The Federal Benefits Open Season opens tomorrow November 11, Veterans’ Day. Here a link to the OPM Director’s Veterans’ Day statement.

Congress will resume its work on Capitol Hill following tomorrow’s holiday.

The Federal News Network reports on the results of OPM’s 2019 Federal Employee Viewpoint Survey. “A quick glance at the results shows employee engagement across government remained stable in 2019 with a score of 68%, the same as the previous year.”  Here’s a link to the OPM’s report on the FEVS.

Forbes provides its perspective on last Friday’s CMS announcement of 2020 Medicare Parts A and B premiums and cost sharing amounts.  The basic Medicare Part B premium increased 7% from 2019 to 2020. CMS blamed the increase on the cost of physician administered drugs covered under Part B.

Business Insider reports regrettably that Kaiser Permanente’s Board Chairman CEO Bernard Tyson died in his sleep last night at the age of 60. .Mr. Tyson worked for Kaiser Permanente for 34 years and served as its corporate leader since 2013. RIP  Kaiser Permanente is the third largest carrier in the FEHBP. “Gregory A. Adams, who previously served as executive vice president and group president, immediately assumed the role of interim chairman and CEO.”

The FEHBlog has been bemoaning the fact that Senate has not joined the House of Representatives (H.R. 748) in in voting to repeal the Affordable Care Act’s high cost plan excise tax a/k/a the Cadillac tax. The FEHBlog expects that the Cadillac tax will have an outsized adverse impact on the FEHBP due to low family sizes and adverse demographics in the FEHBP.  The FEHBlog listened to an American Bar Association Health Law Section webinar on health care reform activities on Capitol Hill. The speakers were two staff members with healthcare portfolios from the majority party of each House. The Republican Senate staff member explained his understanding that the Senate will not act on repealing a tax, even one has harebrained as this one (FEHBog edit) without an offset or pay go, e.g., increased revenue and/or decreased spending. The Democrat House staff member pointed out that the 2017 tax reform bill did not require a pay-go and could have, but did not, include the controversial ACA taxes. Sigh.

Speaking of the House of Representatives, Govexec.com reports that “the House will vote the week of Nov. 18 on a measure to keep federal agencies open past Nov. 21, when a current stopgap bill is set to expire.” The article suggests that the extension may only be for 30 days rather than three months.  A brief extension could trigger post traumatic stress disorder for federal employees.

Also the Centers for Medicare and Medicaid Services announced today the 2020 Medicare Parts and B premium and cost sharing amounts. Highlights

• The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019. 

• For 2020, the Medicare Part B monthly premiums and the annual deductible are higher than the 2019 amounts. The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.

In other news:

• Healthcare Dive reports that the Medicare Payment Advisory Commission, which advises Congress on Medicare issues, has concluded that both vertical and horizontal hospital consolidation is correlated with higher healthcare costs, n yet another study finding rampant mergers and acquisitions drive up prices for consumers. The American Hospital Association reports that 

several commissioners urged MedPAC staff to examine how consolidation among hospitals correlates with consolidation among other stakeholders, including health insurers, pharmacy benefit managers and group purchasing organizations, in order to assess impacts in the context of larger health care environment dynamics. The commissioners also challenged some staff conclusions that federal policy does not create incentives for consolidation, noting Medicare underpayments and electronic health record requirements as possible drivers

• Becker’s Hospital Review reports on the Leapfrog Group’s Fall 2019 hospital safety ratings. 

Tammy Flanagan offers more advice for the Federal Benefits Open Season which begins on Monday.

CVS Health and Humana reported their third quarter results this week. Fierce Healthcare reports that CVS Health is pleased with the success of its new HealthHub retail locations and its acquisition of Aetna.  Healthcare Dive reports that Humana, which enjoyed good quarterly results, “has been preparing for a meaningful headwind as the health insurance fee is reinstated in 2020. CEO Bruce Broussard said the payer trimmed 2% of its workforce and warned that some members will experience an increase in premiums and a reduction in benefits as a result of the HIF.”  It’s a shame that Congress can’t get it together to repeal these counterproductive ACA taxes.

Health Payer Intelligence discusses how health insurers (Blue Cross of Rhode Island) are using telehealth to fill coverage gaps (child psychiatrists in this case.)

The FEHBlog appreciate the time that readers take to send comments or questions. The FEHBlog does try to reply in the blog or by sending messages to carriers.

The FEHBlog noted on Sunday that OPM has released its FEHBP 2020 plan comparison tool in advance of Open Season.  Govexec.com reports on new features in the plan comparison tool

In terms of enhanced display, “as you’re scrolling through the different plans, the header bar is now frozen, so that people know where they are when they’re surfing,” the official said. The agency made some other technical changes to the website to improve visibility and organization of information. 

Overseas enrollees can now check a box so that they don’t have to enter their ZIP code to be able to search for plans. For Medicare enrollees, there is a new enhanced section that displays what they can expect to pay for services and benefits under Medicare parts A and B. 

Well done.  Moreover,

OPM is working to reduce the number of pages of plan brochures, which are also available through the agency’s website. * * * 

 Finally, for federal dental and vision coverage, OPM added links to the plans’ websites, provider directory and brochures. 

Good moves.

The FEHBlog noted CMS’s major Medicare 2020 payments to providers rule making last Friday. Becker’s Hospital CFO Reports provides nine key takeaways from these regulatory actions that impact the healthcare economy.

Last week, the FEHBlog provided two weeks on the HLTH conference. Here’s a third link from MedCity News. By the way, while this link like this one as well concern the patient experience, that’s the flip side pf the plan member coin.

Last 18 months or so there has been  a lot of press excitement about the creation of the Amazon – Berkshire Hathaway — JPMorgan healthcare consortium Haven Health to provide at least initially a health plan to their employees.  Becker’s Payer Issues reports that

JPMorgan is offering 30,000 workers in Ohio and Arizona two insurance plans under Haven Healthcare next year. The plan will be run by Cigna and Aetna and offers such perks as monthly financial rewards for meeting wellness goals, such as keeping blood pressure below a specific threshold. The money could be used to offset other out-of-pocket expenses, like prescriptions or physician visits, according to people familiar with the plan cited by Bloomberg.   

Congress remains in session on Capitol Hill this week. We are less than three weeks away from the November 21 continuing resolution deadline. The Senate has passed passed a consolidated domestic appropriations bill (HR 3055) last week  It needs to pass two other consolidated bills, including defense and then the two Houses can hold a conference committee. That’s unlikely to happen within two weeks and it’s therefore likely that Congress will punt the issue down the road into early 2020 as noted in this space recently. Why o why hasn’t the Senate approved the House passed bill repealing the ACA’s high cost health plan excise tax a/k/a the Cadillac tax?

The federal benefits open season begins on November 11, one week from tomorrow. The FEHBllog was pleased to see that OPM already already has launched the 2020 version of its online plan comparison tool. The FEHBlog is puzzled why CMS has not released the 2020 Medicare Parts A and B premium and  cost sharing information yet.

Health Payer Intelligence offers an article explaining why health savings accounts are useful for all employees, including the younger generations. .

The Centers for Medicare and Medicaid Services has had a very busy week:

• Monday, the agency finalized the repeal of the national health plan identifier and other entity designation rule under HIPAA.  The notice explains that 

This final rule eliminates the regulatory requirement for health plans to obtain and use an HPID and eliminates the voluntary acquisition and use of the OEID. The final rule also simplifies the process for deactivating the existing identifiers to minimize operational costs for covered entities. On or after the effective date of this final rule, any active HPID or OEID will be automatically deactivated in the Health Plan and Other Entity Enumeration System (HPOES). If your organization has an HPID or OEID, please take action now to save any necessary information from those records. This rule will become effective 60 days after its publication date.

• Yesterday and today, the agency released final rules for Medicare’s calendar year 2020 payment systems for hospital outpatient payment care, physician care, and durable medical equipment / end stage renal disease care.  Healthcare Dive adds that 

[In these rulemakings] President Donald Trump’s administration is pushing back a proposal that would have required hospitals to make public the secret rates it negotiates with insurers. 

CMS said it received more than 1,400 comments on revealing rates and will respond to those comments in an upcoming rule. 

The proposal first put forward in July went one step beyond a CMS move from last year, which required hospitals to post the list price, or the initial price before insurance negotiations, online in a machine-readable format. Many criticized the move and said the data was useless for consumers with insurance coverage.

In other news Healthcare Dive

•  offers its take the the HLTH conference;

Therapy for Peanut Allergies  –It’s a terrifying reality for 2.5 percent of parents – the possibility that at any moment, their child might be unable to breathe due to an allergic reaction. Though emergency epinephrine has reduced the severity and risk of accidental exposure, these innovations are not enough to quell the ever-present anxiety. But development of a new oral immunotherapy medication to gradually build tolerance to peanut exposure holds the opportunity to lend protection against attack.

Bravo for the innovators.

Fierce Healthcare brings us up to date on the HLTH Conference held in Las Vegas earlier this week.

Axios reports that New York State’s surprise billing law which relies on payer-provider arbitration raising health care costs. Told you so.

Yesterday, the Department of Health and Human Services launched “FindTreatment.gov, a newly designed website that will help connect Americans looking for substance abuse treatment with approximately 13,000 locations across the United States.”

“Visitors can access information on location, treatment options, payment and insurance information, and over 13,000 state-licensed facilities, based on data compiled by SAMHSA

Examples of treatment include:

    Residential treatment – Live-in care, lasting for a month up to one year
    Outpatient treatment – Treatment at a program site while the patient continues to live on their own
    Detoxification – Supervised withdrawal from substance use
    Interim care – When immediate admission to other care isn’t available”

Earlier this week, the U.S. Food and Drug Administration released a report on prescription drug shortages.

The report identifies three root causes for drug shortages:

1. Lack of incentives for manufacturers to produce less profitable drugs;
2. The market does not recognize and reward manufacturers for “mature quality systems” that focus on continuous improvement and early detection of supply chain issues; and
3. Logistical and regulatory challenges make it difficult for the market to recover from a disruption.

The report also recommends enduring solutions to address drug shortages. These solutions include

1. Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages;
2. Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and
3. Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.  

Telehealth providers are looking to move beyond urgent care services   For example,

• American Well announced a new venture with the Cleveland Clinic called the Clinic. “The Clinic will offer convenient online access to expert care across a wide array of specialties without requiring individuals to leave their homes. Through a secure digital platform powered by American Well, people from around the world will be able to connect with Cleveland Clinic’s leading specialists and receive insights, opinions, recommendations, and assistance for a variety of conditions.”  The American Hospital Association delves into the deal here.

Walgreens’s roughly 400 walk-in clinics and CVS’s 1,000 Minute Clinic locations have at best barely broken even for the companies. The goal now for both is to shift away from treating minor or acute issues and focus instead on people with chronic conditions such as diabetes, heart disease and hypertension.

The news is that Walgreens “said Monday it will close the roughly 160 in-store health clinics the company runs itself in the U.S., while keeping 220 clinics that are run by local health systems. It didn’t provide an estimate for the financial impact.”

Last but not least, Health Payer Intelligence reports that

To counteract the high-cost, high-risk potential of using opioids to treat back pain, UnitedHealthCare (“UHC”) created a benefit that does not rely on medication or technology but rather on physical therapy and chiropractic care.

The benefit allows eligible employers to offer physical therapist and chiropractor visits with no out-of-pocket costs. Members who already receive physical therapist and chiropractic care benefits under UHC’s employer-sponsored health plans and who have maxed out their visits will not receive additional visits under this benefit.

However, for those who still have visits to use and who choose physical therapy or chiropractic care over other forms of treatment, the copay or deductible for those visits will be waived and they will receive three visits at no cost.  UHC has high expectations for the fiscal and physical impacts of this benefit.

Congress remains in session on Capitol Hill this week.

Healthcare Dive informs us that

Amazon has bought tech startup Health Navigator in its first major health-related acquisition since the Seattle-based retailer purchased PillPack last year, the company confirmed to Healthcare Dive.  Health Navigator, which provides online symptom checking, clinical documentation support and triage tools to route patients to the correct site of care, will be folded into Amazon’s virtual medical clinic Amazon Care.

Amazon Care currently (at least for now) is an employee benefits program for Seattle area based Amazon employees. Amazon’s HQ is in located that fair city.

Speaking of virtual care, Health Data Management reports on CVS’s Health’s Minute Clinic’s Video Visit option.  A Video Visit “costs $59 and is for patients ages two years and up who are seeking treatment for a minor illness, injury or skin conditions.” It’s available in most States and accepts FSA and HSA payments (and credit cards generally), not not insurance coverage “at this time.” Here is a link to the Video Visit FAQs.

Kaiser Health News discusses a new pharma payment model nicknamed Netflix pricing. The model “mimic[s] that media-streaming service ― call for capped costs or flat-rate subscriptions for cheap access to the drugs [particularly drugs that cure major illnesses such as Hepatitis C].”  Washington State is using such a contract to purchase from “AbbVie buys a package of services that includes outreach and testing to identify patients as well as the drugs to treat them.”  Patient advocates are objecting to the fact that the State is refusing to release details on the pricing model.

The FEHBlog head about this model at the HCP=LAN conference last week. Drug pricing is complicated by the fact that the price that Medicaid pays for a prescription drug sets the floor for other deals with the exception of Medicare Part D plans.

Yesterday, the FEHBlog attended the Health Care Payment Learning and Action Network’s (HCP LAN) summit in Washington, DC. The HCP LAN issued its annual its annual alternative payment method measurement report, which found progress in replacing fee for service payments with value based payments. Here are links to Healthcare Dive and Health Payer Intelligence articles on the summit and this report.

Defense News reports on the Senate’s efforts this week to pass necessary fiscal year 2020 appropriations bills. The upshot is the Congress is “mulling” an extension of the current continuing resolution from November 21 until February or March 2020. Federal News Network reports that the Senate appropriators do not plan to provide any fund for an OPM-GSA merger without authorizing legislation being in place. The House of Representatives is refusing to pass such authorizing legislation.

The Office of Personnel Management has announced “a new Federal Long Term Care Insurance Program (FLTCIP) plan offering: FLTCIP 3.0. The new plan and rate structure is available to applicants who apply for coverage on or after October 21, 2019. It does not impact current FLTCIP enrollee plans or premiums.  Tammy Flanagan explains the new offering here.