,673 compared to $4,283).
It's worthwhile reading.

The Hill reports that U.S. public health authorities are concerned about an ebola outbreak in the Congo.  The article reminded the FEHBlog that an Ebola vaccine has been developed.
“We are doing better at response, but not much better at rapid detection, which is important,” said Tom Frieden, a former CDC director who now runs the public health organization Resolve to Save Lives. “This was spreading for a while before [it was] recognized.” 
Aiding the response further is a new vaccine, finalized in the last days of the West Africa outbreak. About 4,000 doses of the vaccine are headed to the epicenter of the new outbreak, where they will be used in two ways: First, health-care workers, those most vulnerable to exposure, will be vaccinated. Then, those who have come into contact with anyone infected, and the contact’s contacts, will be vaccinated, a practice known as ring vaccination.

Friday, May 18, 2018


OPM Director Dr. Jeff Pon appeared before the House Oversight and Government Reform Committee on Wednesday to discussion the President's management agenda. The Federal Times reports that Dr. Pon's wound up defending the Administration's proposal for a pay freeze and retirement benefit cuts. 

Earlier this week, the Food and Drug Administration approved for marketing two important new prescription drugs:

  • NPR reports that the FDA approved "a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches." The drug is called Aimovig  and it's manufacturer is Amgen. 

"Drugmaker Amgen says is has set the list price at $6,900 a year. Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and some expensive drugs have fizzled after insurance companies sharply limited which patients they would cover. 
"With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients."

  • Business Insider reports that the FDA approved the first drug "made expressly to treat signs of opioid withdrawal. The drug will be sold under the brand name Lucemyra by pharmaceutical company US WorldMeds, and its active ingredient is lofexidine. The compound stops the brain from getting flooded with the chemical transmitter that produces most of those flu-like withdrawal sensations.  Mark Pirner, the medical director of clinical research for US WorldMeds, told Business Insider the drug addresses an issue that's central to the problem of opioid use disorder, or OUD." This development will improve medication assisted treatment of OUD.  HHS Secretary Alex Azar cheered this news. 

Wednesday, May 16, 2018

Midweek Update

On Monday May 14, OPM posted an indemnity benefit plan pre-notice solicitation on  The Federal Employees Health Benefits Act calls for OPM to contract for a government wide service benefit plan, a government wide indemnity benefit plan, employee organization plans and comprehensive medical plans. The indemnity benefit plan slot which Aetna held from the inception of the FEHBP in 1960 until roughly 1990 has been vacant for nearly thirty years. OPM tried to solicit insurer interest in filling the slot in 2008 and it's trying again this year. In the FEHBlog view, OPM's efforts are bound to fail until the agency convinces Congress to change the financing mechanism from the antiquated retrospective experience rating method prescribed in the 1959 FEHBA (5 U.S.C. Sec. 8902(i)) to a modern approach based on the ACA's medical loss ratio.

Following up on the President's blueprint to lower prescription drug prices, here are links providing reactions from the healthcare industry, courtesy of Health Payer Intelligence, and Drug Channels.  Healthcare Dive reports that HHS Secretary Alex Azar
underscored proposed changes made in President Donald Trump's "American Patients First" blueprint in a speech to the American Enterprise Institute, where he defended against criticism that Trump dropped support of Medicare directly negotiating drug prices.  Azar argued that the free market is better equipped to drive down costs while preserving consumers' right to choose what works for them.  Trump's plan seeks to merge some parts of Medicare Part B into Part D, which the pharmaceutical industry has opposed. The secretary warned that if pharma doesn't bring the administration "a plan for which drugs make sense to move from Part B to Part D, we'll decide that for them." 
The FEHBlog is not a fan of Medicare negotiating for drugs because Medicare engages in legally permissible price fixing which shifts costs onto the FEHBP and private sector plans. The FEHBlog, who has been in the car a lot this week, is enjoying listening to the EconTalk podcasts, one of which delved into this issue (the interviewer and guest don't share the FEHBlog's opinion by the way.)

Also on the topic of prescription drug prices, CMS yesterday "released a redesigned version of the Drug Spending Dashboards. For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices."  Take a look

Closing tidbits --
  • Govinfo Security reports that HHS's Office for Civil Rights which is responsible for the HIPAA Privacy and Security Rules plans a re-do for the Privacy Rule's accounting for disclosures individual right. 
  • Media Post reports "the number of data breaches totaled 685 in the first quarter of 2018 -- a four-year low, down from 1,444 in the same quarter last year and 1,153 in 2016, according to the Q1 2018 Data Breach QuickView Report, a study by Risk Based Security. And while it’s still a large number, only 1.4 billion records were exposed, compared with 3.4 billion in the first quarter of 2017. A single incident in India accounted for 81% of those exposures. However, the number far exceeds those of the three years leading up to 2017.  Fraud accounted for 1.27 billion of these exposed records, but it still was only the seventh-most common breach type, accounting for 4.8% of the incidents."
  • The National Institute for Health Care Management has released the slides from its recent expert panel presentation on the future of healthcare in our country. Check it out. 

Sunday, May 13, 2018

Weekend update

Congress remains in session this coming week on Capitol Hill. The Supreme Court is headed toward the end of its current term next month. The Hill identified five cases already argued before the Court that await their decision. None of them pertain to healthcare.

Bloomberg reports on healthcare and prescription drug industry reaction to the President's blueprint for lowering prescription drug prices.

Federal News Radio discusses the Postal Service's latest quarterly financial report and the state of Postal reform. In this regard,
"[Postmaster General Megan] Brennan says the Postal Service has been “fully cooperating” with the [President's] postal task force.  “The Postal Service welcomes the task force study because we believe that it deserves to be studied, and that the larger public policy issues need to be addressed,” she said. 
The White House task force will also look at the root causes of the decline in mail volume, and whether the Postal Service should keep its monopoly on letter delivery.
Brennan said USPS isn’t prepared to let go of its letter business anytime soon. 
“That’s one of the few tools we have to help support the universal service obligation. We’re required to maintain an expansive transportation retail and delivery network to serve every address six days a week,” she said.
Health Payer Intelligence reports on the results of J.D. Power's annual survey of health insurer customer service satisfaction.
The JD Power 2018 Commercial Member Health Plan Study found that consumer satisfaction with the health plan industry [was stable from 2017 to 2018] still lags behind other industries in terms of convenience, helpfulness, and the availability of user-friendly purchasing experiences.
“Commercial health plans have been battling a perfect storm of rising costs, payment reforms and consolidation, which has distracted them from focusing on improving overall customer satisfaction in the sector compared with other industries,” said Valerie Monet, Senior Director of US Insurance Operations at JD Power.
Only 47 percent of health plan members fully understood how their plan works.  Respondents said that they have significant trouble understanding certain administrative processes, such as when pre-approvals are needed for medical services or treatments.
Clearly room for improvement exists.

Friday, May 11, 2018


President Trump announced his blueprint for lowering drug prices today. Here's a link to a Fierce Healthcare article on the announcement.

The IRS announced 2019 chained CPI-U inflation adjusted amounts for health savings accounts and high deductible health plans. The HSA contribution limit is increased by $50 for self only coverage and $100 for family coverage. There's no change to minimum HDHP deductible, The out-of-pocket maximum for HDHP coverage is increased by $100 for self only coverage and $200 for family coverage. Fulsome details may be found in this Society of Human Resource Managers report.

Thursday, May 10, 2018

This and that

Tammy Flanagan writing in discusses changes on the federal benefits horizon here. separate reports that earlier this week
At a civil service reform town hall hosted by the nonprofit Partnership for Public Service, Office of Personnel Management Director Jeff Pon defended the Trump administration’s plan to freeze the pay of all civilian federal employees in 2019 as needed to “collect data” on compensation and as a chance to “right-size” the pay for different government occupations.
Dr. Pon also defended his agency's legislative proposal to cut federal employee retirement benefits. And of course, OPM has proposed to cut the government contribution for popular FEHB plans with average quality scores based on OPM's plan performance system.

Speaking of cuts, BNA reports on the state of health insurer "struggles" to control benefit costs and improve quality of health care.

Healthcare Dive more specifically informs us that
A new Health Care Pricing Project study on employer-based health insurance and hospital pricing found that insurers are paying “substantially different prices for the same services.” Health spending on the privately insured varies by a factor of three across the country, with half of the variation caused by hospital pricing differences and half by quantity.
After all, healthcare is local, as they say.

Beckers Hospital Review reports that
[This week] Bay Area Regional Medical Center in Webster, Texas [which is located outside Houston] * * * officially closed its doors, laid off about 700 employees and plans to seek bankruptcy protection. Also, a lawsuit filed against Bay Area Regional Medical Center this week by a lab testing company revealed the hospital may owe Cigna and Aetna a combined $43 million.

Let's close with a couple quirky points:

  • Health IT Security reports that last Tuesday the House Energy and Commerce Health Subcommittee held a hearing on the topic of aligning privacy protection for certain substance use disorder patients with the HIPAA Privacy Rule. Hopefully that bill will pass Congress this year as the specialized rules, which pre-date HIPAA by 30 years, are unnecessarily complicated for providers and payers. 
  • reports that "Malicious crypto-miners have supplanted ransomware as the top healthcare cybersecurity threat." Que? Here's a link to a Malwarebytes Labs piece on the #1 threat. 

Tuesday, May 08, 2018

Tuesday's Tidbits

The Centers for Medicare and Medicaid Services released today its first rural health care strategy. The strategy focuses on the following objectives:

  • Apply a rural lens to CMS programs and policies
  • Improve access to care through provider engagement and support
  • Advance telehealth and telemedicine
  • Empower patients in rural communities to make decisions about their healthcare, and
  • Leverage partnerships to achieve the goals of the CMS Rural Health Strategy.

Speaking of telehealth, the Society for Human Resource Management offers a helpful article for employers and health plans on how to increase utilization of that service.

CVS Health and Cigna both reported first quarter 2018 financial results. In the context of those presentation, CVS Health CEO Larry Merlo, according to Forbes, said that its merger with Aetna is expected to close later this year, and Cigna CEO David Cordani, according to Beckers Hospital Review, said his company's merger with Cigna is on the same track to close.

Employee Benefits News offers a pharmacist's business perspective on these two mergers here.

Finally Fierce Healthcare reports that
Pennsylvania-based Geisinger Health announced Sunday it plans to make [genetic] testing a "routine" part of preventative healthcare at its facilities. [Geisinger is an early if not the first adopter of this approach.] The idea is to make DNA sequencing part of its standard screening tests along the lines of the mammograms, colonoscopies and cholesterol checks that are regularly performed on patients to detect disease earlier. Officials said Geisinger patients will be able to work with their family physician to modify their lifestyle and minimize risks that may be revealed, they said.
Bravo, Geisinger which by the way currently offers FEHB coverage.

Sunday, May 06, 2018

Weekend update

Congress is back in town this coming week follow district/state work sessions last week.

This is Public Service Recognition Week. This celebration "is organized annually by the Public Employees Roundtable (PER) and its member organizations to honor the men and women who serve our nation as federal, state, county and local government employees." Maazal tov to all.

In this regard, Federal News Radio provides a set of slides with demographic background on the federal workforce. Here's the one that grabs the FEHBlog's attention. "45% of the federal workforce is over the age of 50." Bear in mind that the enrollment of the FEHBP is roughly split between employees and annuitants. Consequently, FEHBP carriers face a demographic challenge. The saving grace is the FEHBP's use of a single risk pool per plan option that includes all age groups paying the same premium.

Warren Buffett chaired the annual Berkshire Hathaway meeting on Saturday. Reuters reports on what Mr. Buffett and his vice chairman said about the "healthcare company being set up by Berkshire Hathaway Inc, Inc and JPMorgan Chase & Co. to lower patient costs" for their employees and eligible family members. Mr. Buffett expects the company's CEO to be named "within a couple of months."

Forbes columnist Avik Roy discusses the country's drug pricing woes in advance of the President's anticipated speech on that topic which may occur on Tuesday May 6.
The conventional wisdom in Washington is that the only way to reduce drug prices is through price controls. But that’s not true. Competition—especially from unbranded generic drugs—has dramatically reduced prices of most major drugs whose patents have expired. But Congress and the FDA have erected barriers to further competition that deserve to be torn down. 
He presents reform ideas, some of which the FDA has undertake and others of which require Congressional action.

Friday, May 04, 2018


The Hill uses a recent Food and Drug Commissioner speech among other resources to read the tea leaves about the President's upcoming speech on drug prices.  The FDA Commissioner suggests that the Administration wants to plow manufacturer rebates into lower prices for consumers.

The Wall Street Journal reports that
The opioid epidemic has unfairly increased health insurance costs across the board, not just for those suffering from addiction, plaintiffs allege in five proposed class-action lawsuits filed Wednesday. 
The suits, brought on behalf of people and businesses who have paid for health insurance in California, Illinois, Massachusetts, New Jersey and New York since 1996, represent a new front in litigation seeking to hold corporations accountable for the opioid crisis. 
Already, drug makers and distributors collectively face more than 600 civil lawsuits brought by local and state municipalities trying to recoup costs borne from opioid abuse.
When will the federal government join these lawsuits?

Recent surveys --

  •  Becker's Hospital Review lists 100 "great" U.S. hospitals. 
  • The Commonwealth Fund has issued its annual state health scorecard, and the results aren't pretty. 
  • Health Payer Intelligence reports on an interesting employer health care survey. "Sixty-four percent of employees that participated in a new survey said financial incentives helped connect them to necessary healthcare resources and equip them for improved member engagement." What's more, "Eighty-two percent of employees said that participating in a high-deductible health plan helped enforce better healthcare decision making."

Wednesday, May 02, 2018

Midweek update

Healthcare Informatics reports on Health and Human Services Secretary Alex Azar's speech to the World Health Congress. The Secretary is keen on making health care pricing transparent to consumers. Why not require doctors to provide a summary of services and prices similar to the summary of benefits and coverage that the ACA requires health plans to produce, e.g., my practice participates in the following networks, if I perform this type of service out of network it would cost $X.
Azar also referenced issues around pharmaceutical pricing. “We also want to lower the high prices of drugs,” he said. “HHS is working with the president to focus on a number of issues, including high-list prices, seniors in government programs overpaying for drugs, and foreign governments getting a free ride on American innovation. We’re working on this. I can assure you the President wants to go further, much further. Action is desperately needed. I believe we can help lower the cost of medicine while still stimulating innovation. We have to do so going forward.” 
Concluding his speech, Secretary Azar said that the potential for change, and the initiatives he had just referenced, are among the reasons “why I’m so optimistic.” Fundamentally, he said, “The time has simply come for this [transformational change] to happen. The status quo just cannot hold. The way we do business in American healthcare, from insurance, to IT, to drug pricing, to patient billing, has got to change.” He said he believes that “The power of informed individuals will deliver high-quality healthcare. Getting to that system won’t be the most comfortable process for some entrenched players,” he warned, but he said the opportunities are many, and exciting, and he added, “I exhort all of you to engage with us on the initiatives we’ve presented today, because the opportunities are [so great]. Change is necessary, change is coming,” he said, and asked the leaders gathered at the conference to be a part of that change.
Healthcare Dive discusses a wide-ranging PwC report on merger and acquisition activities in healthcare.  In the course of discussing tech company involvement with healthcare, the publication observes based on the PwC report that
More than half of consumers surveyed said they believe technology companies can improve the patient experience, reduce costs, simplify healthcare and increase their access to personal health information. But they also expressed concerns about the quality of products and services offered by tech companies and privacy of their information. For example, 36% said they would not be very comfortable getting diagnostic tests through a tech company and 36% were uncomfortable with the idea of a virtual doctor visit.
Consumers are, however, embracing health retailers like CVS Health, Walgreens Boots Alliance and Walmart. Slightly more than half said they would be very or somewhat likely to get a wound treated or get staples or stitches at a retail clinic, and 61% said they would use an at-home strep test purchased at a retail store. Payers like CVS are banking on these loyal retail customers to drive increased use of basic healthcare services at clinics.
Health IT Security offers a very informative report on HHS Office for Civil Rights advice on development of legally mandated electronic protected health information security risk assessments. Definitely worth a gander.

Tuesday, May 01, 2018

Tuesday's Tidbits

Federal News Radio reports that
In a wide-ranging conversation with reporters Monday morning [April 30],  [OPM Director Dr. Jeff] Pon outlined his vision for OPM and its role in modernizing 40-year-old statutes that govern how agencies recruit, retain, compensate and manage federal employees. 
“We’ve been nibbling around the edges of civil service reform in the [19]90s and also in the 2000s,” Pon said. “We’ve looked at pay systems, but I’m really looking at wholesale change. We’re looking to make sure that the fabric of the civil service is ready for the next 40 years." 
OPM can push change with four main mechanisms: legislation, executive order, agency-specific authority and OPM authorities. “I’m going to be pushing on all four,” Pon said. “We are going to ask our legislators on ambitious things. We are going to ask for greater authorities for the OPM director to make sure that this position can manage agency-wide HR policies.” 
The ACA regulators, the Health and Human Services Department, the Labor Department, and the Treasury Department, have issued a new Affordable Care Act rule.  Last year, a federal judge here in the District of Columbia ordered the ACA regulators to reconsider an aspect rule that has been standing since 2010. The American College of Emergency Physicians had challenged the way in which the ACA regulators had created a basis for paying out of network emergency care. The ACA regulators stuck with their original and relatively practical approach. The regulators rejected further complications proposed by ACEP which is fine with the FEHBlog. The matter now goes back to federal court.

Health IT Analytics is telling us that
The Blue Cross Blue Shield Association's network of value-based care programs, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), is outperforming other initiatives in 96 percent of care and cost quality metrics.
The Blue Distinction Total Care Program is the healthcare industry’s largest national network of value-based care programs. Overall, Total Care doctors, hospitals, and clinical care teams are outperforming other healthcare providers in 22 of 23 nationally-recognized industry quality measures.
Members of the program have produced a 10 percent reduction in emergency room visits and a 15 percent decrease in hospitalizations year-over-year.
Impressive.  The FEHBlog appreciates provider-payer cooperation.

Speaking of healthcare metrics, Healthcare Dive reports that "Hospital re-admissions that occur in the first week after a patient is discharged are more likely to be preventable than those occurring later, according to a new study in the Annals of Internal Medicine that suggests it may be time to rethink the association between hospital quality and 30-day readmission rates." Amen to that. NCQA take note.

The large telehealth provider American Well announced this week that it is acquiring another telehealth company Avizia which focus on providing telehealth services to hospitals and health systems. "Today, Avizia powers over 1,300 hospital deployments and is a leader in comprehensive acute care telemedicine implementation for large health systems. The company has a significant global presence in over 38 countries, with strong clinical use cases across behavioral health, chronic care, stroke, pediatrics and urgent care at over 70 health systems."

The Wall Street Journal reports that "CareMore, a California-based subsidiary of Anthem that provides health care to 150,000 Medicare and Medicaid patients across the country, is screening its elderly patients for loneliness."  Evidently, loneliness can adversely affect health, particularly in the elderly. Another social determinant of health. Good luck with that.

Good luck also to the National Institutes of Health which according to Fierce Healthcare "has set [May 6 as the] start date for the full launch of its All of Us precision medicine research project.}
NIH announced that nationwide enrollment in All of Us will begin on May 6 with launch events to be hosted in seven cities: New York City, Chicago, Birmingham, Alabama, Detroit, Kansas City, Kansas, Nashville and Pasco, Washington.  
All of Us seeks to enroll more than 1 million volunteers over the next 5 to 6 years as one of the "most ambitious" research efforts in the country, said Francis Collins, M.D., director of NIH, at a press briefing Tuesday. "Imagine the research we could enable," he said, with access to "one of the largest and most diverse cohorts" ever made available. 
People who are interested in participating in the study can visit this website.  The FEHBlog enrolled.