Greetings from San Francisco where the FEHBlog is attending the American Bar Association’s annual meeting.

The AP reported on Wednesday that

The government is clarifying a policy change that will limit the prescribing of opioid painkillers to federal workers. The Labor Department issued a statement Tuesday saying the limitations will apply to employees injured on the job and covered under the government’s workers’ compensation program. Last week at a White House briefing a senior administration official suggested the change would apply to the federal [employees] health plan, which is a much bigger program.

The FEHBlog thinks its safe to say that the FEHBP is already on top of this issue.  Keeping pace with concerns about opioid restrictions and proper coverage of opioid addiction treatment are the issues at the heart of the ongoing opioid use crisis for FEHBP carriers.

The Government Employees Health Association (“GEHA”) announced yesterday that the Office of Personnel Management has awarded GEHA the government-wide indemnity plan contract. This statutorily mandated FEHB plan slot has been vacant since 1990. GEHA will flll the vacancy with two new options effective January 1, 2020.  GEHA is calling its new plan “Elevate.”

“The Elevate plans are specifically designed to help members achieve the health they need to live the lives they want,” said Darren Taylor, GEHA president and CEO. “We are excited to enhance our collaboration with OPM and continue to partner with our federal employee members on their health and wellness journeys.”

Good luck to GEHA.

Fierce Healthcare reports on Blue Cross of Illinois opening wellness centers for its members on the south side of Chicago. The FEHBlog likes the idea of insurers opening these facilities for members.

Healthcare Dive discusses at length the issue of whether low government prices cause hospitals to charge higher prices to commercial payers.  Because there’s no doubt that the pricing gap exists, the real issue is whether or not the gap can be reduced.

• Interesting USA Today editorial board interview with AHIP’s CEO Matt Eyles. 

• Troubling New York Times article about a Food and Drug Administration report alleging that Novartis “concealed manipulated data from the Food and Drug Administration while applying for approval of an extremely expensive gene therapy treatment and then delayed reporting the issue.”  This data concerned the $2.1 million per treatment gene therapy drug that the FDA approved last May.  “The F.D.A. said patients were not at risk, and that the treatment could still be sold. But the news that a drugmaker had manipulated or mishandled data is an unsettling moment for the pharmaceutical industry. Many companies are racing to develop breakthrough gene therapy treatments for rare and intractable diseases.”

• Equally troubling is this Washington Post article about a 27 year old man with Type 1 diabetes who ran out of his parent’s coverage and switched from a prescription insulin to an over the counter insulin. The young man died as a direct result. The article explains the public health crisis created by the following factors —

The more affordable form of the medication — sold by Walmart since 2000 under its ReliOn brand — is known as “human insulin.” It predates the genetically altered “analogue” insulin doctors routinely prescribe. While human insulin can require as many as four hours to take effect, with varying levels of success, analogue insulin is more precise and takes as little as 20 minutes to regulate blood sugar levels, patient advocates say. [Analogue insulin prices nearly tripled since 2002,  Human insulin is useful for Diabetes 2 but not Diabetes 1}.

• Finally, the Journal of the American Medical Association / Internal Medicine  offers an  editorial on whether there is hope of a pancreatic cancer screen test. The need for such a test is illustrated by the fact that “It is estimated that in 2019, about 57, 000 people will be diagnosed with pancreatic cancer in the United States and that it may soon overtake colon cancer to become the second-most common cause of cancer-related death.1 Based on recent progress in the treatment of colon cancer, the best hope for reducing the cancer-specific mortality of pancreatic cancer may be early diagnosis and treatment.” Good luck.

Congress is on recess until after Labor Day.

The FEHBlog was taken with Peggy Noonan’s Medicare for All discussion in her latest Wall Street Journal column about last week’s Democrat Presidential candidate debates —

I never minded the phrase “Medicare for All” because I figured it meant this: “We would like Medicare or some other governmental entity to be available to all who need it, and will come up with ways to ease them in and give people in trouble a break. What everyone wants is the plastic card in the wallet that says you’ve got coverage, so the ambulance isn’t turned away and the kids are treated. We can work this out. We’re America.” 

America would respond to that. A great nation must take care of its stressed, its incapable, its unlucky. 

But I don’t think that the American people understood, at least until the first debates, that Medicare for All means this: “All private insurance is abolished, we’re taking it away, you’re going to be forced into a program we’ll run, we’re going to squish this down on your head, the hospitals will have to conform with our directives whether they bankrupt it or not, and the health-insurance industry and its jobs will be extinguished.” 

And on top of that we will all have to pretend the cost of this will come from savings due to reduced paperwork, or a tax on the wealthy. 

It’s all so crazy. I heard no one in the debates say, “Guys, you are making a mistake to give the state all the power in this area. The government can rarely make things dramatically better in huge and complicated matters like this, but it is always capable of making it worse.” 

I would be very surprised if most people watching didn’t think that’s exactly what they’ll do, make it worse. 

I didn’t hear anyone say, “As you revolutionize the entire health sector, you have to be leery of upsetting all the things that make American medicine, for all its flaws, the most advanced and cutting-edge system in the world, with the greatest doctors and scientists.”
Some candidates pointed out that such sweeping plans were impractical, unrealistic, unworkable. I didn’t hear any philosophical or historical reservations.

Amen to that. It certainly would make more sense to provide needy people with better access to government funded health centers combined with good catastrophic insurance protection.

The Hill reports that earlier today the President did sign a two year federal budget deal that “suspends the debt ceiling through July 2021, removing the threat of a default during the 2020 elections, and raises domestic and military spending by more than $320 billion compared to existing law over the next two fiscal years.” Congress now has the foundation to finalize Fiscal Year 2020 appropriations bills in September.

Upon further examination of the Senate record, the Senate yesterday did begin consideration of  Dale Cabaniss’s nomination to be OPM Director. This suggests that Ms. Cabaniss’s nomination may be confirmed before long.

Today, the Centers for Medicare and Medicaid Services finalized the Medicare Part inpatient prospective payment system rule for the 2020 government fiscal year.

The increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 3.1 percent. This reflects the projected hospital market basket update of 3.0 percent reduced by a 0.4 percentage point productivity adjustment. This also reflects a +0.5 percentage point adjustment required by legislation.

The final rule also throws a bone to rural hospitals.

Employee Benefits News reports that Health Care Services Corp, a large Blue Cross licensee, is finding success with its telehealth program.  The report includes an interview with HCSC’s VP for market solutions, Tom Meier.

EBN also reports on a recent Center for Disease Control study on diabetes rates in the United States.

Large employers may be excited about recent research which looked at National Health Interview Survey data and found a near-term decline in new cases of diabetes as well as a plateau in existing U.S. cases. While the news that new cases of diabetes may be declining does sound promising, benefit managers should resist the urge to break out the champagne. 

Although, it’s understandable why they would want to celebrate. More than half of Americans under age 65 — roughly 158 million people — have health insurance through an employer, and chronic conditions like diabetes are major drivers in the year-over-year increases in employee health benefit costs. 

Two key points in the study stand out. First, researchers suggested education and prevention programs may have played a role in the decline and urged “continued emphasis on multilevel, multidisciplinary prevention to reduce both Type 2 diabetes and diabetes complications.” In other words, stakeholders must double-down, rather than let up, on interventions to prevent diabetes. Second, because the NHIS data includes only diagnosed cases of diabetes, researchers didn’t explore the rate of prediabetes. 

The article seeks to focus health plan attention on people with pre-diabetes. Interestingly,

A recent Quest Diagnostics study, found that individuals at risk of developing Type 2 diabetes who take part in an employer-sponsored wellness program that couples laboratory screening with digital interventions reduced their risk of developing the chronic disease for up to eight years. Levels for all biometric markers in the risk model, including fasting glucose, improved across all study cohorts and 62% of participants lost weight after the program, with 31% losing 5% or more body weight.

The Hill reports that “Senators left Washington on Thursday for a five-week August recess, capping off a slog of a summer stretch. Before leaving, lawmakers passed a two-year budget deal, which suspends the debt ceiling through mid-2021, and confirmed 13 judicial nominees and other high-profile picks, including Kelly Craft to be the U.S. ambassador to the United Nations.” The Senate did not consider before the break S. 1895, the bipartisan bill to lower healthcare costs, H.R. 748, the House passed bill to repeal the ACA’s high cost plan tax, or Dale Cabaniss’s nomination to be OPM Director.

The Federal News Network brings us up to date on the Trump Administration’s efforts to shift most OPM functions over to the General Services Administration.

The administration recently informed Congress of its plans to move the administrative support functions for two OPM-led councils, the Chief Human Capital Officers Council and the Performance Accountability Council, to GSA, Margaret Weichert, acting OPM director and deputy director for management at the Office of Management and Budget, told reporters Tuesday afternoon [July 30]. 

It’s a relatively small change, as GSA already supports several governmentwide executive councils and organizations, such as the Chief Information Officers Council and the Chief Financial Officers Council.

Following up on the Weekend Update, MedCity News reports that two generic drug manufacturers, Mylan and Pfizer’s UpJohn division merged to form a newco on Monday as the Wall Street Journal predicted. “Pfizer shareholders will own 57 percent of the new company, while Mylan shareholders will own 43 percent.”

The Trump Administration today announced an “action plan” to import lower cost prescription drugs into the U.S. principally from Canada.  Health Affairs blog discusses the action plan here.  Health Affairs observes

Today’s announcement certainly represents a significant shift for HHS on drug importation, but it also does not appear that the agency is eager to implement this plan in the near future. The administration is merely stating its intention to release such plans in the fuHelath ture, rather than actually doing so today. Such plans could then take months or years to implement. Most importantly, the plan relies on others — states, wholesalers, and manufacturers themselves — to do the federal government’s work for it, to demonstrate the potential for importation to be done safely and effectively. Finally, the state-based importation programs would be only demonstration projects, which (in addition to only applying in a geographic subset of the country) would be time-limited and require renewal.

Health Data Management reports that

The Centers for Medicare and Medicaid Services is launching a pilot program that leverages HL7’s Fast Healthcare Interoperability Resources standard to enable clinicians to access claims data directly within their workflow. At Tuesday’s White House Blue Button Developers Conference, CMS announced the Data at the Point of Care pilot, part of the Trump administration’s 2018 MyHealthEData initiative designed to put patients in control of their own healthcare information so they can make informed medical decisions.

Blue Button 2.0 is a FHIR based application that allows Medicare beneficiaries to access their claim information. The new initiative will allow clinicians to use a different FHIR based application to access claims data for the purpose of filling gaps in their records. HDM further reports at this White House conference that “Amazon, Google, IBM, Microsoft, Oracle, and Salesforce once again have pledged to work to advance HL7’s Fast Healthcare Interoperability Resources application programming interface.”  The FEHBlog has high hopes that the FHIR standard will solve the problem of electronic health record interoperability.  In time, the FHIR standard will allow clinicians and health plans to share healthcare quality data.

On a related note, Becker’s Hospital Review offers three things to know that about the growth of blockchain technology in healthcare.

Yesterday, pursuant to the President’s recent health quality and pricing transparency executive order, the Centers for Medicare and Medicaid Services published a proposed hospital price transparency rule for calendar year 2020 that

implements Section 2718(e) of the Public Health Service Act [part of the Affordable Care Act] and improves upon prior agency guidance that required hospitals to make public their standard charges upon request starting in 2015 (79 FR 50146) and subsequently online in a machine-readable format starting in 2019 (83 FR 41144)..  Section 2718 is entitled “Bringing Down the Cost of Health Care Coverage.”  Section 2718(e) requires each hospital operating within the United States to establish (and update) and make public a yearly list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.  In the proposed rule, we propose the following: (1) definitions of “hospital”, “standard charges”, and “items and services”; (2) requirements for making public a machine-readable file online that includes all standard charges [redefined to include both gross charges / rack rate and negotiated rates with health plans] for all hospital items and services; (3) requirements for making public payer-specific negotiated charges for a limited set of ‘shoppable’ services [serves that are scheduled in advance] that are displayed and packaged in a consumer-friendly manner; and (4) monitoring for hospital noncompliance and actions to address hospital noncompliance (including issuing a warning notice, requesting a corrective action plan, and imposing civil monetary penalties), and a process for hospitals to appeal these penalties. 

Modern Healthcare observes that several hospital systems already offer online personalized lookups of out of pocket costs for “shoppable” services.  This approach preserves the confidentiality of the negotiated insurer rates.

Speaking of hospitals, Medpage Today offers a clickable slideshow of U.S. News and World Report hospital rankings which were published this week.  The top three overall are the Mayo Clinic, Mass General, and Johns Hopkins.

Today, CMS announced that “the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, is projected to decline. Over the past three years, average Part D basic premiums have decreased by 13.5 percent, from $34.70 in 2017 to a projected $30 in 2020.”

Speaking of pharmacy benefits, the Associated Press is reporting

The government’s employee health plan [our beloved FEHBP] will tighten its rules for covering prescription opioid painkillers starting this fall, the Trump administration said Monday.The announcement by a senior administration official was part of a White House drug policy briefing. The official spoke on condition of anonymity under the media coverage rules established for the event. *** Under the new policy, initial prescription [for acute pain issues] will be a for 7-day supply, instead of 30 days, the official said. Patients will be able to get up to three refills of 7-days apiece. Formal re-authorization that involves consulting a clinical professional will be required every 28 days.

The FEHBlog expects that these standards generally are in effect in the FEHBP already. 

In other news, Fierce Healthcare informs us that CVS Health announced an expansion of its Transforming Diabetes program that several FEHB plans use.

The Senate remains in session for this final week before its August recess.

The Wall Street Journal reports that the giant prescription drug manufacturer Pfizer “is in talks to merge its off-patent drugs business with generic drugmaker Mylan NV, according to people familiar with the matter, in a deal that would create a giant global seller of lower-priced medicines.” The deal could be announced as early as tomorrow. The article’s description of the complicated nature of the prescription drug manufacturers business structures is quite interesting.

Health Payer Intelligence discusses how Blue Cross of Michigan is using virtual wellness program to successfully drive member engagement.

“The program uses a virtual format, allowing us to be scalable and deliberate,” Bjorkquist explained. “It has separate sessions for members and employers, on the same topic, and delivers content using live webinar capabilities, PowerPoint, and graphics. The intent was always to host the sessions live with audio and video, as opposed to just a podcast or audio webinar, which most people are doing.” 

The sessions are TED style, lasting approximately 13 to 14 minutes and focus on key wellness activities that will ideally improve member health. 

These sessions focus on kindness, mindfulness, financial well-being, emotional health, exercise, nutrition, meditation, social isolation, and other relevant topics. The virtual coordinator offers tips, examples, and promotes opportunities for the members to engage in activities related to the subject of the week.

Fierce Healthcare reports on four recent initial public offering in digital health companies, the most recent being Livongo and Health Catalyst.

Fierce Healthcare also reports on a new CVS Health and Aetna Foundation social derminants of health initiative oriented toward Medical and employer sponsored plan business. .

The initiative also includes the launch of a new tool aimed to help employers with Aetna plans track the impacts of the social determinants on their healthcare costs. The insurer is set to release the tool before the end of the month and add additional functionality early next year. 

Using the tool, employers will gain insights on the health of their workforce, but it will also provide valuable feedback to CVS to determine what interventions may be most useful to specific populations, according to the announcement.

The Hill reports that the U.S. House of Representatives left town today for its summer recess after passing the compromise two year budget deal. The House will return to Capitol Hill on September 9. The Senate will remain in session for the next week in order to pass the budget deal and fingers crossed the House passed bill repealing the ACA’s high cost plan tax (H.R 748).  

Health Leaders Media tells us about the Senate Finance Committee’s 19-9 decision today to approve its bipartisan leadership bill to lower Medicare and Medicaid prescription drug costs.  It is conceivable that some of the bill’s provisions could wind up as amendments too S. 1895 the bill to lower health care costs. The article indicates that the House of Representatives is developing its own bill to lower prescription drug spending.

Healthcare Dive reports that

CVS Health will trial a coordinated care pilot for knee replacements in Aetna beneficiaries later this summer, CVS CEO Larry Merlo said at a Medicare Advantage conference in Washington on Tuesday. 

In the pilot, pre- and post-operative care for Aetna MA and commercial members undergoing a knee replacement procedure will be managed by a clinical team in the home, at CVS pharmacy locations and via telehealth. 

The trial is the first in a series of initiatives CVS and its payer arm Aetna are working on, Merlo said, and will be available for as many patients as possible according to a spokesperson.

The pilot will begin in Houston where CVS Health opened its first Health Hub store late last year.

Stat reports that the Senate Finance Committee leaders, Chairman Chuck Grassley (R Iowa) and Ron Wyden (D Ore.) have introduced a bill to control prescription drug spending under Medicare and Medicaid to the tune of $100 billion in savings over ten years.

The Wall Street Journal discusses health insurer efforts to improve the smartphone apps that they make available to consumers.

Insurers say new services aim to go beyond one-off telemedicine encounters, with personalized doctor recommendations, online appointment-booking and pricing information, as well as a growing array of mental-health offerings. “How do we use technology to guide people to the care that’s best for them?” said Firdaus Bhathena, CVS’s chief digital officer. “We’re working on the actual connected end-to-end experience.”

Cool.

Recently, the FEHBlog pointed out recent Centers for Disease Control statistics finding a 5% drop in opioid crisis deaths from 2017-18.  This ABC News article discusses this and other aspects of this sobering CDC report.

Between 2012 and 2017, the rates for white and black people aged 25 to 44 increased 21% each for both groups, while Hispanic people of the same age range saw a 13% rise. Sally Curtin, a statistician at the CDC’s National Center for Health Statistics and one of the report’s authors, said an uptick in suicides, homicides and drug overdoses contributed to the higher rates for the younger part of the group.. 

Also disturbing is this Reuters report concerting a study finding that sizable numbers of Americans take antibiotics without a prescription.

When people take antibiotics without a prescription, they often take unnecessary medication or choose an inappropriate drug or dose, the study team notes in the Annals of Internal Medicine. People might get sicker when they self-medicate with a drug that’s not effective for their illness, exposing themselves to potentially preventable complications – and they can also make antibiotics less effective not just for their own use but for others who need these drugs. Every time somebody takes antibiotics they don’t need, it contributes to antibiotic resistance, according to the U.S. Centers for Disease Control and Prevention.

There’s a public health issue for you.

The Internal Revenue Service announced today that the employer health coverage affordability percentage for 2020 will be 9.78%, e.g., the employee contribution for self-only coverage is less than 9.78% of W-2 income.  In the FEHBP the calculation is made against the lowest cost nationwide plan available to all employees. That 2020 percentage is down slightly from 2019’s 9.86% figure. The affordability percentage is used along with 60% minimum actuarial value to determine whether an applicable large employer complies with the affordability requirements of the ACA’s employer shared responsibility mandate. While the ACA’s individual shared responsibility provision is kaput, the employer mandate is alive and well.