Thursday Observations

David Ermer–Uncategorized–

The Wall Street Journal reports today that

Insurers are scrambling to blunt the expense of new drugs that can carry prices of more than $2 million per treatment, offering new setups aimed at making the cost of gene therapies more manageable for employers.

Cigna Corp. announced Thursday a new program that allows employers and insurers to pay per-month fees for a service that will cover the cost of gene therapies and manage their use. CVS Health Corp. says it plans to offer a new layer of coverage specifically for gene therapies, which would handle employers’ costs above a certain threshold. Anthem Inc. said it is looking at special insurance setups to help employers protect themselves from the financial impact of the drugs.

Helpful.

The Internal Revenue Service announced on Tuesday that the agency plans to collect $15,522,820,037 (yes that’s 15 trillion) from health insurers next year based on an Affordable Care Act tax unless Congress acts to further suspend or repeal that levy.  The tax necessarily increases premiums in the FEHBP which the tax heavily impacts. Cost curve up.

Healthcare Dive informs us that

UnitedHealth Group plans to link its network of tens of thousands of physicians in its population health management and care delivery business, OptumHealth, with insights it gleans from its data analytics business, OptumInsights.

  • Patients and providers will be able to access health data in real time as part of this new “digital ecosystem,” Optum CEO Andrew Witty, former chief at GlaxoSmithKline, said Thursday at the Wells Fargo Securities Healthcare Conference. It will link all Optum care locations in a particular geography and rely on a risk-based, capitated fee structure to align all participating players together, Witty said.
  • Currently, UnitedHealth has bandwidth in about a dozen U.S. cities to implement the program. It plans to partner with health systems where it doesn’t have a strong enough provider presence to advance value-based care and tackle chronic diseases. 
Impressive. 

In legal news, the U.S. Justice Department this week petitioned the U.S. Court of Appeals for the D,C, Circuit for a full court rehearing of the recent three judge panel decision to resurrect a federal labor union claim for damages against OPM and its contractor Keystone Government Solutions due to the 2015 data breach.