Weekend update

Congress is out of town this week for the Independence Day holiday. The FEHBlog is surprised that the Senate did not consider Dale Cabaniss's nomination to become OPM Director last month. Congress returns to Capitol Hill next week for the remainder of July. A Congressional recess will occur in August because this is not  Congressional election year.

The Wall Street Journal reports that

Doctors are taking a second look at the procedure known as shock therapy, saying the long-stigmatized treatment is safer than before and can be remarkably effective in patients with severe symptoms. 

Electroconvulsive therapy, its official name, is a brief electrical stimulation of the brain that causes about a minute-long seizure, helping to realign disrupted circuits. Although the treatment’s most serious potential side effect—memory loss—remains a meaningful risk, advances in technology and technique have reduced the severity. Experts say ECT is among the most effective treatments for serious depression when medications and talk therapy don’t work.

Given the fact that the FEHBP's enrollment is 50% annuitants, it's worth calling attention to this Fierce Healthcare story on a recent UnitedHealth survey finding that

Nearly 70% of Americans ages 62 and older named physical health their top concern * * * In fact, 86% of the demographic are worried about falling ill or becoming hospitalized in the near future. 

Other concerns for this demographic that made the UnitedHealthcare survey included cognitive health (16%), social health (13%), and financial health (6%). Collectively, health was of greater concern than financial stability, with 63% of respondents saying maintaining physical ability to live in retirement was more of a concern than maintaining financial stability (37%).

FEHB plans typically offer healthcare coaching programs. Perhaps coaching program attention should be directed at annuitants (if not already.)

TGIF

Govexec.com reports on an OPM employee town hall held yesterday. The FEHBlog admires the job that Acting OPM Director Margaret Weichert does at OPM. It's certainly not easy particularly considering she also holds a larger job at OMB and she knows how to maintain her cool.

Minneapolis Business Journals reports that UnitedHealth Group has named an Optum executive Dirk McMahon to replace Steve Nelson who is retiring after 15 successful years as CEO.

The Wall Street Journal reports that two large non-profit midwest hospital systems, Sanford Health and Unity Point, intend to merge their operations.

Sanford and UnityPoint have more than $11 billion in combined operating revenue from health-care and health-insurance operations and hospitals across Iowa, Illinois, Minnesota, North Dakota, South Dakota and Wisconsin. Sanford also operates long-term-care services in two dozen states after its January merger with the Evangelical Lutheran Good Samaritan Society, a Sioux Falls-based nonprofit.

StatNews offers an interesting report on flu vaccine effectiveness rates. Many vaccines have effective rates of at least 90%. The flu vaccine, whose composition changes annually, is considered successful if it has a 40% effectiveness rate. Last years vaccine had a 29% effectiveness rate. Nevertheless,

Flu shots are recommended for virtually all Americans age 6 months or older. Officials say the vaccine is still worthwhile since it works against some strains, and it likely prevented 40,000 to 90,000 hospitalizations over the winter flu season.

Becker's Hospital Review informs us that "Access to a patient portal through the EHR can help improve patients' self management of healthcare services, resulting in increased outpatient appointments and reduced emergency room visits and hospitalizations, according to a recent study published in PLOS One." Bravo.

Thursday Thoughts

The FEHBlog was stunned to read in Health Payer Intelligence that "PwC’s Health Research Institute (HRI) predicted a six percent increase in medical cost trend in 2020, with a five percent net growth rate after adjusting for increased employee cost sharing or altering of benefits." Wow.

The FEHBlog was prompted by a pop up notice on his computer to look into a new arrangement between Amazon and Rite Aid drug stores. The FEHBlog thought that the deal concerned PillPack. However, it turns out according to TechCrunch, that Rite-Aid agreed to allow Amazon to place its new Amazon package pickup service called Counter in one 100 of their stores, at least to start.

The FEHBlog ran across a press release confirming that UnitedHealth's Optum unit has closed on the acquisition of DaVita's Medical Group with the exception of Davita's Las Vega's doctors who wound up with Intermountain Healthcare at the direction of the Federal Trade Commission. It's an interesting trend that large insurers are rapidly expanding into providing healthcare. Whether intended or not, such a move is necessarily a hedge against a Medicare for All bill passing in the next decade that would kill the U.S. private health insurance market.

Federal News Network reports that the House Oversight and Reform Committee beat OPM like a drum again today over the President's reorganization plan. One of the Committee's takeaways is that

Stephen Billy, OPM Deputy Chief of Staff, testified that his agency could not provide a legal analysis of the Administration’s plan to abolish an agency that provides health care and benefits to more than 8 million people because it does not exist. This makes it clear that the Administration has no idea whether its actions related to eliminating OPM are legal, and proves that the Administration’s plan is reckless and ill-conceived.

The Administration never intended to abolish FEGLI, FEHBP, FEDVIP, etc. and the reorganization would not kill those programs. The Administration intends to transfer these functions to GSA and send the policy work to OMB.  Similarly, and for many years, federal government procurement policy is set in OMB and the contracts are created and administered in the agencies principally GSA. No doubt this particular OPM-GSA transfer requires Congressional action. But it's not reckless or ill-conceived. Acting Director Weichert sought bipartisan legislation to iron out the fine points.

Today, according to the Wall Street Journal, the House relented from its position and passed a Senate bill on emergency appropriations for the Mexican border. Does the FEHBlog think this means that eventually the House will accede to a Senate appropriations bill that adopts the Administration's reorganization plan for OPM. No way. The FEHBlog does not think that anyone in Congress wants to expend political capital on this issue. (as opposed to making political hay on it which is happening now) He does think that this development means that it's more likely that the bipartisan Senate bill to lower healthcare costs (S. 1895) will become law this year (see PwC report above).  

Midweek update

At today's Senate Health, Education, Labor, and Pensions Committee meeting, the Committee approved by a 20-3 vote a further revised version of S. 1895, a bill to lower healthcare costs, for full Senate consideration.  The Chairman Sen. Lamar Alexander ( TN) expects additional bipartisan bills from the Senate Finance Committee and other committees to be included in the bill before a Senate vote is held before the August recess.  The FEHBlog  listened to the hearing and hoo boy there was an entertaining combination of bipartisanship and hyperbole. The FEHBlog is looking forward to finding and reviewing a current version of the bill, which as they say on the Hill has legs.

Also today, the House of Representatives approved HR 3351, the Fiscal Year 2020 Financial Services and General Government appropriations by a 224-196 vote. As discussed in this Federal News Network article, the bill, which now goes to the Senate, includes a 3.1% 2020 pay raise for federal employees and clamps down on Trump Administration efforts to dismantle OPM.

Tomorrow, the U.S. Supreme Court will hold its last decision day for the October 2019 term. Today the Supreme Court issued its decision in Kisor v. Wilkie, an Administrative Procedure Act case that the FEHBlog had been following. The decision is too complicated for full FEHBlog treatment. Suffice it to say that the Supreme Court did not reach the outcome that the FEHBlog hoped to read. But it's not the end of the legal world either.

In other judicial news, a three judge panel of the U.S. Court of Appeals for the 5th Circuit, which on July 9 will hear the Texas v. United States case concerning the ACA's constitutionality, asked the parties for supplemental briefing on the following topics:

(1) Whether or not the state intervenors and the U.S. House of Representatives have standing to intervene in this appeal, see, e.g., Va. House of Delegates v. Bethune-Hill, No. 18-281 (U.S. June 17, 2019), and whether the interventions were timely as to all issues, including whether the U.S. House of Representatives’ intervention was timely as to both orders of the district court;
(2) Whether or not, if none of the intervenors have standing, there is a live case or controversy between the plaintiffs and the federal defendants given their positions on appeal, see United States v. Windsor, 570 U.S. 744 (2013); and
(3) What the appropriate conclusion is if the federal defendants’ change in position has mooted the controversy and no other defendant has standing to appeal. See, e.g. U.S. Bancorp Mort. Co. v. Bonner Mall P’ship, 513 U.S. 18 (1994); United States v. Munsingwear, Inc., 340 U.S. 36 (1950).

As you can see from item 1, the panel's action was triggered by a very recent U.S. Supreme Court decision. The FEHBlog's sense is that if the Court finds that the intervening defendants lack standing, then the whole case, including the district court decision, would collapse like a house of cards. But we shall see. The FEHBlog firmly expects the Fifth Circuit or the Supreme Court to reverse the district court decision holding the ACA constitutional if the courts get to the merits.

Also today, the HHS Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, issued frequently asked questions on permissible uses and disclosures of protected health information for coordination / continuity of care purposes. Check the out.

Tuesday Tidbits

The House of Representatives began debate this afternoon of the Fiscal Year 2020 Financial Services and General Government Appropriations bill (HR 3351) which funds OPM, its Inspector General and the FEHBP, among other line items.  Federal New Network reports on Democrat and federal employee union efforts to block the Administration's efforts to transfer certain OPM functions, including FEHBP administration to the General Services Administration. HR 3351 would block funding for this initiative.

The Senate Health Education Labor and Pensions Committee will consider the bipartisan leadership bill to lower healthcare costs (S 1895) tomorrow morning. The FEHBlog skimmed through this lengthy bill yesterday. It substance a wide variety of hot button issues, like price and quality transparency and data exchange, surprise billing, and drug pricing. Needless to say while bipartisan, it remains controversial so tomorrow's meeting will be interesting.

The Wall Street Journal reported this morning on a noticeable surge in hospital lawsuits against patients for collection of unpaid bills

The Affordable Care Act, the signature achievement of former President Barack Obama, set new requirements for nonprofit hospitals that were largely expected to curb aggressive collection efforts. These hospitals must post and provide information on their financial-assistance policies and send notices that they are planning to sue. They also must limit the amount charged to the uninsured and wait four months before using stepped-up collection efforts such as filing a lawsuit. And yet, concerns persist.

Affordable Care Act indeed!

On the prescription drug front --

• The Wall Street Journal reports that "AbbVie Inc. agreed to buy Allergan AGN 25.36% PLC for about $63 billion in a bet by the two drugmakers that a combination will deliver new sources of growth that they have struggled to find on their own." The article adds that "Buying Dublin-based Allergan would deliver a dominant position in the $8 billion-plus market for Botox and other beauty drugs, as well as a number of popular eye treatments, as AbbVie braces for the end of patent protection for the world’s top-selling drug, Humira."

• Drug Channels explains how a CVS Health lawsuit recently revealed three aspects of Amazon's PillPack strategy. 

Finally, Health Data Management discusses the efforts of cooperative Blockchain Health Utility Network to identify and implement blockchain technology in the healthcare sector. "Blockchain offers the potential to find easier solutions in healthcare for problems that stem from lack of standards or doubts about how to facilitate the secure exchange of healthcare information, said Dan Sanders, director of technology and innovation for Anthem."

Monday Musings

The President, as anticipated, did issue today an executive order on improving healthcare price and quality transparency. The order directs administration action from the Department of Health and Human Services, the Internal Revenue Service and other agencies on pretty aggressive timelines. The Wall Street Journal reports in this regard that

Some action could come soon because the administration is already working on two unrelated rules that deal with pricing. HHS is expected in July to release a hospital payment rule that may include price-disclosure requirements, and a separate health-information rule could also require rates to be publicly shared. Either regulation could become a tool for delivering on the order.

The Journal also explains that

President Trump’s order reflects a deeper worry over the escalating cost of health care animating voters and shaping the presidential election. More than two-thirds of people say that reducing health-care costs should be a top priority for the president and Congress this year, according to a January survey by the Pew Research Center. 

The Senate Health Education Labor and Pensions Committee's bipartisan bill to lower healthcare costs (S. 1895) has two titles (III and V) dealing with healthcare pricing and quality transparency. The FEHBlog expects this bill to pass the Senate but whether it can clear the House of Representatives is an open question.

The rules stemming from today's Executive Order likely will face legal challenges. In this regard, the Supreme Court took another Affordable Care Act case today. The Court will consider the case discussed at this Scotusblog link during its October 2019 term. The FEHBlog wrote an article for the American Bar Association's Health Law Section eSource on the Federal Circuit decisions that the Supreme Court will review in this case. Is there another law that has been the subject of so many legal challenges??

The FEHBlog is a fan of Russ Roberts' EconTalk podcast. Check out today's episode with Eric Topol about his new book Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. Learn about incidentalomas.

Weekend update

Congress remains in session on Capitol Hill this week. The House of Representatives is expected to vote on the Fiscal Year 2020 Financial Services and General Government appropriations bill (H.R. 3351), which includes OPM appropriations, early this week. The House Rules Committee takes up the bill tomorrow afternoon. Also as mentioned last week, the Senate Health Education Labor and Pensions Committee will vote on its bipartisan bill to lower healthcare costs (S. 1895) on Wednesday at 10:30 am.

Last Friday, the U.S. Court of Appeals for the D.C. Circuit issued its decision in the OPM data breach case. In 2015 OPM announced a massive breach of federal employee personal data. The American Federation of Government Employees brought a lawsuit for compensatory damages on behalf of group of 38 named plaintiffs and similarly situated class members. The National Treasury Employees Union alleged that OPM violated its members constitutional right to informational privacy for which declaratory and injunctive relief is appropriate. The federal district court dismissed both cases for lack of standing / a remediable injury making federal court jurisdiction appropriate. The district court further held that the plaintiffs' claims were barred by sovereign immunity, the government's general protection against lawsuits which had not been waived here. The Court of Appeals held that the plaintiffs did assert standing and that the AFGE claim alleged a cognizable claim for OPM breach of the federal Privacy Act. The Court of Appeals agreed with the district court that the NTEU's constitutional claim is not cognizable. The case now goes back to the district court although it's likely that OPM and NTEU may ask the Supreme Court to review the Court of Appeal's decision. Here's a link to an article from the Hill on this decision.

The Wall Street Journal reports that

The death rate for cardiovascular disease—which includes heart disease and strokes—has fallen just 4% since 2011 after dropping more than 70% over six decades, according to mortality statistics from the Centers for Disease Control and Prevention.

Particularly alarming is that the death rate is actually rising for middle-aged Americans.

The overall cardiovascular-disease death rate is an under-recognized contributor to the recent decline in U.S. life expectancy. While that has been driven mostly by deaths from drug overdoses and suicides, improvements in cardiovascular health are no longer providing a counterbalance. 

According to the article, the cardiovascular death rate is being driven by obesity driven diabetes type 2.  The Journal also provides a list of steps that adults can take to reduce the risk of cardiocvascular disease.  Here's a link to a similar American Heart Association list. The key step in the FEHBlog's view is exercising self control and keeping in regular touch with your primary care provider.

TGIF

Happy Summer Solstice!

The Wall Street Journal reports that on Monday the President will issue an executive order mandating healthcare price transparency.  "It’s unclear how aggressive the order will be because of the pushback from industry, and some White House advisers who have urged a more measured approach, sources said."

Healthcare Dive reports on Cigna CEO David Cordani's encouraging address to an AHIP conference earlier this week.

"We all know there is an election coming up and we all know there is a present narrative around this because society demands more value from us today. The question is: are we going to resist, are we going to collaborate, or as we look at the path forward, will we choose to lead by being able to identify the bright spots that are working?" he asked.

For its part, Cigna is promising to bend the cost curve of healthcare by committing to deliver a rate of medical cost growth that will not exceed the consumer price index by 2021. 

Health Payer Intelligence informs us about an AHIP initiative on social determinants of health known as Project Link.

Project Link encompasses three major components:

•     A learning collaborative in which insurance providers can discuss social determinants of health and social barriers, sharing how to set up new programs, what tools to use for tracking results, and how to know if the programs are successful
•     The new Project Link Website shares positive solutions for non-medical health factors through access to AHIP staff’s research, AHIP members’ programs, and various digital resources including The Healthcare Policy Podcast
•     New payer partnership opportunities with different kinds of entities encourage healthy outcomes through conquering social barriers

The Joint Commission, which accredits hospitals, nursing homes, etc. announced a new antibiotic stewardship accreditation standard for outpatient facilities that takes effect on January 1, 2020.

Tammy Flanagan, on govexec.com, offers helpful information on the options available to married couples with at least one employed federal worker for survivor benefits, including continuation of FEHBP coverage. Check it out.

Midweek update

Following up on yesterday's Senate Health Education Labor and Pensions Committee hearing, "Senate health committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) today introduced S.1895, the Lower Health Care Costs Act of 2019 — bipartisan legislation to deliver better health care at lower cost." The Committee leadership has scheduled a markup and vote on the submitted bill for June 26 at 10:30 am. Here's a link to a Workshare Comparison of the discussion draft of S. 1895 vs. the submitted version of S. 1895.

Also today the Federal Trade Commission sought public comment on a proposed consent decree approving United Healthcare's acquisition of Davita's medical group for $4.3 billion. The settlement principally involves divestiture of the Davita medical group in the Las Vegas area. The consent decree will be open to public comment for 30 days after the decree is published in the Federal Register.

Yesterday, the FEHBlog pointed out a recent American Healthcare Quality and Research report on hospital readmission. Becker's Hospital Review explains AHRQ focused on readmissions for 18 of the 21 principal diagnosis categories listed in ICD-10's diagnosis coding system. Three categories were excluded for lack of data, or because they involved planned aftercare. The average readmission cost for any diagnosis in 2016 was $14,400." The Review then listed the average readmission cost in 2016 for those 18 evaluated diagnoses.

Tuesday Tidbits

Healthcare Dive reports on today's Senate Health Education Labor and Pensions Committee hearing on its bipartisan bill to lower healthcare costs. The FEHBlog understands that the next step will be the release of a revised bill.

Health Payer Intelligence informs us about America's Health Insurance Plans' Congressional testimony last week criticizing vertical healthcare provider mergers.  AHIP's "statement emphasizes that one major cause of rising health care costs is vertical provider consolidation—when more and more of a region’s doctors and medical experts work for the same hospital or health system. We highlight research findings showing that when health systems in a region get bigger and squeeze out competition, prices go up for consumers." Of course, as Health Payer Intelligence points out, the provider associations make similar claims about payer consolidation. In the FEHBlog's view, there's no doubt that the Affordable Care Act gave tremendous momentum to provider and payer consolidations.

The Government Accountability Office made public a report on OPM's retirement application processing delays. On page 7 there's a chart breaking down the following statistic given in the report:

31.6 percent of federal employees who were on board as of September 30, 2017, will be eligible to retire in the next 5 years. Some agencies have particularly high levels of employees eligible to retire in the next 5 years.

The federal Agency for Healthcare Quality and Research released an updated report on the frequency and associate cost of hospital readmissions occurring within 30 days of discharge. The following bullets caught the FEHBlog's eye:

• In 2016, blood diseases had the highest readmission rate (25.3 percent), followed by neoplasms (17.9 percent). Pregnancy/childbirth had the lowest readmission rate (3.6 percent).
• The average cost of readmission was higher than the average cost of the index admission for two-thirds of the types of principal diagnoses.

Weekend update

Congress remains in session on Capitol Hill this coming week. On Tuesday, the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs.

This bill seeks to resolve the problem of surprise out of network billing. Kaiser Health News discusses a prime example of this problem -- air ambulance billing. The article notes that the current version of the HELP bill does not tackle air ambulance billing, but the bill is expected to be refined over the next weeks.

The FEHBlog was very impressed by this Wall Street Journal essay by a Johns Hopkins University bio-ethicist, Dr. Travis Reider, who became addicted to opioids following a motorcycle crash.  Here's an excerpt:

Opioids are not only dangerous; they also can be powerfully effective. Perhaps the greatest challenge about them today is to resist the urge to be simplistic or reactionary. America’s current crisis of overuse has led some prescribers to avoid the drugs completely, and it has led politicians to occasionally consider ham-fisted policy solutions, like limiting the lengths or dosages of prescriptions regardless of any individual patient’s needs. But when a medication has both risks and benefits, what we need isn’t one-size-fits-all policies but nuance.

The author goes onto explain what he means by nuanced policies. For example,

Doctors also must provide an exit strategy. In many instances, this would only require a plan for the number of days of use and a modest taper. But the longer a patient is exposed, the more complex the strategy may be. For every patient on opioid therapy, there must be a clinician who sees long-term management and tapering as their job. We cannot allow medical professionals to play hot potato with opioid patients, trying to toss them to someone else before the timer goes off. 

TGIF / Happy Flag Day

Yesterday, the Trump Administration finalized a rule that will permit large, medium, and small employers to offer individual coverage and excepted benefit health reimbursement arrangements to their employees effective January 1, 2020.  Here's a link to the FAQs on the new rule. 

The FEHBlog is a fan of Trump Administration rules, such as the association health plan rule, the limited duration plan rule and this rule, that expand consumer choice of health plan coverage in the wake of Congress's decision to zero out the individual health insurance mandate at the beginning of this year. The new rule can be used by employers who are subject to the ACA's employer mandate which has remained in effect subject to certain conditions.

Beckers Hospital Review reports briefly on a House Ways and Means Committee hearing on Medicare for All bills held yesterday. Medicare for All would provide no consumer choice at all.

Speaking of Medicare, the Centers for Medicare and Medicaid Services issued FAQs on its expanded Section 111 reporting program for group health plans, including FEHB plans, that kicks in on January 1, 2020.

Midweek update

Healthcare Dive reports on a House Energy and Commerce Health subcommittee hearing held yesterday on the surprise billing issue.  Payers prefer that Congress set a rate for surprise out of network care and providers prefer that Congress requires independent dispute resolution to resolve the surprise billing disputes, such as baseball arbitration in which a third party selects one the parties' proposals without negotiation. The Affordable Care Act does include a requirement that health plans pay a certain minimum amount for emergency care but that law does not require the out of network provider to accept the payment as setting the patient's debt. See ACA FAQ #15 at this link.    The payers want that finality.  In any event the new law will have a broader scope than true emergency care. The legislators were warning the industry representatives yesterday that they needed to resolve this issue quickly or legislation will happen. Expect enacted legislation.

Healthcare Dive also discusses how Humana has integrated real time benefit information, e.g., cost sharing, prior authorization, into the popular Epic electronic medical record via a tool called IntelligentRx. Smart move. Expect to see more of this integration.

Fierce Healthcare offers an interesting interview with Walgreen's Chief Medical Officer.

FH: Going forward, how do you see consumers' use of digital platforms for accessing healthcare services changing?
PC: We see that the digitization of healthcare has been well received by consumers, but there are some situations where you need to be physically there. For example: lab services. We’re running a full primary care practice at Walgreens and to be able to have that direct face-to-face interface with the provider we also find is valuable. I don’t think those two areas compete; I think they are more complementary than competitive.
As a primary care physician, I find these changes in offerings in terms of different venues of care to be very exciting. We have a challenge in this country in terms of an aging population and the increasing prevalence of chronic disease. I think we need many different ways to approach healthcare and the digital aspect is very exciting.

Tuesday Tidbits

The Hill reports that the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs next Tuesday June 18. The Committee Chairman, Sen. Lamar Alexander (R TN) plans to move the bill through Committee quickly as he reported "has said he hopes the full Senate can vote on the package in July. It could be combined with another bipartisan health care package aimed at lowering drug prices that the Senate Finance Committee is working on."

Today, the House Appropriations Committee approved for floor consideration the financial services and general government appropriations bill for the next fiscal year. The vote was along party lines.  The Federal Times reminds us that "Appropriations legislation often goes through thorough changes as it moves from House to Senate consideration and back, making it likely that the general government and financial services bill will likely look different in some ways by the time it is signed into law."

Following up on Express Script's roll out of a digital formulary, CVS Health has announced a new vendor management services for employers and other plan sponsors. Healthcare Dive explains that the new program "will allow employers to contract and manage their relationship with third-party vendors that offer employee benefits, which could be both digital and non-digital tools." Big Health's Sleepio app is the first available tool. CVS Health advises that "Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits."

Finally, here's a Reuter's report on the state of the measles breakout.

Monday Musings

Well yesterday the FEHBlog could not find a relevant Congressional hearing this week. Today FCW.com reports that the House Appropriations Committee will mark up its subcommittee approved financial services and general government appropriations bill tomorrow.  Here's a link to the Committee's announcement.

The OPM appropriations discussion begins on page 74 of the Committee report.  FCW.com explains that the Committee "calls on OPM to do a better job on its own, with the $309 million in funding allowed by the bill. Lawmakers want OPM to speed up retirement processing, eliminate delays to federal hiring and improve the user experience at USAJOBS, the only front door for applicants to federal jobs."

Health Payer Intelligence reports that the large Blue Cross licensee is acquiring Beacon Health Options, a behavioral managed care company that serves millions of people across the country.  Here's a link to the companies's press release issued last Thursday.  Health Payer Intelligence explains that

Beacon Health Options is not a payer, but instead contracts with different payers to help manage mental and behavioral health for beneficiaries. It also works with employers to help offer this as a benefit to workers. 

The acquisition by Anthem will allow Beacon Health Options to fully scale its offerings, the organizations said. In combination with Anthem’s existing mental and behavioral health management programs, the pair will be able to promote patient-centered care. 

Fierce Healthcare discusses the American Medical Collection Agency data breach. Because the company connects consumer debts for large laboratory companies, among other heath care providers, the breach is estimated to effect 20 million people.  The FEHBlog found this Krebs on Security post illuminating.

Studies

• Fierce Healthcare informs us that

Individuals who are living with chronic or acute conditions have a much different view of the social determinants of health (SDOH) compared with researchers and the media, according to a new study (PDF) out of the Anthem Public Policy Institute.

Individuals are focused on daily influences such as finding the right doctor and nutritional food, while researchers focus on more structural factors such as education and income level, according to the report. Partnered with Quid, the report made these determinations by examining the conversations in news articles and academic papers along with patient forums focused on cancer, diabetes and mental health conditions.

• The Federal Times disturbingly reports that 

Nationwide efforts to address the opioid epidemic have resulted in a reduction in the number of opioids prescribed to patients and the length of time a physician can prescribe such medication to a patient without extenuating circumstances.

But a June 6 report by the U.S. Postal Service’s Office of Inspector General found that the number of postal workers who receive opioid prescriptions under the Federal Employees’ Compensation Act program has not seen a similar reduction.

Here's a link to the full Postal Service Inspector General report.  

  

Weekend Update

Congress remains in session this week on Capital Hill. The FEHBlog does not see any relevant hearings coming up. We continue to await Senate action on the Dale Cabaniss nomination to be OPM Director.

Healthcare Dive has summarized major organizational comments submitted last week on the Senate Health Education Labor and Pensions Committee’s bipartisan discussion draft of a health care reform bill  Not much industry consensus.

Managed Care magazine discusses a Wall Street Journal open by Hoover institution scholar Scott W. Atlas MD.  The piece floated thenFEHblog’s boat.

TGIF

The FEHBlog as yet can't find any public comments on the Senate Health Education Labor and Pension Committee's discussion draft of a health care reform bill. He did gather a potpourri of public comments on the Health and Human Services / Office of National Coordinator proposed rules on electronic health record interoperability and price transparency in a dropbox for your information.

Healthcare Dive reports on the final two days of the evidentiary Tunney Act hearing before U.S. District Judge Richard Leon concerning the consent decree that lead to the Justice Department's approval of the CVS Health acquisition of Aetna last November. The judge requested post hearing briefs and will hear oral argument from counsel in mid-July.

The FEHBlog has always been a fan of reference pricing. The Health Affairs blog today discusses the success of a CALPers reference pricing initiative for outpatient surgery. Check it out.

Midweek Update

Becker's Hospital Review reports that the Blue Cross Blue Shield Association CEO Scott Serota, who has been in office since 2000, plans to retire at the end of next year.

The same publication further informs us that

OptumCare, the healthcare delivery unit of UnitedHealth Group, won't own inpatient care or post-acute care services, the health insurer's CEO said during an annual strategy conference, according to Business Insider. 

When asked by an analyst at the Sanford C. Bernstein 2019 Annual Strategic Decisions Conference in New York City whether UnitedHealth plans to expand OptumCare, CEO David Wichmann and CFO John Rex said they want to build out the company to generate $100 billion in annual revenue by 2028. That's up from $16 billion last year.  

The executives said they'll expand their footprint in areas outside of the hospital. These include urgent care practices, surgical centers and primary care offices. 

Mr. Wichmann said while it won't be building any hospitals, he does see the insurer partnering with health systems for hospital-based services. 

Express Scripts recently announced that beginning next year it will offer plan sponsors a digital health technology formulary that

will help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. Available in 2020, the digital health formulary will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition. 

By adopting a digital health formulary, plan sponsors can confidently deploy a digital health product to their members knowing it has been through a uniform review process to ensure its safety, quality, usability and affordability. The digital health formulary also will:

• reduce the administrative burden for plan sponsors associated with contracting and managing digital health companies,
• help improve affordability by leveraging Express Scripts' size and scale in the purchasing of digital health products, and
• create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market.

Initially, the digital health formulary will include solutions for diabetes, cardiovascular, behavioral health and pulmonary conditions, and will later expand to include tools for other chronic and complex conditions. 

What will they think of next? 

Finally, in this year's OPM call letter for benefit and rate proposals, OPM asked FEHB plans to consider helping control the dispensing of opioids to women who give birth by caesarian section. The Wall Street Journal reports that several top hospitals have developed a solution to the problem:

Fairview [Hospital, a member of he Cleveland Clinic system] started a pilot program in March 2018. Nurses started explaining to women that they were trying to reduce opioid use. They offered to alternate large doses of ibuprofen (Motrin) with acetaminophen (Tylenol) every three hours. Women could still request oxycodone, an opioid, for “breakthrough” pain. 

The hospital’s opioid use in C-section patients immediately dropped by more than two-thirds, Dr. Chiang says. Opioid-free hospital stays have increased to 44% from 12% over the past year. 

“The patients were doing much better. They were more awake and not so sleepy or lethargic,” Dr. Chiang says. Two other Cleveland Clinic hospitals with maternity wards also changed their protocols last year. 

Bravo.

Tuesday Tidbits

Healthcare Dive reports on CVS Health's investor announcements today.  Of note --

• CVS Health plans to open 1,500 HealthHUB stores by the end of 2021 as part of its enterprise growth strategy. By the end of this year, the pharmacy chain will expand on its initial three-store Houston pilot program and open additional locations in Houston, Atlanta, Philadelphia, southern New Jersey and Tampa, Florida.
• HealthHUBs devote about 20% of retail space to health services, focusing on preventive care, wellness activities and education and management of chronic conditions like asthma and diabetes, according to the company. 

Healthcare Dive also reports on the first day of federal district court hearings on a consent decree related to CVS Health's acquisition of Aetna last year under the Tunney Act. Today the Court heard from opponents to the merger. Tomorrow the Court will hear from supporters of the merger. The hearing wraps up on Thursday. 

We have entered virgin territory here because this is the first judicial hearing under the Tunney Act, a law which requires the Court to decide whether a consent decree is in the public interest. In the CVS Health acquisition, the Justice Department is seeking a consent decree to require Aetna to spin off its Medicare Part D business -- the spin off to Wellcare has already happened. The Cigna acquisition of Express Scripts avoided the Tunney Act because the Justice Department approved that deal without seeking a consent decree.

Speaking of Wellcare, Healthcare Payer Intelligence informs us that 

Humana broke with company policy to not comment on potential merger and acquisition matters to quell rumors of a possible merger with competitor Centene in a recent filing to the Securities and Exchange Commission. The Louisville-based company stated that it “will not make a proposal to combine with Centene as an alternative to Centene’s proposed transaction with WellCare Health Plans, Inc.” Apparently, the negative impact of speculation on the company’s stock was too much to ignore.

Finally, Healthcare Dive also lets us know that "More than 2,800 comments poured in on two wide-reaching HHS rules to promote interoperability and discourage information blocking in healthcare, with industry groups largely lauding the goal but not the means of achieving it." If at first you don't succeed, etc.

 

Monday Musing

The Wall Street Journal reports that

Everyone agrees costs for consumers have soared. Drug prices are climbing faster than inflation, a big reason workers’ out-of-pocket expenses for health care leapt 53.5% between 2006 and 2016, according to the Economic Policy Institute. Today, as costs continue to rise, spending on health care makes up nearly 18% of U.S. gross domestic product, more than double health care’s share in 1980. All told, 69% of Americans said reducing health-care costs should be a top priority for the president and Congress, according to a 2019 Pew survey. The number has risen steadily from 59% in 2014.

Nevertheless, 

Because so many people are content with their own coverage, any politician pushing policies deemed too disruptive can easily lose the argument.  For all those who worry about the state of health care in the U.S., an even bigger percentage of Americans—4 out of 5, according to Gallup—rate the quality of their health-care coverage as either “excellent” or “good.”

Tricky situation.  The key in the FEHBlog's opinion is to encourage people to use their healthcare coverage effectively, e.g., take advantage of the "free" preventive care, visit your primary care doctor and take his or her advice.

Further Coda to Weekend Update

The House Appropriations Subcommittee on Financial Services and General Government today approved by voice vote its fiscal year 2020 bill [discussed in yesterday Update and initial Coda]. The bill now moves onto full Appropriations Committee Consideration. 

Coda to the Weekend Update

Govexec.com reports tonight that the House Appropriations Subcommittee on Financial Services and General Government released the fiscal year 2020 appropriations bill that will be marked up tomorrow evening.  In pertinent part --

• the bill includes a provision to increase Federal civilian pay by 3.1 percent in 2020, and
• Office of Personnel Management (OPM) –The bill includes $339 million, an increase of $43.4 million, for OPM. The bill rejects the Administration’s proposed merger of OPM with GSA.

Weekend update

Congress returns to Capitol Hill this week. As Federal News Network noted on Friday. the House Appropriations Subcommittee on Financial Services and General Government will mark up its Fiscal Year 2020 appropriations bill tomorrow evening at 7 pm.  This bill includes FEHBP and OPM appropriations, thereby raising the Administration's OPM reorganization plan.

On Tuesday morning, the House Energy and Commerce Subcommittee on Health will consider a raft load of healthcare bills, including a bill (HR 3030) to continue for another decade the expiring ACA obligation of health plans to fund the Patient Centered Outcomes Research Institute. (The FEHBlog predicted this development.)  Meanwhile a bipartisan House bill (H.R. 1398) and a corollary Senate bill (S. 172) to extend the current suspension of the ACA's onerous health insurance tax for two more years beyond 2019 languish without committee consideration.

Also on Tuesday, according to a Wall Street Journal report,

CVS Health Corp. is expected to defend its acquisition of insurer Aetna Inc. in two high-profile settings Tuesday, seeking to sell skeptical investors and a federal judge on the nearly $70 billion deal. 

CVS lawyers are slated to be in a Washington, D.C., federal court for the start of an unusual three-day proceeding in which U.S. District Judge Richard Leon is considering whether the Justice Department adequately protected competition when it approved the deal last year. 

In New York, the Woonsocket, R.I.-based health-care company is holding an investor day to discuss its outlook, with analysts looking for evidence that CVS can improve its financial performance amid challenges to its core businesses.    

The U.S. Supreme Court starts the last month of its October 2018 term tomorrow. Oyez.com offers a list of the decided and as yet undecided cases from the current term.  The FEHBlog has been keeping his eyes on Kisor v. Wilkie

A case in which the Court will decide whether to overrule Auer v. Robbins, 519 U.S. 452 (1997), and Bowles v. Seminole Rock & Sand Co., 325 U.S. 410 (1945), which direct courts to defer to an agency’s reasonable interpretation of its own ambiguous regulation.

Fierce Healthcare reports on an Optum list of five drugs pending Food and Drug Administration approval that are expected to have a significant market impact.

The products spotlighted are:

1. Onasemnogene abeparvovec, a gene therapy under the brand name Zolgensma that was recently approved by the Food and Drug Administration. [This is the drug that the manufacturer has priced at $2.1 million per patient (over five years).]
2. NKTR-181, an opioid that is designed to be less prone to abuse. 
3. Golodirsen, a treatment for Duchenne muscular dystrophy. 
4. Upadacitinib, a treatment for rheumatoid arthritis. 
5. Tafamidis meglumine, a first-in-class treatment for transthyretin amyloid cardiomyopathy under the brand name Vyndaqel. 

As the FEHBlog has received advice about the importance of walking 10,000 steps (roughly four miles daily), the FEHBlog nearly fell off his chair laughing when he read this MarketWatch article last Friday.