Congress remains in session this week on Capital Hill. The FEHBlog does not see any relevant hearings coming up. We continue to await Senate action on the Dale Cabaniss nomination to be OPM Director.

Healthcare Dive has summarized major organizational comments submitted last week on the Senate Health Education Labor and Pensions Committee’s bipartisan discussion draft of a health care reform bill  Not much industry consensus.

Managed Care magazine discusses a Wall Street Journal open by Hoover institution scholar Scott W. Atlas MD.  The piece floated thenFEHblog’s boat.

The FEHBlog as yet can’t find any public comments on the Senate Health Education Labor and Pension Committee’s discussion draft of a health care reform bill. He did gather a potpourri of public comments on the Health and Human Services / Office of National Coordinator proposed rules on electronic health record interoperability and price transparency in a dropbox for your information.

Healthcare Dive reports on the final two days of the evidentiary Tunney Act hearing before U.S. District Judge Richard Leon concerning the consent decree that lead to the Justice Department’s approval of the CVS Health acquisition of Aetna last November. The judge requested post hearing briefs and will hear oral argument from counsel in mid-July.

The FEHBlog has always been a fan of reference pricing. The Health Affairs blog today discusses the success of a CALPers reference pricing initiative for outpatient surgery. Check it out.

Becker’s Hospital Review reports that the Blue Cross Blue Shield Association CEO Scott Serota, who has been in office since 2000, plans to retire at the end of next year.

The same publication further informs us that

OptumCare, the healthcare delivery unit of UnitedHealth Group, won’t own inpatient care or post-acute care services, the health insurer’s CEO said during an annual strategy conference, according to Business Insider. 

When asked by an analyst at the Sanford C. Bernstein 2019 Annual Strategic Decisions Conference in New York City whether UnitedHealth plans to expand OptumCare, CEO David Wichmann and CFO John Rex said they want to build out the company to generate $100 billion in annual revenue by 2028. That’s up from $16 billion last year.  

The executives said they’ll expand their footprint in areas outside of the hospital. These include urgent care practices, surgical centers and primary care offices. 

Mr. Wichmann said while it won’t be building any hospitals, he does see the insurer partnering with health systems for hospital-based services. 

Express Scripts recently announced that beginning next year it will offer plan sponsors a digital health technology formulary that

will help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. Available in 2020, the digital health formulary will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition. 

By adopting a digital health formulary, plan sponsors can confidently deploy a digital health product to their members knowing it has been through a uniform review process to ensure its safety, quality, usability and affordability. The digital health formulary also will:

• reduce the administrative burden for plan sponsors associated with contracting and managing digital health companies,
• help improve affordability by leveraging Express Scripts’ size and scale in the purchasing of digital health products, and
• create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market.

Initially, the digital health formulary will include solutions for diabetes, cardiovascular, behavioral health and pulmonary conditions, and will later expand to include tools for other chronic and complex conditions. 

Healthcare Dive reports on CVS Health’s investor announcements today.  Of note —

• CVS Health plans to open 1,500 HealthHUB stores by the end of 2021 as part of its enterprise growth strategy. By the end of this year, the pharmacy chain will expand on its initial three-store Houston pilot program and open additional locations in Houston, Atlanta, Philadelphia, southern New Jersey and Tampa, Florida.
• HealthHUBs devote about 20% of retail space to health services, focusing on preventive care, wellness activities and education and management of chronic conditions like asthma and diabetes, according to the company. 

Humana broke with company policy to not comment on potential merger and acquisition matters to quell rumors of a possible merger with competitor Centene in a recent filing to the Securities and Exchange Commission. The Louisville-based company stated that it “will not make a proposal to combine with Centene as an alternative to Centene’s proposed transaction with WellCare Health Plans, Inc.” Apparently, the negative impact of speculation on the company’s stock was too much to ignore.

Finally, Healthcare Dive also lets us know that “More than 2,800 comments poured in on two wide-reaching HHS rules to promote interoperability and discourage information blocking in healthcare, with industry groups largely lauding the goal but not the means of achieving it.” If at first you don’t succeed, etc.

The Wall Street Journal reports that

Everyone agrees costs for consumers have soared. Drug prices are climbing faster than inflation, a big reason workers’ out-of-pocket expenses for health care leapt 53.5% between 2006 and 2016, according to the Economic Policy Institute. Today, as costs continue to rise, spending on health care makes up nearly 18% of U.S. gross domestic product, more than double health care’s share in 1980. All told, 69% of Americans said reducing health-care costs should be a top priority for the president and Congress, according to a 2019 Pew survey. The number has risen steadily from 59% in 2014.

Nevertheless, 

Because so many people are content with their own coverage, any politician pushing policies deemed too disruptive can easily lose the argument.  For all those who worry about the state of health care in the U.S., an even bigger percentage of Americans—4 out of 5, according to Gallup—rate the quality of their health-care coverage as either “excellent” or “good.”

Tricky situation.  The key in the FEHBlog’s opinion is to encourage people to use their healthcare coverage effectively, e.g., take advantage of the “free” preventive care, visit your primary care doctor and take his or her advice.

The House Appropriations Subcommittee on Financial Services and General Government today approved by voice vote its fiscal year 2020 bill [discussed in yesterday Update and initial Coda]. The bill now moves onto full Appropriations Committee Consideration. 

Govexec.com reports tonight that the House Appropriations Subcommittee on Financial Services and General Government released the fiscal year 2020 appropriations bill that will be marked up tomorrow evening.  In pertinent part —

• the bill includes a provision to increase Federal civilian pay by 3.1 percent in 2020, and
• Office of Personnel Management (OPM) –The bill includes $339 million, an increase of $43.4 million, for OPM. The bill rejects the Administration’s proposed merger of OPM with GSA.

Congress returns to Capitol Hill this week. As Federal News Network noted on Friday. the House Appropriations Subcommittee on Financial Services and General Government will mark up its Fiscal Year 2020 appropriations bill tomorrow evening at 7 pm.  This bill includes FEHBP and OPM appropriations, thereby raising the Administration’s OPM reorganization plan.

On Tuesday morning, the House Energy and Commerce Subcommittee on Health will consider a raft load of healthcare bills, including a bill (HR 3030) to continue for another decade the expiring ACA obligation of health plans to fund the Patient Centered Outcomes Research Institute. (The FEHBlog predicted this development.)  Meanwhile a bipartisan House bill (H.R. 1398) and a corollary Senate bill (S. 172) to extend the current suspension of the ACA’s onerous health insurance tax for two more years beyond 2019 languish without committee consideration.

Also on Tuesday, according to a Wall Street Journal report,

CVS Health Corp. is expected to defend its acquisition of insurer Aetna Inc. in two high-profile settings Tuesday, seeking to sell skeptical investors and a federal judge on the nearly $70 billion deal. 

CVS lawyers are slated to be in a Washington, D.C., federal court for the start of an unusual three-day proceeding in which U.S. District Judge Richard Leon is considering whether the Justice Department adequately protected competition when it approved the deal last year. 

In New York, the Woonsocket, R.I.-based health-care company is holding an investor day to discuss its outlook, with analysts looking for evidence that CVS can improve its financial performance amid challenges to its core businesses.    

The U.S. Supreme Court starts the last month of its October 2018 term tomorrow. Oyez.com offers a list of the decided and as yet undecided cases from the current term.  The FEHBlog has been keeping his eyes on Kisor v. Wilkie

A case in which the Court will decide whether to overrule Auer v. Robbins, 519 U.S. 452 (1997), and Bowles v. Seminole Rock & Sand Co., 325 U.S. 410 (1945), which direct courts to defer to an agency’s reasonable interpretation of its own ambiguous regulation.

Fierce Healthcare reports on an Optum list of five drugs pending Food and Drug Administration approval that are expected to have a significant market impact.

The products spotlighted are:

1. Onasemnogene abeparvovec, a gene therapy under the brand name Zolgensma that was recently approved by the Food and Drug Administration. [This is the drug that the manufacturer has priced at $2.1 million per patient (over five years).]
2. NKTR-181, an opioid that is designed to be less prone to abuse. 
3. Golodirsen, a treatment for Duchenne muscular dystrophy. 
4. Upadacitinib, a treatment for rheumatoid arthritis. 
5. Tafamidis meglumine, a first-in-class treatment for transthyretin amyloid cardiomyopathy under the brand name Vyndaqel. 

As the FEHBlog has received advice about the importance of walking 10,000 steps (roughly four miles daily), the FEHBlog nearly fell off his chair laughing when he read this MarketWatch article last Friday.

As Congress returns to Capitol Hill next Monday, Federal News Network muses on the state of the Administration’s proposed shifting of OPM’s services to the Office of Management and Budget and the General Services Administration. It’s worth a read.

Forbes opines, with supporting evidence, that “The day of solo practitioners is coming to an end . In its place will be gaggles of gastroenterologists and flocks of physicians. Mega practices are becoming the norm in American medical care.”

The Journal of the American Medical Association posits as follows:

Question  What are the prices of top-selling brand-name prescription drugs in the United States, and how have these prices changed in recent years? 

Findings  In this economic evaluation of 49 common top-selling brand-name drugs, 78% of the drugs that have been available since 2012 have seen an increase in insurer and out-of-pocket costs by more than 50%, and 44% have more than doubled in price. 

Meaning  Prices of brand-name drugs in the United States are likely to continue to increase, which warrants greater price transparency.

Amen to that.

Health Payer Intelligence reports that UnitedHealth Group is joining other health plans in offering its health plan members access to the smart phone app TalkSpace.

Through the Talkspace, individuals pay a subscription fee for unlimited messaging with one of the company’s 5,000 contracted healthcare professionals. To date, the telepsychology company has tailored services specifically to teenagers and couples.

UnitedHealth isn’t the only payer working with the telebehavioral company, which provides services to employers as part of commercial agreements with Aetna, New Directions Behavioral Health, and Magellan Health. All told, five million lives have access to these telemental services.

Earlier this month, the FEHBlog noted a Wall Street Journal article stating that the President planned to issue an executive order on healthcare pricing transparency in mid-June. Today the Washington Post reports that

The most far-reaching element favored by the White House aides developing the order would require insurers and hospitals to disclose for the first time the discounted rates they negotiate for services, according to health-care lobbyists and policy experts familiar with the deliberations. The idea has stirred such intense industry opposition, however, that it may be dropped from the final version, the sources said.

The article suggests that the executive order may include expanded requirements on hospitals to make their prices public and restrictions on hospital consolidation. The executive order must be implemented through the federal agency rule making process.

On the prescription drug front, the FEHBlog ran across this new IQVIA report about the rapidly growing number of new specialty drugs to treat cancer.

• Spending on all medicines used in the treatment of patients with cancer reached nearly $150 billion in 2018 up 12.9% for the year, driven by therapeutic drugs, as spending on supportive care drugs declined 1.5% in 2018.  * * *
• Growth in spending on oncology therapeutics through 2023 is forecast at double-digit levels in the United States * * * .

Recently the FEHBlog discussed a New Yor Times article on the “flourishing” use of stem cells to treat various joint problems and illnesses.  Today, the Food and Drug Administration issued a press release making it clear that these stem cell treatments must receive FDA approval for marketing.

R3 Stem Cell, LLC of Scottsdale, Arizona, and its chief executive officer, David Greene, M.D. The company, through its affiliated centers or clinics throughout the U.S., offers unapproved stem cell products to treat a variety of diseases and conditions, such as Lyme disease, diabetes, Parkinson’s disease, stroke, kidney failure and amyotrophic lateral sclerosis (ALS). The products offered by R3 Stem Cell, LLC are not approved by the FDA.

The Department of Health and Human Services announced today that

The Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee established by the Comprehensive Addiction and Recovery Act of 2016 – PDF, today released its final report on acute and chronic pain management best practices, calling for a balanced, individualized, patient-centered approach. 

To ensure best practices for the treatment of pain, the Task Force final report underscores the need to address stigma, risk assessment, access to care and education. It also highlights five broad categories for pain treatment: medications, interventional procedures, restorative therapies, behavioral health, and complementary and integrative health approaches. 

“There is a no one-size-fits-all approach when treating and managing patients with painful conditions,” said Vanila M. Singh, M.D., MACM, Task Force chair, and chief medical officer of the HHS Office of the Assistant Secretary for Health. “Individuals who live with pain are suffering and need compassionate, individualized and effective approaches to improving pain and clinical outcomes. This report is a roadmap that is desperately needed to treat our nation’s pain crisis.”

Federal News Network offered an article this week on the problems with the federal workforce’s demographics.

Just 770 employees in an IRS workforce of 80,000 are under the age of 30, Jerry Leach, the agency’s director of human capital analytics and technology, said last week at a panel discussion produced by Government Executive. About 230 employees are under the age of 25.  * * * Meanwhile, about 24-to-25% of the IRS workforce is eligible to retire, he added. The IRS isn’t alone.

Not surprisingly given these demographics and the fact that half of the FEHBP’s enrollees are annuitants, the average age of an FEHBP enrollee is around 60. That brings us to the closing highlight — a Kaiser Health News article about a physician who cares for the elderly and wants other doctors to learn how to treat this cadre. Sounds like good advice for health plan customer service staff too.