Yesterday, the House Oversight and Reform Committee held a hearing on the financial condition of the U.S. Postal Service.  The upshot of the hearing according to reports from Govexec.com and the Federal News Network is that the Committee wants a 10 year financial stability plan from the Postal Service before it will move forward with postal reform legislation. The Postal Service is expected to submit the plan to Congress this July.

The Congressional Budget Office released a lengthy report today on policy considerations of single payer legislation. Modern Healthcare observes that the CBO report “largely put a damper on the idea of a U.S. single payer healthcare system.” Check it out.

Last week, the FEHBlog heard Centers for Disease Control experts talk about the importance of including pharmacists in care management teams.  Over 20 years ago, the FEHBlog heard a pharmacist working at a PBM make the same point. She suggested that health plans should compensate pharmacists for their consumer advice. In this regard, its worth pointing out this Forbes article reporting that

[The pharmacy chain] Walgreens has partnered with the National Council for Behavioral Health and the American Pharmacists Association to make training available to Walgreens pharmacy staffers in “mental health first aid,” which those involved say will help assist patients suffering from mental health conditions or substance abuse.

Walgreen’s has given mental health first aid its own website.

It turns out that this is National Childhood Immunization Week and a wide array of Health and Human Services officials are voicing their support for those immunizations.  The FEHBlog heard a helpful discussion on childhood immunizations on today’s Econtalk episode.  Here’s an except:

Emily Oster, a Brown University economics professor:  I think that sometimes in these debates about vaccines you get the feeling that people think the CDC [Centers for Disease Control] is just standing on one side, being like, ‘Oh, it’s fine. Trust us. We’re experts.’ And then the anti-vaccination side can seem more evidence-based, because they are saying, ‘Well, look at these papers. Look at this evidence that we have come up with.’ And I think, you know, that’s not right. The conclusions that the CDC is drawing, and these American Academy of Pediatrics is drawing from, these are really carefully researched. This is a thousand pages which reflects, you know, reviews of thousands and thousands for studies by many, many, many people over a period of many years. And, the conclusion is vaccines are safe and effective. But, it’s not just something people are saying. It is something we have evidence for.

Here’s a related Business Insider article on the ongoing measles outbreak which has reached 704 cases nationwide.

Employee Benefit News identifies a handful of employee wellness program engagement strategies, which make sense to the FEHBlog.

mHealthIntelligence discusses an American College of Physicians (“ACP”) survey on adoption of telehealth by internists.

According to the ACP, survey respondents cited the typical barriers to implementation – reimbursement, licensing and regulations – but they also worried that the technology would be more cumbersome and time-consuming than helpful, and they worried that their patients would not have access to the technology they’d need. 

For its part, the ACP is looking to meet that challenge. The organization plans on making available “practical resources specific to an internal medicine practice,” including guidance on reimbursement, use cases, regulatory guidelines and advice on workflow changes. 

“We hope these resources can help close the gap between physician use of telehealth and patients’ desire for flexibility and access to their physicians,” Tabassum Salam, MD, FACP, the ACP’s vice president for medical education, said in the press release.

Agreed.

Following up on a post about the Association Health Plan (“AHP”) litigation last week. the National of Association of Plan Advisors reports that the U.S. Labor Department (“DOL”) has appealed the adverse ruling against AHPs to the U.S. Court of Appeals for the District of Columbia Circuit. Further, DOL confirmed in a press release issued today that

the Department will not pursue enforcement actions against parties for potential violations stemming from actions taken before the district court’s decision in good faith reliance on the AHP rule’s validity, as long as parties meet their responsibilities to association members and their participants and beneficiaries to pay health benefit claims as promised. Nor will the Department take action against existing AHPs for continuing to provide benefits to members who enrolled in good faith reliance on the AHP rule’s validity before the district court’s order, through the remainder of the applicable plan year or contract term.

Congress returns to work on Capitol Hill this week following a two week break. The FEHBlog had understood that OPM’s Acting Director Margaret Weichert would appear before the House Oversight and Reform Committee on May 1 to provide details on the OPM reorganization.  Federal News Network clarifies that

[While] Weichert was supposed to testify before the committee May 1, and OPM was supposed to provide documents subpoenaed by the committee at the same time [* * * ,] [Rep. Gerry] Connolly [D VA] said Weichert postponed until later in the month, and OPM isn’t providing the documents until she testifies.

The Health and Human Services Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, delivered good news to HIPAA regulated entities late Friday afternoon by releasing a notice of enforcement discretion concerning HIPAA’s Civil Penalties. OCR rationalized its enforcement policy by aligning the maximum penalty amount with the culpability tier.

According to Modern Healthcare, “the possible penalties for each tier now look like this:

    Tier 1: $100-$50,00 per violation, capped at $25,000 per year the issue persisted
    Tier 2: $1,000-$50,000 per violation, capped at $100,000 per year the issue persisted
    Tier 3: $10,000-$50,000 per violation, capped at $250,000 per year the issue persisted
    Tier 4: $50,000 per violation, capped at $1.5 million per year the issue persisted.”

Previously the maximum penalty was $1.5 million at all culpability tiers.

Healthcare Dive reports that Humana and telehealth provider Doctor on Demand have developed a new virtual primary care program called On Hand. On Hand is integrated with Doctor on Demand’s Synapse platform.

Doctor On Demand’s Synapse platform provides a range of health and wellness services, from preventive health to chronic care, urgent care and behavioral health, all through video visits. The platform also allows patients to access their digital health records and updates, including from connected devices. 

Per DocWire News, Doctor on Demand was created in 2012 by Jay McGraw and his father Dr. Phil McGraw, host of TV’s “Dr. Phil.”

The FEHBlog was surprised to read in Healthcare Dive that the Federal Trade Commission is “suing “Surescripts, accusing the health IT vendor of acting illegally to maintain monopolies in electronic prescription markets for routing orders from providers to pharmacies and for determining patient eligibility for coverage of the drugs.” CVS Health,  Express Scripts, and two pharmacy trade associations own SureScripts. The Dive adds

Surescripts said it processed 1.77 billion transactions last year, a nearly 30% increase from the year before, and touted connections to “virtually all” EHR vendors, pharmacy benefit managers, pharmacies and clinicians. In a statement provided to Healthcare Dive, Surescripts CEO Tom Skelton said the company is cooperating with the investigation and has “operated fairly” for more than 18 years.

 In other words, Surescripts is a model for interoperability.

Healthcare Dive also reports that

Amazon has begun marketing [its subsidiary] PillPack’s at-home prescription drug delivery to Amazon Prime members via email and created a webpage about the service. Some customers reported Tuesday they received emails about the monthly medication delivery service, touting zero shipping costs and increased convenience.

Healthcare Dive offers a supportive article about Medicare’s primary care reform initiative discussed in this past Monday’s musings. “Atul Gawande, CEO of the Amazon-J.P. Morgan-Berkshire Hathaway joint venture now called Haven, voiced support [as did the American Medical Association and the American Hospital Association.] He emphasized its potential to enable “using telehealth, health coaches and other innovations.”

The Centers for Medicare and Medicaid Services issued its proposed Fiscal Year 2020 inpatient inpatient prospective pricing rule yesterday.  “The proposed 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 3.2 percent.” Healthcare Dive discusses the proposed rule’s efforts to support rural hospitals.

The Wall Street Journal reports that Anthem, the large Blue Cross licensee, plans to pass along prescription drug rebates to consumers in insured plans. Anthem will allow self-funded employers to decide whether or not to take this step.

Federal News Network reports tonight that

President Donald Trump has officially authorized the transfer of the governmentwide suitability, credentialing and security clearance portfolio from the Office of Personnel Management to the Defense Department. The move was highly anticipated. An executive order, which Trump signed Wednesday evening, makes the transfer official 

The executive order officially renames the Pentagon’s Defense Security Service as the Defense Counterintelligence and Security Agency (DCSA). The DCSA will serve as the primary security clearance provider for all of government, effective June 24.

A week or so ago, the FEHBlog mentioned a study finding low primary care utilization in the Medicare program. Today, the Centers for Medicare and Medicaid Services announced a new program to reverse this trend. “The CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths: Primary Care First and Direct Contracting.” The FEHBlog is a strong believer in the value of primary care. It will be interesting to see whether this new program bears fruit.

The Associated Press reports that the current flu season is now the longest in a decade.

Some experts likened the unusual double waves to having two different flu seasons compressed, back-to-back, into one.  Still, this flu season is not nearly as bad as last winter’s 19-week season, the deadliest in at least four decades. An estimated 80,000 Americans died of flu and its complications last season. The [U.S. Centers for Disease Control] CDC is estimating that flu-related deaths this season in the range of 35,000 to 55,000. More good news: [Lynette] Brammer [from the CDC] said that although the virus is notoriously unpredictable, signs suggest this flu season should be over soon. 

2019 is the centenary of the second year of the worst flu pandemic in modern history. The 1918-1919 flu season killed 40 million people.

Health Data Management reports how hospitals are using technology to take better control over lengths of inpatient stay.

First, instead of addressing operational issues as projects, health systems need to facilitate system-wide culture changes. Second, health systems must replace manual processes with advanced analytics solutions that automate the information needed to drive LOS improvements. Both will help ensure that LOS improvements are sustained over time.

That’s clearly a cost saver for providers, payers and patients.

mHealth Intelligence discusses a PCORI funded study that Yale Medicine is conducting to determine whether remotely deliver care can address the health needs of pregnant women with opioid use disorder.  Yale researched will be comparing

a collaborative care model that uses virtual care for psychiatric consults with a Project ECHO model that uses telemedicine to train remote care providers. Both models will include Medication-Assisted Treatment (MAT) therapy, which combines the prescription of controlled medications to manage withdrawal with mental health counseling. MAT therapy often includes monitoring and therapy though connected care channels, especially for patients in remote areas.

Good luck with that effort.

Happy Easter! Congress remains on its state / district work period for the week following Easter which coincides mostly with Passover.

Govexec.com provides us with background on the President’s pick to lead the Office of Personnel Management, Ms. Dale Cabaniss. Her nomination was received by the Senate on March 5, 2019. The nomination was referred to the Senate Homeland Security and Governmental Affairs Committee.

Ledger Insights provides an overview of the numerous alliances that have developed among health insurers, prescription benefit managers, and clearinghouses to implement blockchain technology.  The article adds that

NASCO has been exploring blockchain with BCBS since 2018. It has already executed a successful pilot that aimed to address several issues. For example, there are problems identifying patients across BCBS entities, stale or incomplete data, and inconsistent data formats. The ultimate goal is to make the process more efficient and improve member experiences.

“As both a co-owner and customer of NASCO, we recognize the value of interoperability as a key pillar of our strategy,” said Bill Fandrich, Senior Vice President and CIO for BCBSM. “Our recent success leveraging blockchain, in partnership with several other Blue plans [and NASCO] in the [new] Coalesce Health Alliance, is one step in that journey.

Yesterday, the Centers for Medicare and Medicaid Services issued the final 2020 notice of benefit and payment parameters under the Affordable Care Act. Two provisions of this lengthy notice impact FEHB and other large group health plans. Per the Fact Sheet:

Employee Benefit News offers a perspective on how employer sponsored health plans can help with the opioid epidemic. The article focuses on improving addiction treatment coverage. It also mentions at the top that employers and plans should encourage members to safely dispose of unused prescription drugs. In that regard,

• The Drug Enforcement Agency is holding an semi-annual National Take Back Day on April 27. 
• The nation’s pharmacies are supporting and supplementing this effort as explained in the CVS Health press release from last October. 
• A Health Affairs blog article discusses controlling opioids in the senior population sector. 

The Federal Times reports that government payroll offices have notified federal employees that generally they can expect to receipt their retroactive 2019 pay raise in their next paycheck for the period covering April 1 through April 14.

The FEHBlog learned from Fortune Brainstorm Health (a useful daily email) that the Journal of the American Medical Association published a clinical study on the efficacy of employer wellness programs.

Question  What is the effect of a multicomponent workplace wellness program on health and economic outcomes?

Findings  In this cluster randomized trial involving 32 974 employees at a large US warehouse retail company, worksites with the wellness program had an 8.3-percentage point higher rate of employees who reported engaging in regular exercise and a 13.6-percentage point higher rate of employees who reported actively managing their weight, but there were no significant differences in other self-reported health and behaviors; clinical markers of health; health care spending or utilization; or absenteeism, tenure, or job performance after 18 months.

Meaning  Employees exposed to a workplace wellness program reported significantly greater rates of some positive health behaviors compared with those who were not exposed, but there were no significant effects on clinical measures of health, health care spending and utilization, or employment outcomes after 18 months.

Healthcare Dives riffs on a RAND study finding low primary care utilization in Medicare.

A dearth of primary care physicians (PCPs) starts a chain reaction leading to lessened care access, more emergency department visits and more spend for payers and providers overall. A recent Premier analysis found that primary care has a bottom line impact for hospitals. More PCPs could help patients better control chronic conditions, resulting in fewer ED visits (and billions in savings for cash-strapped hospitals).

The problem stems at least partially from the fact that health plans, particularly Medicare, underpay primary care providers compared to specialists. It would be interesting to learn whether patients who pay extra for primary care providers who don’t participate in Medicare have better health outcomes.