Weekend update

The weekend update was delayed by the FEHBlog's return from Madison, Wisconsin. The Senate is in session this week while the House of Representatives is in recess.

The FEHBlog, which likes to follow the Big Data trend, noted last year that Aetna, Humana, and United Healthcare had agreed to establish a health care claims databank managed by the Health Care Cost Institute.  (Kaiser Permanente more recently came on board with HCCI.) HCCI issued its first report today which reflected health care provided to 33 million privately insured Americans in 2010. The conclusion came as no surprise to the FEHBlog.

Rising health care prices were the chief cost driver for this demographic group. "HCCI confirmed 2010 prices for the privately insured grew more than utilization after accounting for changes in the mix of medical services provided in hospitals (0.7%) and outpatient facilities (4.6%)."  The Kaiser Health News reports that

As part of the federal health law, all states last year began reviewing premium increases of 10 percent or more, requiring insurers to justify the increases.  There are no similar national efforts to examine price increases by hospitals or other medical providers.

Insurers argue they are just passing along rising costs to consumers, keeping only a narrow profit margin and are often outgunned in contract negotiations by hospitals, many of which are "must-have" facilities in an insurer's network.

"This is an important study that clearly demonstrates that rising prices for medical services are driving health care cost growth," said Karen Ignagni, president and CEO of America's Health Insurance Plans, the industry lobby. "Reducing medical costs is essential to making health care coverage more affordable for individuals, families, and employers."

 The prescription benefits management company Express Scripts issued a report last week titled "Nine Trends in Rx Plan Management." The report notes that

Concerns with member health behaviors have rekindled an interest in wellness programs. While only 58 percent of respondents report that they currently use a wellness plan, 81 percent say they intend to offer one in the next two years.

Integrated pharmacy/medical data is likely to play an increasing role in identifying members at risk, and coordinating efforts with disease management and wellness vendors.

Unfortunately, the Obama Administration's legislative proposal to shift FEHBP prescription drug management from the FEHB plan carriers to OPM, if adopted, would disrupt such ongoing care coordination efforts

Health Data Management reports that the Medical Group Management Association weighed in with 27 pages of comments on the proposed HHS rule to create a standard health plan identifier. The MGMA wants a lot more numbers that HHS.

The proposed rule permits a health plan to enumerate itself with just one identification number, but insurers often have multiple plans with different benefit levels and fee schedules. “Without knowing which entity performs each role in the revenue cycle, physician practices experience difficulties in processing transactions, reconciling claims and posting payments, all contributing to patient dissatisfaction and confusion,” according to the letter.

The MGMA's comments don't make a lot of sense to the FEHBlog because the details about the member's coverage already can be drawn from the member's identification number.  Hopefully common sense will prevail.