Congress remains in session on Capitol Hill this coming week.  Sixty years ago this week, on September 28, 1959, the Federal Employees Health Benefits Program was enacted into law.

This coming week is National Health IT Week.  The themes are Supporting Healthy Communities and driving transformation of our health and wellness ecosystem to promote better health outcomes and health equity.

The Robert Wood Johnson Foundation has updated its Culture of Health Action Framework which it introduced in 2015.

Since 2015, what do the data tell us about our progress in creating a Culture of Health in America?  We are seeing small but positive changes in the appreciation of the social determinants of health and the need for broader community health investments. However, there has been less movement in many of the structural and systems-level factors that critically influence health, well-being and equity.  

In that regard, Fierce Healthcare reports

The Centers for Medicare & Medicaid Services (CMS) recently finalized new flexibilities to allow MA plan sponsors to offer nontraditional benefits that target the social determinants of health such as air quality tools, transportation and meals for the 2020 plan year. CMS broadened those options beginning in the 2019 plan year. 

Researchers at the Urban Institute conducted a series of interviews with MA insurers, health insurance experts and social services providers that highlighted several barriers to embracing benefits that target the social determinants of health: funding challenges and struggles in targeting the right beneficiaries. * * *

As CMS did not allocate additional funding for these benefits, health plans are stuck with limited financial resources to try supplemental benefits, the report noted.  To pay for supplemental benefits, MA plan sponsors must pull from rebates CMS pays out to make up the difference between an insurers’ bid and the national benchmark, if the bid is below that marker. 

However, these rebates are often small, averaging about $107 per member per month in 2015, according to the study. Additionally, insurers pull from these funds for other efforts to lower cost-sharing or to cover benefits such as dental and vision care or gym memberships, which are popular with beneficiaries.  

Quite a conundrum.

The FEHBlog has been contemplating the Centers for Disease Control’s aggressive approach to the vaping crisis. It occurs to him that if the CDC had taken such an approach with the opioid crisis, that crisis may bave been more manageable. See, for example, the Wall Street Journal’s most recent article on Purdue Pharma,  Better to live and learn when it comes to public health.

As we approach the time when OPM announces the 2020 government contribution, the Mercer actuarial consulting firm disclosed that

Health benefit costs will grow by nearly 4% in 2020, according to early results from the latest Mercer National Survey of Employer-Sponsored Health Plans. Based on responses from 1,511 US employers1, Mercer projects that the average total health benefits cost per employee will rise by 3.9% in 2020.

The Hill reports on the House leadership’s bill to lower drug costs now.  The plan hinges on government effectively setting the prices of 250 drugs annually.  The lower prices would be available to both government and private payers. Speaker Pelosi reported plans a vote this yea.

On the technology front —

• CAQH and HL7 have announced an agreement to collaborate in three important areas

1. Prior Authorization: Currently, the prior authorization process is a labor intensive, time consuming, and costly administrative burden for providers and payers. It also frustrates patients and, in some cases, delays care. HL7 and CAQH CORE will collaborate to move the industry towards end-to-end automation of the prior authorization process.
2. Exchange of Medical Documentation: According to the CAQH Index, 84 percent of attachments, or documents that prove medical necessity, are exchanged manually and often contain too much, too little, or the wrong type of information. This delays prior authorizations, hinders the transition to value-based payments, and costs plans and providers time and money. HL7 and CAQH CORE will work to align their respective efforts to support the electronic exchange of clinical information and medical documentation.
3. Value-Based Payments: The transition to value-based payment models has been slowed by a patchwork of administrative and technical approaches and work-arounds. HL7 and CAQH CORE will work together to address the interoperability challenges causing administrative burden for innovative payment models. 

Armed with the results of a telehealth program that greatly reduced hospital readmissions, a Detroit health system is now looking for payer partnerships to expand their reach.

Executives at the Henry Ford Health System say their e-Home Care service, which provides mHealth and telemedicine technology for the Henry Ford at Home program, reduced rehospitalizations by some 45 percent during the first half of 2019, as compared to the same time period in 2018, with a monthly readmission rate dropping to as low as 7 percent.

Federal News Network brings us up to date on fiscal year 2020 appropriations issues —

• The House of Representatives passed a resolution that funds the government into the new fiscal year until November 21, 2019.  The Senate is expected to pass the same resolution next week

• The Senate Appropriations Committee approved its FY 2020 financial services and general government bill unanimously.  The bill and the resolution provide additional funding to OPM which will lose background check revenue when that service fully transfers to the Defense Department on October 1, 2019.          

Despite the hype surrounding the importance of social determinants of health, just a quarter of hospitals and 16% of physician practices screen patients for social needs that affect health outcomes, according to a JAMA study published Wednesday.

The JAMA study concludes

Although across stakeholders there is swelling momentum for addressing social needs, our study findings suggest that most physician practices and hospitals are not screening across 5 key social needs associated with health outcomes. We found that organizations participating in payment reform models were more likely to screen, and that organizations that do not screen reported misaligned incentives as a major barrier to innovations in care delivery. We believe systematic use of screening is a required first step to attend to social needs and improve health; addressing resource barriers, such as time, information, and money, may be a key element in supporting physicians and hospitals in efforts to screen patients for social needs.

Rome, of course, was not built in a day.

On the public health front

• The New York Times informs us about the Centers for Disease Control’s latest weekly report on the vaping crisis. 

The C.D.C. provided the first demographic snapshot of the afflicted: Nearly three-quarters [of the 580 afflicted people] are male, two-thirds between 18 and 34. Sixteen percent are 18 or younger. “More than half of cases are under 25 years of age,” Dr. [Anne] Schuchat [of the C.D.C.] said. Illnesses have now been reported in 38 states, and one United States territory.

• U.S. News and World Report links to this Riverside University, CA, press release stating 

A 4-year-old child from Perris [CA] who recently died tested positive for influenza, health officials said today. The child had underlying health issues and passed away at a medical facility outside of the county. 

It is considered the first pediatric flu-associated death of this flu season (2019-20) in Riverside County. There were nine flu-associated deaths in 2018-2019, and 23 during 2017-2018. 

According to Dr. Cameron Kaiser, Riverside County Public Health Officer, the child’s death is a tragic reminder of how deadly influenza can be. 

“We should never forget that the flu still kills,” Kaiser said. “I always recommend people get their flu shots every year, but a death so early in the flu season suggests this year may be worse than usual. Our hearts go out to the family and loved ones who are grieving.”
It is not too early to get a flu shot, Kaiser said, adding that the Centers for Disease Control and Prevention recommend all persons 6 months of age and older receive a flu vaccination each year, and many providers have this year’s shot already in stock. Children 8 years old and under who haven’t received at least two flu shots in prior seasons may need two shots to be fully protected; consult your primary care provider.

Federal News Network reports on today’s Senate appropriations committee markup of the FY 2020 financial services and general government appropriations bill.

The Senate subcommittee did include a proposal to give the Office of Personnel Management an additional $43 million in 2020 over the previous year’s levels — the same recommendation that cleared the House back in June.

The Senate subcommittee was silent on a federal employee pay raise for 2020 which signal support for the President’s 2.6% proposal. The House of Representatives supported a 3.1% increase in June.
Here’s a link to the Senate subcommittee’s press release. The full committee will take up this bill on Thursday.

Finger-pointing —

• Healthcare Dive discusses dueling reports — an American Medical Association report blaming health care costs on insurer consolidation and a Health Care Cost Institute report placing the blame on hospital consolidation. 

Director Dale Cabaniss officially begins her tenure as Director of the U.S. Office of Personnel Management (OPM) today [September 16] following her Senate confirmation on Sept. 11, 2019.

“I’m honored by the opportunity to serve as the Director of OPM. I look forward to delivering effective and efficient government solutions and taking on the challenges facing Federal employees and their agencies as we work together on behalf of the American people,” said Director Cabaniss.

Good luck Director Cabaniss, and thanks OMB Deputy Director Margaret Weichert for your service as acting OPM Director for nearly the past year. 

Congress remains in session on Capitol Hill this week. On Tuesday afternoon, September 17, the Senate Financial Services and General Government Subcommittee of the Committee on Appropriations will mark up the fiscal year 2020 appropriations bill for its jurisdiction which includes OPM appropriations.  The full Committee will consider the Subcommittee’s marked up bill on Thursday morning, September 19.

The Wall Street Journal’s Numbers columnist offered an interesting piece this weekend on suicides in our country.

According to researchers at Harvard University, nine out of 10 people who attempt suicide and survive won’t go on to die by suicide at a later date. Because of that, blocking access to methods of suicide—such as bridges or firearms—can be a powerful deterrent.

In 2017, the most recent year available, 47,173 people died from suicide, up from 29,350 in 2000, according to the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention.  It is the 10th leading cause of death, according to the CDC, and the focus of efforts to reduce the rate by 20% over the next five years.

The American Medical Association’s Twitter feed today called attention to a related 2017 AMA article

Also this weekend, the Wall Street Journal reported on the data manipulation issues surrounding the blockbuster genetic therapy drug, Zolgensma,  This drug cures spinal muscular atrophy in children under two years old. The most virulent form of this disease Type 1 is fatal at a very young age. Novartis charges $2,1 million for a course of treatment.

The WSJ article explains that the data manipulation was attributable to a company that Novartis had purchased. The acquired company AveXis and thus Novartis are in hot water for not promptly notifying the Food and Drug Administration about the issue.  The article further explains that the FDA deserves credit for quickly determining that the data manipulation although serious from a legal standpoint did not require pulling the life saving drug off the market.

As far as the FEHBlog can tell, Dale Cabaniss has not yet taken the reins at OPM following her Senate confirmation on Wednesday. Yesterday, OPM acting Director Margaret Weichert, who deserves a lot of credit for handling two big government jobs for nearly one year, stated yesterday

I am pleased to announce that Ms. Dale Cabaniss received Senate confirmation yesterday to serve as the next Director of OPM. I want to extend my congratulations and best wishes to her as she begins her appointment here, and I have no doubt that she has the qualifications and vision to lead this agency into the future.

The OPM website still lists Ms. Weichert as the director. Perhaps the swearing in is happening this afternoon and if not it should happen early next week.

Mike Causey from the Federal News Network posted about the 2020 cost of living allowance (“COLA”) for federal annuitants. 

COLAs are based on the increase, if any, of urban living costs from the third quarter of the current year (July, August, September) over the Consumer Price index-W for the previous year’s third quarter, if any.With two months to go in the countdown the potential COLA now stands at around 1.6%. The August COLA will be announced later this month. The COLA for September will be made public Oct. 10.

The full and exact amount of the COLA depends on the increase or decrease in the CPI-W for the months of September and August. Millions of American retirees — Social Security, civil service and military — get a catch-up-with-inflation increase each January. In 2018 the COLA was 2.8% for retirees under the Civil Service Retirement System (CSRS) and 2.0% for those retired under the Federal Employees Retirement System (FERS) which replaced it.

FERS annuitants may be eligible for Medicare’s hold harmless rule  while CSRS annuitants cannot as their Medicare premiums are paid from their Federal annuity benefits, not from Social Security benefits.

Plan Sponsor reports that

U.S. employer-provided medical benefit costs are forecasted to rise 6.5% in 2020, outpacing general inflation by 3.8%, according to the 2020 Global Medical Trend Rates Report released by Aon plc.  The increase for U.S. employer-sponsored medical plans expected next year is due to a combination of higher costs for specialty drugs, moderate price increases for care and flat or decreasing health utilization.

OPM should be announcing the 2020 government contribution toward FEHB coverage later this month along with all of the FEHB plan premiums for 2020. 

Finally, on the public health front,

• Route 50 discusses a Centers for Disease Control (CDC) report on obesity rates in the U.S. 

The nine states where more than 35% of adults are obese are Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, and West Virginia. Higher obesity levels are more concentrated in the South and Midwest, according to the CDC.

• Last night, the CDC released its latest weekly report on the vaping disease crisis. 

About 30 minutes ago, the FEHBlog watched the Senate television channel as the Senate President pro tempore announced a 54 to 38 vote in favor of confirming the President’s nominee Dale Cabaniss to be OPM Director. The next step is for Ms. Cabaniss to be sworn in. 

The Senate this afternoon approved by a 53-41 vote a cloture motion on Dale Cabaniss’s nomination to be OPM Director. According to the Senate’s latest Executive Calendar, the Senate will vote on Ms. Cabaniss’s nomination tomorrow. It appears that there will be a new OPM Director tomorrow.

The Agency for Healthcare Research and Quality has issued its 2018 National Healthcare Quality and Disparities Report. The Report

assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings.

Check it out.

The Kaiser Family Foundation has issued an analysis of 2019 medical loss ratio refunds under the Affordable Care Act that health insurers are obligated to pay.  

Using data reported by insurers to CMS, we estimate insurers will be issuing a total of at least $1.3 billion across all markets – exceeding the previous record high of $1.1 billion in 2012 (based on 2011 experience). The amount varies by market, with insurers reporting at least $743 million in the individual market, $250 million in the small group market, and $284 million in the large group market.

The insurers tend to get tripped up on the state by state approach that the ACA uses.

Mhealth Intelligence reports that the American Medical Association (“AMA”) which controls the medical procedure code set used in claim transactions has added several important new codes to the 2020 CPT 4.

Among the 248 new codes added to the list for the coming year, the AMA has created six for online digital evaluation services, or e-visits, in which care providers can connect with patients at home to exchange information. Three codes – 99421, 99422 and 99423 – relate to patient-initiated digital communication provided by a physician or other qualified healthcare professional, while three others – 98970, 98971 and 98972 – focus on communications with a “non-physician healthcare professional.”

The Senate did take up this afternoon the cloture motion on the President’s nomination to be United Nations ambassador, Kelly Craft.  The roll call vote was 54 in favor of cloture and 38 against. The Senate’s president pro tempore announced that the motion had carried. How could the motion pass without sixteenths votes? The FEHBlog consulted the CRS report on this topic which explains (p. 9) that “pursuant to precedents established by the Senate on November 21, 2013, and April 6, 2017, the Senate can invoke cloture on a nominationby a majority of Senators voting (a quorum being present), The Senate will vote on the UN ambassador’s nomination tomorrow morning and then will take a cloture motion vote on the President’s nomination of Elizabeth Darling, of Texas, to be Commissioner on Children, Youth, and Families, Department of Health and Human Services. If that motion is approved the vote on Ms. Darling’s nomination would occur after 2:15 pm tomorrow afternoon. Thereafter, the Senate will consider the cloture motions for the nominations of six other nominations, including Dale Cabaniss’s nomination to be OPM Director. Ms. Cabaniss is list fourth on this cloture motion list. A vote on Ms. Cabaniss’s nomination is likely this week.

Speaking of nominations, Healthcare Dive reports that

• President Donald Trump is weighing nominating a top executive at the MD Anderson Cancer Center as the next Food and Drug Administration Commissioner, according to multiple reports indicating the Texas oncologist, Stephen Hahn, has become a frontrunner for the post.
• Picking Hahn, or a third candidate said to be in the running, would be a change of course from acting FDA Commissioner Ned Sharpless, the former National Cancer Institute director who replaced Scott Gottlieb as agency chief in March.

Shifting specialty drug administration away from hospital settings could reduce expenses by $4 billion annually, according to a new report from United Health Group.  United Health found that administering specialty drugs in independent physician offices and patient homes, instead of hospital outpatient settings, could save insurers between $16,000 to $37,000 per privately insured patient annually.

its first enforcement action and settlement in its Right of Access Initiative.  Earlier this year, OCR announced this initiative promising to vigorously enforce the rights of patients to receive copies of their medical records promptly and without being overcharged.