The FEHBlog has heard OPM remark about its interest in adding a FEHBP enrollment tool to its FEHB plan comparison tool. Be careful what you wish for —

• Govexec.com reports about problems with Medicare’s plan finder which recently was redesigned for $11 million. 
• Federal News Network reports that TRICARE beneficiaries can’t use their on-line plan enrollment tool during this open season due to a Defense Department system glitch. “The other two options are to enroll by phone or mail.”  

UnitedHealthcare announced yesterday that it will be opening Medicare services centers at 14 Walgreen’s stores.

The UnitedHealthcare Medicare services centers will begin to open in January 2020 at Walgreens stores in the Las Vegas, Phoenix, Cleveland, Denver and Memphis markets. Through these centers, Walgreens customers can learn more about Medicare, meet with service advocates to discuss their UnitedHealthcare plan benefits and even enroll in plans. UnitedHealthcare Medicare Advantage members can also make an appointment for an in-store annual wellness visit at the Medicare services center in Walgreens through UnitedHealthcare’s HouseCalls program, helping make it easier to get needed care, tests and treatment. 

Healthcare Dive adds that “CVS Health, which owns its own insurance plan with Aetna, has made a similar move as it plans to open more than 1,500 HealthHUB stores across the country by the end of 2021. The HealthHUB stores earmark about 20% of CVS retail space to health services, with a special focus on preventive care and wellness.”  The FEHBlog wonders whether FEHB plans also will be marketed at drug stores.

Healthcare Dive also reports that

Life expectancy in the United States has fallen since 2014 after six decades of increasing. The driving force is in middle-aged deaths from drug overdoses, suicides and organ system diseases, according to a wide-reaching report published Tuesday in JAMA. The findings shows disparities in mortality trends across races and geographic locations. The largest increase in midlife mortality rates from 1959 to 2016 was in New England and the Ohio Valley.

No bueno.  On a related note, the Wall Street Journal headlines today that

Federal prosecutors have opened a criminal investigation into whether pharmaceutical companies intentionally allowed opioid painkillers to flood communities, employing laws normally used to go after drug dealers, according to people familiar with the matter.

The investigation, if it results in criminal charges, could become the largest prosecution yet of drug companies alleged to have contributed to the opioid epidemic, escalating the legal troubles of businesses that already face complex, multibillion-dollar civil litigation in courts across the country. Prosecutors are examining whether the companies violated the federal Controlled Substances Act, a statute that federal prosecutors have begun using against opioid makers and distributors this year.

Congress is out of town until December 3. Before leaving town, according to the Hill,

Top negotiators from the House and Senate have reached a long-stalled deal on top-line spending figures for the fiscal 2020 bills.

House Appropriations Committee Chairwoman Nita Lowey (D-N.Y.) and Senate Appropriations Committee Chairman Richard Shelby (R-Ala.) have settled on 302(b)s, which set the top-line number for each of the 12 government funding bills, two sources familiar with the negotiations told The Hill.

The Friday night agreement marks a breakthrough for the government funding negotiations. 

Hopefully, the ball will keep rolling and we will have a final omnibus appropriations bill before the latest deadline, December 20.

Healthcare Dive reports on Dr. Stephen Hahn’s confirmation hearing as FDA commissioner before the Senate Health Education Labor and Pensions Committee last week.

Hahn told senators he would make it a priority to address drug shortages, examine anti-competitive processes used by brand drug manufacturers to protect biologics from biosimilar competition and protect the United States’ drug supply when considering drug importation. Hahn expressed interest in boosting use of patient-focused endpoints in clinical trials for both drugs and devices.

Fierce Healthcare reports that the Stop the Health Insurer Tax coalition has launched a campaign to halt the reimposition of the onerous tax on health insurance premiums for 2020. If history is any guide, a further suspension would apply to 2021 and possibly future years but not 2020 whose premiums already have the HIT payments baked in.

Govexec.com offers another perspective on OPM’s semi-annual regulatory agenda which was released last week. Thee new OPM regulations concern temporary and seasonal employees.  For example,

[A] forthcoming proposal * * * would make temporary and seasonal employees eligible for dental and vision insurance benefits for the first time. Non-permanent feds only won regular health care under the Federal Employees Health Benefits Program in 2015. OPM said the regulation would bring Federal Employees Dental and Vision Insurance Program eligibility requirements in line with FEHBP.  

Health Payer Intelligence discuses a Milliman study, funded by the Bowman Family Foundation, on the growing discrepancy between health plan payments to primary care providers versus behavioral health providers. A point that caught the FEHBlog’s eye is that

Beneficiaries were also 5.2 times more likely to visit an out-of-network hospital for behavioral healthcare needs than they were to visit an out-of-network inpatient provider for medical or surgical care. That statistic spiked 85 percent from 2013.

Tammy Flanagan offers FEHB Open Season tips and secrets in Govexec.com.

The Wall Street Journal offers higher income Medicare beneficiaries tips on how to control their Medicare Part B and D premiums.

For 2018, the latest data available, about 7% of 54.6 million total Medicare Part B recipients owed premium surcharges on that coverage, according to Juliette Cubanski, an analyst with the nonprofit, nonpartisan Kaiser Family Foundation.

Next year some people paying surcharges will benefit because inflation adjustments have resumed for the first time since 2011. This change will drop some people into a lower surcharge category, saving them hundreds of dollars.

Healthcare Dive reports that large hospital systems have been contracting with a Nashville based start up called Contessa “to help them deliver at-home hospital care to patients who otherwise would have been admitted.”  After all, as the old saw goes, people die in hospitals.

The Health Care Cost Institute has provided a very interesting claims based study on the use of out of network providers, who give rise to the surprise billing problem.

The frequency of out-of-network bills varies by type of service. In 2017, nationally:

• 16.5% of visits with emergency room services had an out-of-network claim from an emergency medicine specialist.
• 12.9% of visits with lab/pathology services had an out-of-network claim from a pathologist.
• 8.3% of visits with anesthesiology services had an out-of-network claim from an anesthesiologist.
• 6.7% of visits with behavioral health services had an out-of-network claim from a behavioral health provider.
• 4.2% of visits with radiology services had an out-of-network claim from a radiologist.
• 2.1% of visits with surgical services had an out-of-network claim from a surgeon.
• 2.0% of visits with cardiovascular services had an out-of-network claim from a cardiovascular specialist.

Variation across states differs by type of service

The Wall Street Journal reports that Congress and the President have approved an extension of the continuing resolution funding the federal government through December 20, 2019.  “The bill also provides for a 3.1% pay increase for military personnel, sets funding aside for conducting the decennial census and extends funding for a number of health-care programs” Congress is now in recess until after the Thanksgiving holiday.

Today, the Office of Management and Budget posted the Fall 2019 regulatory update on its website.  A friend of the FEHBlog took the time to identify ongoing regulatory actions that relate to the FEHBP from OPM and HHS.

Updates:

“Federal Employees Health Benefits Program: Data Reporting,” now at OIRA. Expected publication, November 2019.

“Federal Employees Health Benefits Acquisition Matrix Regulations Self Plus One and Contract Matrix Update.” The proposed rule was published on April 2, 2019. The Spring Agenda listed October 2019 as the expected publication date for the final rule. The new expected publication date is January 2020.

“Federal Employees Health Benefits Program Regulations: Revised Guaranteed Issue Conversion Requirements.”             The proposed rule was published on February 21, 2018. The new expected date of the final rule is February 2020. The spring agenda estimated a publication date of July 2019. 

“HIPAA Privacy: Changes To Support, and Remove Barriers to, Coordinated Care and Individual Engagement.” A proposed rule is expected to be published in December 2019. The Spring agenda called for a July 2019 publication. A request for information was published in November 2018. 

“21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program.” A proposed rule was published on March 3, 2019. The Spring agenda called for the publication of November 2019 on a final rule; the new agenda retains that date.

Fierce Healthcare reports on legislative pressure on HHS concerning the last pending regulatory action.

Last week, the FEHBlog noted that the Food and Drug Administration had approved a Pfizer manufacturer bio similar version of Abbie Vie’s blockbuster specialty drug Humira. Fierce Pharma reminds us that due to patent issues, Pfizer cannot laugh its bio similar until 2023. Similarly, the Wall Street Journal reports that patent laws are interfering with the release of small molecule / regular generic drugs. These stories point out that Congress urgently needs to reform the patent laws that impair prescription drug competition.

Finally, Healthcare Dive reminds us that the Project Nightingale issues are still percolating.

There’s no dispute both actors [Ascension Health and Google] are compliant with the 1996 patient protection and privacy law [HIPAA]. But the emergence of details on Project Nightingale last week sparked renewed conversation about data sharing, especially with tech behemoths that come with a checkered past with consumer trust and data use. 

HHS’ Office of Civil Rights opened an investigation into the partnership and multiple legislators including Sens. Mark Warner, D-Va., Bill Cassidy, R-La., and Richard Blumenthal, D-Conn., along with Democrat presidential candidate Amy Klobuchar, issued statements decrying the actions of both companies.

It should come as no surprise that people are sensitive about their medical records.

This afternoon as Federal News Network reports, the House of Representatives passed an extension of the current continuing resolution funding the federal government from November 21, thought December 20, 2019. The Senate is expected to pass the bill and the President is expected to sign the bill into law before November 21 ends.

Meanwhile Govexec.com discusses GEHA’s new indemnity benefit plan options. The FEHB Act creates contract opportunities for two government wide plans — the service benefit plan which is FEP and the indemnity benefit plan which is now GEHA Elevate. The statutory term “indemnity benefit plan” had lost its unique meaning at the time Aetna stopped serving as the indemnity benefit plan carrier in 1990. One this is certain though — a carrier has the most flexibility in nationwide plan design when the plan is lauched, and GEHA has made the most of this opportunity to innovate.

Today, OPM posted its Fiscal Year 2019 financial report on its website. It’s always an interesting read for OPM wonks, like the FEHBlog. In particular, check out the Inspector General’s Top Management Challenges and the OPM’s response toward the end of the document. These sections of the document begin at page 95 of the PDF.

The FEHBlog is a fan of the EconTalk podcast. In this week’s edition, the host Russ Roberts spoke with an anesthesiologist owner of the Surgery Center of Oklahoma. This facility operates on a free market basis. The facility offers transparent, soup to nuts pricing on its website. It prefers payment in cash or cashier check and it does not accept health insurance or government program business. It will enter into contracts with self funded employers. The guest also mentioned a Free Market Medical Association to which his facility or others belong. Interesting angle.

Congress remains in session this week on Capitol Hill. The continuing resolution funding the federal government is scheduled to expire on Thursday November 21. Early this week, Congress is expected to extend the continuing resolution at least for another thirty days.

Here are links to the American Hospital Association, American’s Health Insurance Plans, and the Galen Institute on the hospital and insurer price transparency rules released on Friday.

Modern Healthcare reports that

Blue Cross & Blue Shield of Illinois is teaming up with other Blue plans to help large employers control rising medical costs and improve care for employees.

Known as the Blue high-performance network, the program aims to direct patients toward healthcare providers that consistently offer high-quality care at a lower cost. It’s the first program in 25 years to be driven by the Blue Cross Blue Shield Association—a federation of 36 independent Blue companies—rather than the plans themselves, said Jennifer Atkins, vice president of network solutions for the association.

The Blue high-performance network, or HPN, will launch January 2021 in 55 markets reaching more than 185 million people nationwide. It was designed for large national and regional employers, who Atkins said wanted more consistent quality measurements and prices across the markets in which they operate.

A smattering of medical news that caught the FEHBlog’s eye:

•  The Wall Street Journal reports that “Stents and coronary artery bypass surgery are no more effective than intensive drug treatment and better health habits in preventing millions of Americans from heart attacks and death, a large study found, shedding new light on a major controversy in cardiology.” * * *

“You won’t prolong life,” said Judith Hochman, chair of the study and senior associate dean for clinical sciences at the New York University Grossman School of Medicine. But stents or bypass surgery work better than medicine and lifestyle changes alone in relieving symptoms for people who have frequent angina, or chest pain, the researchers found. The findings, released Saturday at the American Heart Association’s annual scientific conference, should prompt more discussion between patients and their doctors about treatment, she said. 

• On Friday, the Food and Drug Administration (“FDA”) announced its approval of a bio-similar version of the blockbuster specialty drug Humira, which is used to rest inflammatory conditions. Humira is produced by Abbie Vie and the biosimilar is produced by Pfizer. This FDA “approval is one of nine new biosimilar products the FDA has taken action on in 2019, bringing the overall total of biosimilar approvals to 25.”  

Alan P. Spielman, who retired from the position of OPM’s Healthcare and Insurance Director, this past Spring has been named a Meritorious Executive Presidential Rank Award Winner for 2019. Congratulations, Alan.

This morning, the Trump Administration announced the issuance of a final price transparency rule applicable to hospitals, effective January 1, 2021,and a proposed price transparency rule applicable to health plans and insurers excluding grandfathered plans and account base plans.  The proposed rule would be applicable to the FEHBP. The comment deadline for the proposed rule will be 60 days from the rule’s publication in the Federal Register. Healthcare Dive reports on various constiuency reaction to the final and proposed rules.

Healthcare Dive also reports  “Doctors give their EHR systems an F for usability, according to a study conducted by Stanford and the Mayo Clinic in collaboration with the American Medical Association.” This is hardly surprising as the Obama Administration rushed out the free electronic health record program (which cost taxpayers over $30 billion) nearly ten years ago without fully understanding physician needs (or interoperablity).  It will take some time to straighten out this mess.

The Centers for Disease Control, which has been busy this month, released their current report on tobacco use in the U.S. Cigarettes down (“an all-time low of 13.7% in 2018”) but vaping up (“During 2017–2018, e-cigarette use among adults increased from 2.8% to
3.2%, a reversal from the decline observed among adults during
2014-2017.”)  

The Federal Times discusses the Postal Service’s latest annual financial statements. The FEHBlog has read that the Postal Service did present a ten year business plan to Congress over the summer. Congress needs to get on the ball and help the Postal Service out.

The U.S. Forest Service reports that over the next several weeks “The Federal Long-Term Care Insurance Program is hosting a virtual [Federal Employee] benefits fair during open season. You can register online to chat live with carriers and review 2020 plan details.” You can register to participate in the event here.

The FEHBlog has noted that the ACA regulators issued a new Summary of Benefits and Coverage template and related Glossary for use in 2021.  Health Affairs ACA Blog provides a summary of the changes here. Good news — “the changes from the 2017 [current] versions to the new versions are very minimal.”  Details on those changes are summarized in the article.

The Centers for Disease Control has issued its 2019 Antibiotic Resistance Threats Report, and it’s not reassuring.  

According to the report, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died.

Dedicated prevention and infection control efforts in the U.S. are working to reduce the number of infections and deaths caused by antibiotic-resistant germs, but the number of people facing antibiotic resistance is still too high. More action is needed to fully protect people.

For more information consult the new report and the CDC’s website on antibiotic resistance.

The Cigna affiliated prescription benefits manager Express Scripts has unveiled its revamped research lab located in St. Louis, MO. “Working in the Lab is a team of more than 160 experts – including physicians, pharmacists, nurses, data and behavioral scientists, and user experience and solution designers – who use their expertise, our vast data resources and advanced technology to generate and test ideas for improving care, service and costs. In the first half of 2019, solutions created at the Lab delivered health plans, employers and their beneficiaries more than $14 billion in savings.” Good luck.

Here’s a link to OPM’s Federal Benefits Open Season kick off announcement.

The EEHBlog nearly fell off his chair today when he read that the ACA regulators recently updated the Affordable Care Act Summary of Benefits and Coverage templates for use in 2021. Here’s a link to the relevant HHS page and another to the relevant Labor Department page.  The FEHBlog has not checked yet but he assumes that the templates posted on those pages are the same. Hint to the regulators — issue these updates on a regular cycle.

November is national diabetes month and the Centers for Disease Control has a useful website explaining how the widespread disease affects women differently than men.

Diabetes increases the risk of heart disease (the most common diabetes complication) by about four times in women but only about two times in men, and women have worse outcomes after a heart attack. Women are also at higher risk of other diabetes-related complications such as blindness, kidney disease, and depression.

Not only is diabetes different for women, it’s different among women—African American, Hispanic/Latina, American Indian/Alaska Native, and Asian/Pacific Islander women are more likely to have diabetes than white women.

On the healthcare data warehouse front, Healthcare Dive reports that Blue Health Intelligence, an arm of the Blue Cross Blue Shield Association, has agreed to contribute HIPAA de-identified claims data to the Health Care Cost Institute.  HCCI also receives de-identified data from Aetna, Humana, Kaiser Permanente, and Medicare. HCCI advocates for lowering healthcare costs and shares data with researchers. In contrast, the Wall Street Journal has been drawing attention to an arrangement under which a very large health system, Ascension, has retained Google to organize its electronic data.

The data [housed in Google’s cloud] includes personally identifiable information like names and dates of birth; lab tests; doctor diagnoses; medication and hospitalization history; and some billing claims and other clinical records. 

Neither doctors nor patients have been formally notified of the arrangement. Ascension, a Catholic nonprofit based in St. Louis, has more than 2,600 hospitals, nursing homes and other facilities in 21 states and Washington, D.C 

The arrangement is permitted under federal health laws, according to the companies and some privacy experts. Still, it has drawn criticism amid heightened attention to data privacy. 

“The optics are bad. The legal argument is tenuous. Ethically, this is a bad strategy. They need to tell people what they are doing,” said Ellen Wright Clayton, professor of biomedical ethics at Vanderbilt University.  

The Journal reports that the agency responsible for enforcing the HIPAA privacy and security rules is kicking the arrangement’s tires.