Friday, August 23, 2019


Fedsmith reports that OPM has announced that this year's Federal Benefits Open Season will take place from Monday November 11 through Monday December 9, 2019.  This is time when federal and postal employees and annuitants can make changes to their FEHBP and FEDVIP coverage for 2020 and employees can enroll for a flexible spending account (FSAFeds) for 2020.

"Willis Towers Watson's Rx Collaborative, an employer-based pharmacy benefit group purchasing coalition, disclosed in a statement to HR Dive that 40% of its total drug costs were spent on specialty drugs that accounted for less than 1% of its prescriptions in 2018. It also noted that the top 10 drugs by cost made up a fifth of its pharmacy spend that year. * * * The coalition reported a steady decrease in drug price inflation rates over the last three years: 3.5% in 2018, 4.2% in 2017 and 6.8% in 2016."

According to Health IT Analytics, "Sixty percent of healthcare executives are using predictive analytics within their organizations, according to a recent survey from the Society of Actuaries (SOA), and 20 percent of payers and providers plan to begin using predictive analytics within the next year."

Health Data Management reports that "The American Academy of Family Physicians and Health Level Seven International are teaming on a new project to improve the interoperability of social determinants of health data.The Gravity Project, part of HL7’s program to accelerate the adoption of its Fast Healthcare Interoperability Resources (FHIR), is meant to standardize medical codes to support the use of SDOH-related data in patient care, care coordination, population health management, value-based payment as well as clinical research."

Finally Prof. Timothy Jost offers his overview of current Affordable Care Act litigation.  The FEHBlog finds it interesting that while litigation opposing the Trump Administration's association health plan and short term limited duration health plan initiatives, no litigation has arisen as yet opposing the Trump Administration's more recent individual coverage health reimbursement arrangement initiative. The ACA regulators have estimated that once employer become familiar with this rule, 800,000 employers may take advantage of it by 2029 which would result in 11,000,000 more Americans with individual coverage.

Wednesday, August 21, 2019

Midweek update

The FEHBlog ran across two articles on successful healthcare quality improvement efforts --

  • Health Payer Intelligence discusses a Geisinger data analytics effort focused on getting five Medicare Stars, and 
  • Employee Benefits News features an Pacific Business Group on Health CEO's article on a primary care focused initiative to improve quality for large employers in California.
Healthcare Dive reports that 
The Office of the National Coordinator is in talks with Congress and the White House on how to regulate secondary uses of healthcare data. ONC doesn't have statutory authority to vet third-party apps and what they do with consumer data, agency chief Don Rucker told Healthcare Dive, but the agency is looking into a variety of solutions including legislative language on privacy and security provisions or voluntary attestation standards for the apps themselves.  '
Experts are concerned privacy and security have been an afterthought for the agency as it continues to push interoperability into the healthcare industry. But "there's a number of people interested on both sides of the aisle and both sides of the Hill" in addressing the issue, according to Rucker.
The FEHBlog has noted that he has enrolled in the National Institutes of Health's All of Us program.  Fortune Magazine reports that
NIH has an official genetic counseling partner for its ambitious, million-person All of Us research program: Color, a DNA testing and genomic counseling specialist. 
The NIH announced Wednesday that Color will receive a $4.6 million grant (part of $25 million over multiple years) in order to provide what Color describes as the "technological backbone" for the All of Us project. The company is also the sole grantee selected to set up and deliver genetic counseling for Americans participating in the program. 
All of Us is an NIH initiative that was announced under former President Barack Obama. It aims to ultimately collect health and biometric data - including DNA and blood samples, lifestyle information, and environmental data - from one million Americans. The goal is to use this vast dataset in order to better understand what affects health for people of different races, genders, and geographic locations - and, in the process, help spur the development of personalized medicine.

Tuesday, August 20, 2019

Tuesday Tidbits

It's all good new tidbits today!

After years of frequent list price hikes, many drugmakers are showing some restraint, according to the analysis of drug prices provided by health information firm Elsevier.  In the first seven months of 2019, drugmakers raised list prices for brand-name prescription medicines by a median of 5 percent. That’s down from about 9 percent or 10 percent over those months the prior four years, the AP found. From January through July this year, there were 4,483 price hikes, down 36 percent from that stretch in 2015.

  • Fierce Healthcare reports that last week the Food and Drug Administration approved an AbbVie drug that competes with the blockbuster Humira drug to treat rheumatoid arthritis.  The new product Rinvoq should be available in the U.S. by late August, AbbVie said. Rinvoq bears a list price of $59,000, which "is lower than the current leading treatments for moderate to severe rheumatoid arthritis," an AbbVie spokeswoman said by email. 

  • HHS announced the issuance of its 2018 SAMSHA National Survey on Drug Use and Health. “This year’s National Survey on Drug Use and Health contains very encouraging news: The number of Americans misusing pain relievers dropped substantially, and fewer young adults are abusing heroin and other substances,” said Health and Human Services Secretary Alex Azar. “At the same time, many challenges remain, with millions of Americans not receiving treatment they need for substance abuse and mental illness."  This has been the FEHBlog's point. Health plans need to focus on covering evidence based treatment for these problems

  • The American Association for the Advancement of Science informs us that "The U.S. Centers for Disease Control and Prevention report on the use of antibiotics in health care settings across the United States in 2018 tell us that while progress has been made to promote appropriate use of infection-fighting drugs, strengthened and continued efforts and greater resources are needed to protect some of the most valuable medicines we have and prevent the accelerating development of illness-causing bacteria that are resistant to treatment."
  • Forture's Health Brainstorm reports that the U.S. Preventive Services Task Force has given a B recommendation to expanded BRAC genetic counseling for breast cancer.  According to the new recommendation, 

Primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool,” wrote the panel in the journal JAMA. “Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.”
This builds upon existing recommendations by emphasizing that women who have already had breast cancer, or other kinds of BRCA-associated cancers, or those whose families and ancestries put them at particularly high risk of BRCA mutations that can lead to such cancers, should be genetically screened by primary care physicians.
With this information in hand, the panel says, the women can make personal decisions with the help of a genetic counselor on the best ways to reduce the risk of cancer or cancer recurrence.

  • Following up on the blog post yesterday about Fotune Magazine's list of companies that help improve the world, the Business Roundtable, which includes the Nation's largest employers, has released a new "Statement on the Purpose of a Corporation signed by 181 CEOs [including publicly traded healthcare companies] who commit to lead their companies for the benefit of all stakeholders – customers, employees, suppliers, communities and shareholders." Previously this statement lead with making profits for shareholders. Checkout this week's Econtalk podcast episode in which 
Author and economist Tyler Cowen of George Mason University talks about his book, Big Business, with EconTalk host Russ Roberts. Cowen argues that big corporations in America are underrated and under-appreciated. He even defends the financial sector while adding some caveats along the way. This is a lively and contrarian look at a timely issue.
The FEHBlog enjoyed listening to the episode. 

Monday, August 19, 2019

Monday Musings

The Peterson-Kaiser Health System Tracker has released its latest report on the rise in employee premiums and cost sharing for employees with large employer coverage.
For most of those with employer coverage, the cost of the premium is split between the employer and employee. Looking only at the health spending for which workers are responsible (their families’ premium contributions and cost-sharing payments), the average family spent $4,706 on premiums and $3,020 on cost-sharing, for a combined cost of $7,726 in 2018. This represents an 18% increase in the health costs borne by employees and their families from five years earlier ($6,571 in 2013), outpacing the 8% increase in inflation and a 12% increase in workers’ wages over the same period.
Employee Benefit News discusses the use of employer incentives to encourage their employees to price shop for healthcare services.  "These programs [such as Direct Path and Health Joy] both educate employees about the fact that they should price shop for many healthcare services, and encourage them to choose lower-cost options by putting money back in their pockets."

Fortune's Brain Storm newsletters discusses the healthcare companies that landed on the magazine's annual Change the World list. Check it out.

The FEHBlog was bowled over when he read in Modern Healthcare that only this week the federal Environmental Protection Agency is "prohibiting healthcare organizations from flushing hazardous waste pharmaceuticals [like opioids] into the sewer system." Apparently there are healthcare organizations who must come into compliance with this rule. That's nuts.

Sunday, August 18, 2019

Weekend update

Congress is now just about half way through its August recess.  This is the time of the year when OPM completes its benefit and rate negotiations with carriers.

The Washington Post had a lengthy front page story today on how medical debt adversely affects rural people and rural hospitals. Much of the debt arises from emergency room use according to the article but the underlying problem is that rural areas don't have the webs of walk-in clinics and urgett care centers found in urban areas. The federal government is planning to funnel more Medicare money to rural hospitals and as noted here last week, Sen. Check Grassley has introduced a bill to permit rural hospitals to do away with inpatient beds in favor of telehealth.  It's a serious public health problem that the Affordable Care Act does not address.

Health Payer Intelligence offers an article with examples of how health plans and insurers are moving from reactive to preventive care.  In the same vein, Fierce Healthcare discusses how
As the number of high-cost treatments continues to grow, Anthem is launching a new program in Kentucky that aims to work with providers to protect patients from “shock” bills for these therapies. Anthem has teamed up with St. Elizabeth Healthcare, one of the state’s largest providers, as the first partner in the new program. In the model, the health system will absorb part of the cost of these services, discounting them by as much as 45%. 
And NPR's Shots provides "pro tips' on how to stick with healthy habits.

Thursday, August 15, 2019

Thursday hits

NPR discusses efforts in the Senate to join the House of Representatives in passing a bill to repeal the ACA's excise tax on high cost health plans a/k/a the Cadillac tax.

Health Data Management reports that Senate Health Education Labor and Pensions Committee Chairman Sen. Chuck Grassley (R IA) is promoting telehealth as a means to maintain the viability of rural hospitals.
Grassley said he—along with other senators—has reintroduced a bipartisan bill that would allow rural diabetic patients to receive regular vision screening using telemedicine.
More broadly, the Rural Emergency Acute Care Hospital (REACH) Act would create a new “rural emergency hospital” classification under Medicare. Many rural hospitals are currently designated as critical access hospitals under Medicare and as a result have to maintain a certain amount of inpatient beds and provide emergency care services 
However, the REACH Act calls for the creation of a rural emergency hospital designation under the Medicare program that would enable facilities in rural areas to provide emergency medical services without having to maintain inpatient beds. In addition to providing emergency care, rural emergency hospitals could convert the space previously used for inpatient services to provide other medical services, including telemedicine.
Last month, the FEHBlog discussed PBM efforts to create curated wellness apps for their members. CNBC reports that BlueShield of California has rolled out its own curated wellness app called Wellvolution.
[Wellvolution provides] an online portal for members to login via a mobile app or the web. Members will then beasked to answer some basic survey questions about their health goals. From there, they’ll get a recommendation for an app or a service they can use as a wellness perk. If they don’t like it, they can change it up at any time. That way, suggests [BlueShield's Bryce]Williams, “the best tools that our members really like can rise to the top.  The insurer teamed up with a health-tech start-up called Solera Health to develop the service.
Health Payer Intelligence reports on the merger plan of two large New England non-profit health care systems, Harvard Pilgrim Health Care and Tufts Health Plans.  Subject to federal and state regulatory approval, "The [combined] company will offer plans to consumers across the spectrum of socioeconomic and demographic backgrounds, from employer-sponsored insurance and quality health plans to Medicare and Medicaid and dually eligible plans." But not FEHBP.

Healthcare Dive discusses a New England Journal of Medicine analysis of U.S. hospital ranking programs. U.S. News and World Report received the top (but not the highest possible) grade of B. CMS's Hospital Compare website received a C.

Wednesday, August 14, 2019

Midweek update

Healthcare Dive is reporting that "Average monthly premiums for marketplace plans nationwide are expected to increase 0.6% for 2020 coverage — the lowest increase since the launch of the Affordable Care Act plans, according to an analysis of insurer rate filings submitted to all 50 states and D.C." The FEHBlog is glad that ACA marketplace premiums are stabilizing. It's noteworthy that although ACA marketplace plans are subject to the resumption of the ACA's onerous health insurer tax, the premium don't show a big bump for that event. At this point this hefty tax has been imposed on health insurers, including insured FEHB plans, from 2014 through 2016 and 2018. FEHB premiums didn't jump precipitously in those years due to imposition of the tax. FEHB premiums grew very slowly for this year when the tax is suspended. Will there be an FEHB premium boomerang for 2020? Time will tell. Nevertheless, the FEHBlog continues to believe that this tax and the ACA's medical device tax are misguided.

Following up on the report of a Novartis data manipulation scandal last week, the Boston Globe's STAT reports that
The company previously said it was “in the process of exiting” scientists who were responsible for the scandal but did not identify them. In a statement on Wednesday, Novartis (NVS) said that it had appointed a new chief scientific officer for AveXis and that other scientists, Brian and Allan Kaspar, “have not been not been involved in any operations at AveXis since early May 2019,” without elaborating.
The person familiar with the situation, who spoke on condition of anonymity, confirmed that the departure of the Kaspars, who are brothers, was connected to the disclosure of data manipulation related to the gene therapy Zolgensma.
Consumer health technology company Ciitizen reports launching a scorecard grading healthcare providers on the level of their cooperation with HIPAA's individual right to access their medical records. Citizen explains
We plan to refresh the scorecard every few months based on the most recent record requests sent to a particular provider - so improvement and consistency in good performance can be rewarded (and consistency in poor performance can also be brought to public attention).
In conjunction with the scorecard, we also released survey of 3003 hospitals and healthcare systems who responded to anonymous questions about their record release processes. Their responses suggest that 56% of health care providers are out of compliance with one or more aspects of the HIPAA Right of Access.
Here's a link to the HHS website that explains this individual right.  This right also is discussed in your healthcare provider or your health plan's HIPAA notice of privacy practices.

Tuesday, August 13, 2019

Tuesday's Tidbits

The National Business Group on Health issued its 2020 Large Employers' Health Care Strategy and Plan Design Survey today.
The 2020 Large Employers' Health Care Strategy and Plan Design Survey found employers project the total cost of health benefits will rise 5% in 2020, taking cost management initiatives into account. That increase is identical to 2019’s projected increase - but actual costs are coming in lower. Large employers reported the actual increase in 2018 was 3.6%. Including premiums and out-of-pocket costs for employees and dependents, the total cost of health care is estimated to be $14,642 per employee this year, and projected to rise to an average of $15,375 in 2020.  Employers will cover nearly 70% of costs while employees will bear about 30%, or nearly $4,500.  Forty-four percent of employers ranked musculoskeletal issues as the top condition impacting their costs while 85% ranked it among the top three conditions. One in four (25%) employers ranked cancer as the top condition.  
“One of the challenges employers face in managing their health care costs is that health care is delivered locally and change is not scalable.  It’s a market-by-market effort,” said Brian Marcotte, President and CEO of the National Business Group on Health. “Employers are turning to market-specific solutions to drive meaningful changes in the health care delivery system.”
Good point.

Speaking of which, Kaiser Health News reports on 29 Hepatitis A outbreaks across the United States which often follow the path of the opioid crisis.
Dr. Monique Foster, a medical officer in CDC’s Division of Viral Hepatitis, said vaccinating those at highest risk remains the best strategy. “Outbreaks will stop when we have effectively vaccinated the vulnerable people,” she said.
Although the federal government isn’t recommending universal vaccination, several experts said the more people vaccinated, the better. 
“The risk is there. The disease is circulating,” said the University of Kentucky’s Winter. “It’s good for the general public to be vaccinated.” 
With the virus continuing its advance, Penn State’s Haeder said, “it won’t be long before we have it everywhere.”
Meanwhile according to the Wall Street Journal, the U.S. Preventive Services Task Force today "released a draft ["B" level] recommendation that doctors ask their patients about illicit drug use, including opioid painkillers, so they can be directed to treatment." Health plans must cover with enrollee cost sharing final "A" and "B" recommendations when carried out by in-network provider. New USPSTF "A" and :B" level recommendations will be required to be covered without cost-sharing starting with the plan year (in the individual market, policy year) that begins on or after the date that is one year after the date the recommendation is issued / finalized. The Journal's report explains
The group’s draft recommendation, which reverses its previous [2008] stance of not asking about illicit drug use, said it is taking the step in part because 7.5 million people 12 years old and older in the U.S. have been diagnosed with dependence or abuse of illicit drugs in the past year, according to the task force. 
Healthcare Dive reports on healthcare provider suggestions to the Centers for Medicare and Medicaid Services on how to reduce the Medicare administrative burden on them.
Companies took the request for information as an opportunity to air perennial grievances about the highly regulated environment, including inequitable quality measures and reporting requirements, prior authorization that slows down care delivery for patients and problems with interoperability and telehealth.
The FEHBlog dearly wishes that OPM would take a page out of this CMS playbook and apply it to the FEHBP.

Monday, August 12, 2019

Monday musings

Last week, the FEHBlog attended the American Bar Association's annual meeting in San Francisco. Here is a link to an ABA story about an opioid crisis presentation by the American Medical Association's President-elect, Susan Bailey, MD.  Dr. Bailey encourages the FEHBlog's profession to sue health insurers for adequate treatment coverage.
The doctor highlighted three recent legal cases that focus on opioid issues. These cases, she said, show “how legal and medical experts can work together to make sure there is evidence-based care for opioid use disorder patients in correctional settings, and that health insurance companies must use medical evidence to evaluate claims, not just financial evidence. We must work together to hold them to that standard.”
Sigh. Why can't physicians and health plans work together on these important issues?

A UnitedHealth Group report finds that
The annual cost of hospital inpatient services for privately insured individuals exceeded $200 billion in 2018 and is projected to exceed $350 billion in 2029.1 Hospital inpatient spending growth is in luenced by several factors, including prices charged by hospital facilities (hospital prices), prices charged by physicians practicing within these hospitals (physician prices), and patients’ utilization of inpatient services
United notes that hospital prices increases materially exceed physician price increases.  United opines that "Slowing the growth of hospital inpatient costs – by reducing hospital price increases to the level of physician price increases – would make health care more a ordable for consumers and employers." That's easier said than done, of course. Hopefully, S. 1895, the bipartisan bill to lower healthcare costs, will help if enacted.

In the same vein, Healthcare Dive reports that
The frequency and price tags on surprise medical bills for emergency and inpatient services at in-network hospitals is on the rise, according to a study published Monday in JAMA Internal Medicine.
The percentage of emergency department visits resulting in a surprise bill jumped from 32.3% in 2010 to 42.8% in 2016 while the increase for inpatient admissions went from 26.3% to 42%. The cost of the bill in both categories nearly doubled in that time period, with the top 10% of ED visits resulting in a bill of more than $1,000, and the top 10% of inpatient visits costing more than $3,000.
Patients at some hospitals were far more likely to receive a surprise bill. For inpatient, the chance was less than 10% at about half of the nearly 3,300 hospitals included, but the chance was more than 90% at about 15% of hospitals. For ED visits, it was a greater than a 90% chance at 23% of at the more than 4,000 hospitals studied.
For this reason, the FEHBlog's principal goal last week as he travelled through the California sub-acute care system was to avoid the emergency room.

Here's a link to an interesting  Signal story about "8 Emerging Healthcare App Development Trends to Follow in 2019." Check it out.

Sunday, August 11, 2019

Weekend update

The FEHBlog is in the San Francisco airport waiting for his flight back to DC.  He enjoyed the American Bar Association meeting and side trips to the Napa Valley and Yosemite (spectacular).

While in San Francisco, the FEHBlog realized that he had a bacterial infection. He located and visited a walk in clinic. It turned out that treating this particular infection was outside the walk in clinic's scope so he had to visit an urgent care center, which he did. The FEHBlog got the antibiotic prescription that he needed and filled the prescription at Walgreen's, The FEHBlog was surprised by the distinction between walk in and urgent care centers. It strikes the FEHBlog that these types of rather arcane distinctions (from the patient's perspective at least) could push patients to the emergency room. Perhaps the FEHBlog should have checked with insurer first.

Congress remains on state work periods until after Labor Day. Congressional staff comes back early to work in DC on FY 2020 appropriations and big legislation such as S. 1895, the bipartisan bill to lower healthcare costs.

As you know, in the fourth quarter of 2018, CVS Health acquired Aetna, and Cigna acquired Express Scripts, The FEHBlog thought that both PBM / health insurer mergers made sense from a improving health care quality perspective. Healthcare Dive reports that CVS Health and Cigna each reported strong 2nd quarter 2019 earnings earlier this month.

The Boston Globe's STAT reports
The Trump administration finalized late Wednesday [in a Medicare national coverage decision] long-sought rules for when Medicare will cover CAR-T treatments, the cutting-edge, often curative therapies that harness patients’ own immune cells against their cancer. 
Under the new policy, Medicare will pay for CAR-T therapies so long as they’re administered in health care facilities that follow the Food and Drug Administration’s special safety rules, known as risk evaluation and mitigation strategies, or REMS. Medicare will also pay for CAR-T even when it’s used to treat conditions that aren’t FDA-approved. The two CAR-T treatments on the market, Gilead’s Yescarta and Novartis’ Kymriah, are approved to treat non-Hodgkin lymphoma and acute lymphoblastic leukemia, respectively. The policy is likely a positive development for hospitals . . . .

Friday, August 09, 2019


Greetings from San Francisco where the FEHBlog is attending the American Bar Association's annual meeting.

The AP reported on Wednesday that
The government is clarifying a policy change that will limit the prescribing of opioid painkillers to federal workers. The Labor Department issued a statement Tuesday saying the limitations will apply to employees injured on the job and covered under the government's workers' compensation program. Last week at a White House briefing a senior administration official suggested the change would apply to the federal [employees] health plan, which is a much bigger program.
The FEHBlog thinks its safe to say that the FEHBP is already on top of this issue.  Keeping pace with concerns about opioid restrictions and proper coverage of opioid addiction treatment are the issues at the heart of the ongoing opioid use crisis for FEHBP carriers.

The Government Employees Health Association ("GEHA") announced yesterday that the Office of Personnel Management has awarded GEHA the government-wide indemnity plan contract. This statutorily mandated FEHB plan slot has been vacant since 1990. GEHA will flll the vacancy with two new options effective January 1, 2020.  GEHA is calling its new plan "Elevate."
"The Elevate plans are specifically designed to help members achieve the health they need to live the lives they want," said Darren Taylor, GEHA president and CEO. "We are excited to enhance our collaboration with OPM and continue to partner with our federal employee members on their health and wellness journeys."
Good luck to GEHA.

Fierce Healthcare reports on Blue Cross of Illinois opening wellness centers for its members on the south side of Chicago. The FEHBlog likes the idea of insurers opening these facilities for members.

Healthcare Dive discusses at length the issue of whether low government prices cause hospitals to charge higher prices to commercial payers.  Because there's no doubt that the pricing gap exists, the real issue is whether or not the gap can be reduced.

Tuesday, August 06, 2019

Tuesday Tidbits

  • Interesting USA Today editorial board interview with AHIP's CEO Matt Eyles. 
  • Troubling New York Times article about a Food and Drug Administration report alleging that Novartis "concealed manipulated data from the Food and Drug Administration while applying for approval of an extremely expensive gene therapy treatment and then delayed reporting the issue."  This data concerned the $2.1 million per treatment gene therapy drug that the FDA approved last May.  "The F.D.A. said patients were not at risk, and that the treatment could still be sold. But the news that a drugmaker had manipulated or mishandled data is an unsettling moment for the pharmaceutical industry. Many companies are racing to develop breakthrough gene therapy treatments for rare and intractable diseases."
  • Equally troubling is this Washington Post article about a 27 year old man with Type 1 diabetes who ran out of his parent's coverage and switched from a prescription insulin to an over the counter insulin. The young man died as a direct result. The article explains the public health crisis created by the following factors --
The more affordable form of the medication — sold by Walmart since 2000 under its ReliOn brand — is known as “human insulin.” It predates the genetically altered “analogue” insulin doctors routinely prescribe. While human insulin can require as many as four hours to take effect, with varying levels of success, analogue insulin is more precise and takes as little as 20 minutes to regulate blood sugar levels, patient advocates say. [Analogue insulin prices nearly tripled since 2002,  Human insulin is useful for Diabetes 2 but not Diabetes 1}.

  • Finally, the Journal of the American Medical Association / Internal Medicine  offers an  editorial on whether there is hope of a pancreatic cancer screen test. The need for such a test is illustrated by the fact that "It is estimated that in 2019, about 57, 000 people will be diagnosed with pancreatic cancer in the United States and that it may soon overtake colon cancer to become the second-most common cause of cancer-related death.1 Based on recent progress in the treatment of colon cancer, the best hope for reducing the cancer-specific mortality of pancreatic cancer may be early diagnosis and treatment." Good luck.

Sunday, August 04, 2019

Weekend Update

Congress is on recess until after Labor Day.

The FEHBlog was taken with Peggy Noonan's Medicare for All discussion in her latest Wall Street Journal column about last week's Democrat Presidential candidate debates --
I never minded the phrase “Medicare for All” because I figured it meant this: “We would like Medicare or some other governmental entity to be available to all who need it, and will come up with ways to ease them in and give people in trouble a break. What everyone wants is the plastic card in the wallet that says you’ve got coverage, so the ambulance isn’t turned away and the kids are treated. We can work this out. We’re America.” 
America would respond to that. A great nation must take care of its stressed, its incapable, its unlucky. 
But I don’t think that the American people understood, at least until the first debates, that Medicare for All means this: “All private insurance is abolished, we’re taking it away, you’re going to be forced into a program we’ll run, we’re going to squish this down on your head, the hospitals will have to conform with our directives whether they bankrupt it or not, and the health-insurance industry and its jobs will be extinguished.” 
And on top of that we will all have to pretend the cost of this will come from savings due to reduced paperwork, or a tax on the wealthy. 
It’s all so crazy. I heard no one in the debates say, “Guys, you are making a mistake to give the state all the power in this area. The government can rarely make things dramatically better in huge and complicated matters like this, but it is always capable of making it worse.” 
I would be very surprised if most people watching didn’t think that’s exactly what they’ll do, make it worse. 
I didn’t hear anyone say, “As you revolutionize the entire health sector, you have to be leery of upsetting all the things that make American medicine, for all its flaws, the most advanced and cutting-edge system in the world, with the greatest doctors and scientists.”
Some candidates pointed out that such sweeping plans were impractical, unrealistic, unworkable. I didn’t hear any philosophical or historical reservations.
Amen to that. It certainly would make more sense to provide needy people with better access to government funded health centers combined with good catastrophic insurance protection.

Friday, August 02, 2019


The Hill reports that earlier today the President did sign a two year federal budget deal that "suspends the debt ceiling through July 2021, removing the threat of a default during the 2020 elections, and raises domestic and military spending by more than $320 billion compared to existing law over the next two fiscal years." Congress now has the foundation to finalize Fiscal Year 2020 appropriations bills in September.

Upon further examination of the Senate record, the Senate yesterday did begin consideration of  Dale Cabaniss's nomination to be OPM Director. This suggests that Ms. Cabaniss's nomination may be confirmed before long.

Today, the Centers for Medicare and Medicaid Services finalized the Medicare Part inpatient prospective payment system rule for the 2020 government fiscal year.
The increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 3.1 percent. This reflects the projected hospital market basket update of 3.0 percent reduced by a 0.4 percentage point productivity adjustment. This also reflects a +0.5 percentage point adjustment required by legislation.
The final rule also throws a bone to rural hospitals.

Employee Benefits News reports that Health Care Services Corp, a large Blue Cross licensee, is finding success with its telehealth program.  The report includes an interview with HCSC's VP for market solutions, Tom Meier.

EBN also reports on a recent Center for Disease Control study on diabetes rates in the United States.
Large employers may be excited about recent research which looked at National Health Interview Survey data and found a near-term decline in new cases of diabetes as well as a plateau in existing U.S. cases. While the news that new cases of diabetes may be declining does sound promising, benefit managers should resist the urge to break out the champagne. 
Although, it’s understandable why they would want to celebrate. More than half of Americans under age 65 — roughly 158 million people — have health insurance through an employer, and chronic conditions like diabetes are major drivers in the year-over-year increases in employee health benefit costs. 
Two key points in the study stand out. First, researchers suggested education and prevention programs may have played a role in the decline and urged “continued emphasis on multilevel, multidisciplinary prevention to reduce both Type 2 diabetes and diabetes complications.” In other words, stakeholders must double-down, rather than let up, on interventions to prevent diabetes. Second, because the NHIS data includes only diagnosed cases of diabetes, researchers didn’t explore the rate of prediabetes. 
The article seeks to focus health plan attention on people with pre-diabetes. Interestingly,
A recent Quest Diagnostics study, found that individuals at risk of developing Type 2 diabetes who take part in an employer-sponsored wellness program that couples laboratory screening with digital interventions reduced their risk of developing the chronic disease for up to eight years. Levels for all biometric markers in the risk model, including fasting glucose, improved across all study cohorts and 62% of participants lost weight after the program, with 31% losing 5% or more body weight.