The FEHBlog discovered this weekend that he can link his health savings account debit card to his Amazon.com account and Amazon can tell whether or not it’s appropriate to use that card for a particular purchase. Convenient.
Check it out. An irony discovered in the article is that U.S. Justice Department has indicted electronic health record vendors In sum
10 years after President Barack Obama signed a law to accelerate the digitization of medical records—with the federal government, so far, sinking $36 billion into the effort—America has little to show for its investment. Kaiser Health News (KHN) and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials, and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it.
Quite sad.
This morning, the Office of Management and Budget released the second and final phase of the President’s FY 2020 budget proposal. The second phase included agency appendices with their individual budget proposal. The Office of Personnel Management (“OPM”) budget proposal is found beginning on page 1085 of the General Service Administration (“GSA”) appendix. We learn that OPM plans to take another shot at getting Congress to approve incorporating quality measure scores into the government contribution calculation (p. 1094).
Also check out the budget proposal’s analytical perspectives on strengthening the federal workforce, which is chock a block full of federal employment data and reorganization which explains the current approach on folding OPM’s healthcare and insurance unit into GSA.
Happy St. Patrick’s Day. Congress is hold a state work period recess this week. Here is a link to the Week in Congress’s report on last week’s actions on Capitol Hill.
Avik Roy, the Forbes columnist, suggests that the problem of surprise emergency room bills could be resolved if Congress
caps out-of-network [emergency care] prices [in the commercial market, e.g. FEHBP] at the lower of the median privately contracted rate and Medicare’s rates. Not only will such a policy end price exploitation by out-of-network emergency care providers, but also by in-network providers. It will also give market participants the opportunity to do better than Medicare, whether through value-based contracts, simple price competition, or other innovations.
A worthy idea. Health Payer Intelligence offers a report on the status of the issue on Capitol Hill.
Healthcare Dive reports that the Department of Health and Human Services announced that it is actively seeking to resolve a major regulatory headache for payers and providers created by a 1975 law (and implementing rules known as 42 CFR Part 2) that inhibits coordination of caring with patients with opioid addiction, among many substance use disorders. Good luck.
Last week, the Trump Administration announced that “National Cancer Institute Director Norman “Ned” Sharpless will serve as acting commissioner of the Food and Drug Administration,” when Dr. Scott Gottlieb steps down next month. According to MedCityNews
Sharpless has served as NCI director since October 2017, having previously served as director of the University of North Carolina’s Lineberger Comprehensive Cancer Center, since January 2014. He received his medical degree from UNC in 1993, followed by a residency in internal medicine at the Massachusetts General Hospital and a hematology-oncology fellowship at Harvard Medical School’s Dana-Farber/Partners Cancer Care.
OPM today released its call letter for 2020 FEHBP benefit and rate proposals. Here’s a link to the letter. FEHBP carriers must submit their 2020 benefit and rate proposals to OPM no later than May 31, 2019.
The Health Care Cost Institute released an interactive report on U.S. health care spending by locality over the period 2012 through 2016. Healthcare Dive notes that “Despite huge variations between cities and towns, one trend held true: Over the four-year period, the average area saw healthcare prices rise 13% and utilization drop by 17%.”
Forbes comments on a recently announced strategic alliance between Blue Cross of North Carolina and Cambia Health Solutions “that merges operations and management of two companies operating Blues plans on the East and West coasts.
Reuters reports that “The rate of first-time opioid prescriptions declined 54 percent between 2012 and 2017 in the U.S., largely because many doctors stopped prescribing the painkillers, according to a study of more than 86 million people covered by private insurance.” That’s good news, and this pendulum swing mimic what happened in this country in the early 20th century according to the excellent Sam Quinones book Dreamland about this opioid catastrophe. The problem for health plans at this stage is covering addiction treatment which made difficult by the fact that there is no unquestioned standard of care.
Healthcare Dive tells us that “Bipartisan leaders of the Senate Finance Committee have invited the five biggest pharmacy benefit managers to testify next month [April 3] on their role within the drug pricing system, the latest to take the hot seat on the topic.” The FEHBlog will keep an eye on that.
The FEHBlog was intrigued by this AHRQ news that the agency has released on the Apple Store and Google Play a free app called Question Builder. Patients can
Use the Question Builder app to:
Prepare and organize questions by type of medical encounter.
Take photos of insurance cards, pill bottles, or even a skin rash.
Access consumer education materials and videos.
The agency notes that “All input resides on users’ own devices; nothing is stored in the app.” Health plans should publicize this app to their members.
The Senate Homeland Security and Governmental Affairs Committee held a hearing on the postal reform recommendations publicly issued by a Presidential Task Force, including the OPM Director, late last year. The FEHBlog has been following Postal reform because one of the reform initiatives that the Postal Service pushed was to set up a Postal Service Health Benefits program within the FEHBP. Under this new program, annuitant coverage would be fully integrated with Medicare thereby reducing the Postal Service’s FEHB funding burden.
The FEHBlog, who did not watch the hearing, ran across this valuable Govexec overview of the hearing which in the FEHBlog’s estimation aligns with the written testimony. To wit,
Gary Grippo, the Treasury Department’s deputy assistant secretary for public finance and one of the leaders of the postal task force, * * * argued that a popular, bipartisan proposal to require all postal retirees to use Medicare as their primary form of health care coverage [as described above] would shift postal liabilities to taxpayers. Such a move, he said, would break with the mandate that the Postal Service remain self-sufficient. [OMB Deputy Director / OPM Acting Director Margaret] Weichert, too, said the administration was “categorically opposed” to anything that would shift USPS away from self-funding, which she suggested Medicare integration would do.
- Net spending increased each year of the study period, from $250.7 billion in 2012 to $341.0 billion in 2016.
- Total health insurance premiums allocated to the pharmacy benefit of health plans increased from 12.8 percent in 2012 to 16.5 percent in 2016.
- Policies with capped out-of-pocket expenses and cost-sharing assistance from manufacturers helped shelter patients from rising drug costs throughout the study period.
FEHBP member cost sharing for prescription drugs is capped in accordance with the Affordable Care Act. FEHBP coverage for prescription drug skews much higher than 16.5% because the Program has a large cadre of Medicare prime annuitants. For those enrollees and spouses, Medicare pays for hospital care while the FEHBP pays for prescription drugs.
Just two months into the year, the existing program has already lowered prescription drug costs for consumers by an average of $130 per eligible prescription. UnitedHealthcare data analytics demonstrate that when consumers do not have a deductible or large out-of-pocket cost, medication adherence improves by between 4 and 16 percent depending on plan design, contributing to better health and reducing total health care costs for clients and the health system overall.
The President released his Fiscal Year 2020 budget proposal yesterday. FY 202 begins on October 1, 2019. While this Office of Management and Budget document recognizes the existence of the Federal (“GSA”)Employees Health Benefits Program, it does not recognize the existence the Office of Personnel Management. As Bloomberg Government predicted (previous FEHBlog post), the FEHBP entry in the budget proposal (page 127) is listed under the General Services Administration (“GSA”).
A Government Reorganization fact sheet accompanying the budget proposal states in pertinent part that
The [OPM] reorganization will continue in FY 2019 with planning and initial implementation, including the transfer of background investigations to the Department of Defense and other OPM functions to the General Services Administration (GSA), to the extent permitted by law. The Budget reflects the complete reorganization of OPM’s remaining functions within GSA in FY 2020, including OPM’s Retirement Services and Healthcare & Insurance organizations, through a combination of legislative proposals and appropriations to cover GSA’s transition costs of assuming OPM’s remaining functions.
By the way the FEHBP entry states that GSA is seeking legislative approval to modify the FEHBP government contribution in a way that would save the federal treasury $1.884 billion over the period 2022 through 2029. Details will be forthcoming likely next week.
Congress remains in session on Capitol Hill this coming week. The Senate Homeland Security and Governmental Affairs Committee will be hold a postal reform hearing on Tuesday March 12 at 2:30 pm. OPM Acting Director Margaret Weichert is one of the witnesses at that hearing. Here’s a link to the Week in Congress’s report on last week’s Congressional actions.
The President’s Fiscal Year 2020 proposed budget will be released in two steps beginning tomorrow. Bloomberg Government reports
Government management is going to be highlighted in President Donald Trump’s fiscal 2020 budget set for release on March 11, but the centerpiece will be the follow-up to the sweeping overhaul and reorganization plan put out in June 2018, said the official who is familiar with the budget plan.
Where the 2018 plan listed 34 reorganization proposals, this year will focus on the merger of the Office of Personnel Management into a single entity within the General Services Administration, the agency primarily responsible for federal buildings and support services.
That section of the budget proposal will be worth checking out.
Healthcare Dive reports on favorable financial prospects for healthcare payers in 2019 although it opines that payers are facing strong headwinds beginning in 2020. Surprisingly the article does not mention the ill advised Medicare for All movement which would torpedo the privacy healthcare payer industry, including as the FEHBP and Medicare Advantage.