Congress is on a home work period this week for Presidents’ Day. Here’s a link to the Week in Congress’s report on last week’s actions on Capitol Hill.

Govexec.com updates us on when federal employees can expect their 1.9% pay increase for 2019 to kick in.  Due to red tape, “it could take weeks for federal workers to see the retroactive raise in their bank accounts.”

Federal News Network reports that new federal retirements are trending up. “Nearly 12,000 more federal employees retired in 2018 compared to 2017, according to a Federal News Network analysis of the past year’s data from the Office of Personnel Management.”  A good economy does encourage people to make job changes.

The Centers for Medicare and Medicaid Services announced a five year pilot expansion of Medicare ambulance coverage to include non-emergency transportation. The pilot scheduled to begin next year aligns with private sector health plan efforts to team up with Uber or Lyft to provide members with non-emergency transportation to urgent care centers and doctor’s offices. Healthcare Dive reports on this development here.

The President has signed into law H. Jt. Res. 31, a bill that funds the federal government through the end of this fiscal year, September 30, 2019. Because this bill covers OPM, its provisions include the standard FEHBP appropriations measures — a provision restricting abortion except in cases of rape or incest or where the life of the mother is endangered, a provision mandating coverage of female contraceptives, and a provision prohibiting the application of full Cost Accounting Standards coverage to FEHBP carriers.

Healthcare Dive provides its perspective on the now concluded HIMSS conference.  Health Data Management suggests two ways for the healthcare industry to get quick returns from blockchain.

CVS Health this week highlighted its new HealthHub store. CNBC explains the concept here.  In short,

CVS is trying to leverage its ability to provide hands-on help with a new “care concierge” in the store who helps guide customers through the new health services and provides more care coordination between the pharmacy, the clinic and the other services.

CVS opened the three HealthHUBs in the Houston area in December. The company will use those locations to test the new services. [A CVS Health representative] said CVS won’t turn all of its stores into HealthHUBs but will likely take individual pieces and roll them out across more stores if they’re successful.

StatNews reports on the moderate efficacy of this season’s flu vaccine.

Dr. Alicia Fry, head of epidemiology and prevention in the CDC’s Influenza Branch, cautioned against drawing too many comparisons at this point in the flu season. The season has been mild, Fry said, and there have been fewer infections than last year. That means there are less data on which to calculate the interim estimate.

Fry called the signs of effectiveness so far “encouraging” and said the level of protection provided by the vaccine is within the range of what one would expect during a flu season when H1N1 viruses predominate.

It’s also an improvement over last year, when the mid-season estimate of how the vaccine was working showed that about three-quarters of people who got a flu shot were not protected against H3N2 viruses, which were causing the most illness last year.

The FEHBlog has run across several interesting articles about the HIMSS heathcare IT conference:

• A Healthcare Dive article on attendee reaction to the new HHS proposed rules of data sharing and other stuff.
• A Healthcare IT News interview with Judy Faulkner, the chief exec of the largest electronic health record distributor, Epic, and
• A Healthcare IT News article concening telehealth vendor presentations at the conference. 

Healthgrades released another round of U.S. hospital ratings. The FEHBlog personally does not put a lot of stock in ratings like this. If he had to use a hospital, he would try to ask people who worked there, particularly nurses. Old school.

Speaking of which, Accenture issued a colorful chart filled report on how U.S. generations address healthcare differently. Not surprisingly, the younger generations don’t tend to have primary care providers (“PCP”) and the older generations do. The FEHBlog did not have a regular primary care provider until 2011. Now with mortality beginning to come into clearer focus, he visits his PCP regularly and religiously follows his advice. That my friends is human nature.

Nevertheless the FEHBlog thinks that it’s a good move for health plans, etc. to encourage people to pick up the PCP habit much earlier. That habit probably will involve weaving together relationships among telehealth providers, pharmacy clincics and actual doctor offices.  The effort is complicated by the ACA induced aggregation of small medical practices into large ones but the electronic health records do facilitate handing off patients among practices and providers within practices. Hope springs eternal.

It appears to the FEHBlog that the federal government is on track to avoid another partial government shutdown this week. Fingers remain crossed.

Federal News Network reports that

The Office of Personnel Management has chosen to continue its relationship with ID Experts, the company originally tasked to provide free credit monitoring and identity theft protection services to victims of the agency’s 2015 cyber breaches.
OPM awarded a follow-on contract to ID Experts under the General Services Administration’s identity protection services multiple-award blanket purchase agreement (BPA). The contract began on Jan. 1 and will continue through at least June 2020. ID Experts said the contract has an option for up to five years.
The contract is worth at least $416 million, according to USA Spending data.
Individuals currently enrolled in the MyIDCare don’t need to take action to continue their service and will be automatically covered, ID Experts said in a statement announcing the continued contract.

Speaking of data breaches,

In 2018, 15,085,302 patient records were breached, according to new data released today in the Protenus Breach Barometer. Published by Protenus, an AI-powered healthcare compliance analytics platform that protects patient data for the nation’s leading health systems, the Breach Barometer is the industry’s definitive source for health data breach reporting.  

There was a slight increase in the number of breaches, from 477 in 2017 compared to 503 in 2018. Alarmingly, the number of affected patient records almost tripled from 5.5 million in 2017 to 15 million in 2018. As first reported in 2016, a trend of at least one health data breach per day remained in 2018.

This brings us to the HIMSS conference. Here’s a link to CMS Administrator Seema Verma’s speech at the conference today. Apropos of the Administrator’s talk, HHS yesterday announced a proposed CMS rule and a proposed Office of National Health IT Coordinator rule that are intended to open existing road blocks to healthcare information sharing.

Regulatory Focus reports on today’s House Ways and Means Committee hearing on prescription drug pricing.  The Committee’s chair and ranking minority member advised that they are committed to working together “to take meaningful action to lower the cost of prescription drugs in the US health care system.”

The Health Care Cost Institute released its 2017 report on healthcare cost and utilization.  “While overall spending growth slowed in 2017 compared to 2016, the report finds that prices continued to drive rising costs.  “Health care spending growth exceeded 4 percent for the second consecutive year, outpacing per capita GDP growth,” said Niall Brennan, president and CEO of HCCI. “And for the most part, Americans aren’t using more health care services, which means we’re essentially paying more and more for the same amount of health care.”

Fierce Healthcare discusses a Deloitte Consulting report visualizing health plans of the future. “Deloitte suggests five steps insurers should be taking now as they plan for these looming changes:

• Build an internal culture that focuses on business transformation
• Make investments in technology sooner rather than later
• Being reorienting staffers to what work will look like—highly automated and electronic—compared to current processes
• Incorporate governance for data into existing policies and practices
• Keep a close eye on cybersecurity risks, and be prepared for emerging threats.”

Meanwhile, the President’s Council of Economic Advisors issued a report on the market advantages and cost savings to consumers and the government offered by the Administration’s deregulatory efforts in the healthcare market.

Congress remains in session on Capitol Hill this week. Here’s a link to the Week in Congress’s report to last week’s actions there.

Tomorrow, he Senate Health, Educations, Labor and Pensions Committee is holding a hearing on pain management during the opioid crisis.

Federal News Network reports that postal reform does not appear to be on the House Oversight and Reform Committee’s radar. Perhaps the Senate Homeland Security and Governmental Affairs Committee will take the lead on this important issue again.

The big health information technology conference, HIMSS, will be held this week. HIMSS offers HIMSS TV for those who can’t attend in person. Blockchain will be one of the topics addressed at the conference. Modern Healthcare offers an article with an update on the development of healthcare uses of blockchain, e.g., improving provider directories.

The Wall Street Journal’s review section from the weekend paper lead with an article on how to make practical plans for the end of life (not the will part).  It’s worth reading.

Congress has another week to avoid a resumption of the partial government shutdown. Fingers crossed.

OPM has named  Clare Martorana to be its new chief information officer according to the Federal News Network. Ms. Martorana joins OPM from the U.S. Digital Service. Ms. Martorana “becomes the fifth CIO since 2015.”

Studies, studies, studies —

• Express Scripts released its 2018 Drug Trends Report. According to the Center for Biosimilars, ESI expects U.S. drug spending to rise about 2% over the next three years. However,

Inflammatory drugs comprised the costliest therapy class for the third year in a row, costing employers $174.45 per member per year, up 14%. Diabetes came in second at $114.85 per member per year, an increase of 4.1%. Spending on insulin, which accounts for 15.3% of diabetes prescriptions, increased just 0.3% in 2018, with a 1.5% decline in unit costs and a 1.8% rise in utilization. In 2018, patients paid 16.9% of total insulin costs, an average of $43.19 per prescription, up $3.33 from 2017.

• Healthcare Dive reports that “More effective primary care could save emergency departments an estimated $8.3 billion annually, according to a new Premier analysis.” “The [Premier] report notes that chronic disease patients visiting EDs are often uninformed about how to manage their disease and often lack access to primary care services.” These expensive ED visits could be prevented if the patients regularly visited primary care providers. In this regard Health Payer Intelligence reports that Blue Cross’s Medicare Advantage experiment with using Lyft for members needing non-emergency care trips is paying off. 

Kaiser Health News provides a helpful overview of the healthcare topics in the President’s State of the Union address last night.  President “Trump vowed to take on prescription drug prices, pursue an end to the HIV epidemic and boost funding for childhood cancers.”

The Federal Times discusses an OPM request to the public for information on how to create a unified enrollment system for the FEHBP.  Benefeds provides a platform that works for the the federal employee dental, vision, and flexible spending. Here’s some advice from the FEHBlog make sure that the new enrollment system allows FEHBP carriers to reconcile premiums with enrollees. Stunningly, the current system does not provide that capability which the common operating rules for HIPAA 820 electronic premium roster transaction standardized for over five years ago.

Healthcare Dive reports on a study published in Health Affairs concluding that hospital prices have rising faster than doctor’s prices recently. “The findings suggest that policy measures aimed at cutting healthcare costs should focus on issues like antitrust enforcement, incentivizing more cost-efficient physician referrals and reference pricing.” The study must have struck a nerve because the Healthcare Dive report mentions an American Hospital Association retort to the Health Affairs study.

In that regard, Becker’s Hospital Review reports that “Dallas-based Baylor Scott & White Health and Houston-based Memorial Hermann Health System have decided to discontinue merger discussions roughly four months after signing a letter of intent to combine their organizations.” The merger would have placed 15% of the hospitals located in Texas under one management.

Healthcare Dive reports that two large Catholic healthcare systems, Dignity Health and Catholic Health Initiatives, have closed their merger agreement by forming a nonprofit health system called CommonSpirit Health. “The $29 billion system will serve 21 states with more than 700 care locations and 142 hospitals. The company also includes research, virtual care and home health capabilities.”

Healthcare Dive also reports that Amazon’s Pill Pack company appears poised to engage in a nationwide rollout. Pill Pack provides customers with personalized, ready to use, prescription pill packs. The FEHBlog thinks it’s a whale of an idea.

David Friend, managing director at BDO Consulting, said Amazon’s move with PillPack represents a threat to both traditional pharmacies and PBMs. Ultimately, “they’re going to cut out the pharmacy business and the PBMs,” Friend, told Healthcare Dive. “If they cut the prices enough, consumers are going to say, ‘why should I have to go through more complexity and pay more?'”

The FEHBlog’s favorite healthcare quality consultants, Discern Health, have released their notes on CMS’s Quality Conference. Check them out.

Speaking of conferences, mhealthintelligence.com discusses what’s on tap for next week’s big HIMSS conference which focuses on digital health. The conference will be held in Orlando. Focus will be placed on telehealth. Employee Benefit Adviser offers some guidance on how to build utilization of employer sponsored telehealth programs. “The missing piece of the puzzle is employee education, Matthew Herrera, assistant vice president of strategic partnerships at benefit provider Careington International, said. If employers aren’t advocating for the healthcare strategy, they shouldn’t be surprised by its lack of success.”

Last but not least, Forbes columnist Avik Roy offers his perspective on the Trump Administration’s initiative to end prescription drug rebate programs in Medicare and Medicaid.

As a result, any discounts that [prescription benefit managers] PBMs negotiate with drug manufacturers would have to apply to the “list price” that patients using those drugs pay, instead of being transmitted in the form of rebates that reduce everyone’s premiums.

The likely result, over time, should be that list prices in the future look more like the net prices of today, as rebates get converted into direct price discounts. That should mean lower out-of-pocket spending and better patient adherence to medications, especially for seniors enrolled in Medicare Part D prescription drug plans.

Most importantly, the end of PBM rebates in Medicare Part D should lead to higher utilization of low-cost generic and biosimilar drugs, as PBMs will no longer have an incentive to favor branded drugs in their formularies, unless those branded drugs compete with generics on price.

Congress remains in session this coming week on Capitol Hill. Here’s a link to the Week in Congress’s report on last week’s actions on the Hill.  The President’s State of the Union address will be given on Tuesday night.

On Tuesday morning, the Senate Health, Labor, Education and Pensions Committee will hold a hearing on how primary care affects health care costs and outcomes. In the FEHBlog’s view, positively.

On Wednesday mornings, House Committees will be holding hearings on protecting workers with pre-existing conditions and the Texas v. United States lawsuit challenging the Affordable Care Act’s constitutionality. The oddity of the first hearing is that Congress passes a law protecting those workers in 1996. It’s unfortunate that Congress did not extend that law to the individual as well as the group market. In any event, if the Supreme Court were to find the ACA unconstitutional, which the FEHBlog finds highly unlikely, the 1996 law (HIPAA) would go back into effect.  As for the Texas v. U.S. case, it’s worth noting that on Friday, U.S. District Judge Ellen Hollander dismissed the State of Maryland’s lawsuit that is a mirror image of the U.S. v. Texas lawsuit. The court found that the Maryland lawsuit is unnecessary. Here’s a link to the opinion. The FEHBlog, as a Maryland taxpayer, agrees, and he hopes that Maryland will call it a day on this case. Maryland is an intervenor defendant in the Texas case.

NPR has a story discussing winners and losers from the the Trump Administration’s recent proposed decision to end prescription drug rebate arrangements in Medicare and Medicaid. The FEHBlog sees it as a financial wash for PBMs and health plans. About a decade ago, OPM required experience rated FEHB plans to engage in transparent pricing with prescription benefit managers (“PBMs”) in order to facilitate audits of the PBMs.

As a result of this decision, the PBMs must give 100% of rebates to the experience rated carriers. PBMs increased their administrative fees in response to this decision which maintained the economic status quo. In this case, which in the FEHBlog’s opinion, will eventually impact the FEHBP, the PBMs and manufacturers will lower point of sale prices to account for the end of rebates. The manuafacuterers will continue to pay volume discounts.  Plan prescription drug spending will drop as will cost sharing for those who use formulary drugs. It’s a change that will help the chronically ill. Time must be given to implement it.

Today, the Department of Health and Human Services announced a proposed rule that would modify the federal healthcare programs anti-kickback act to redirect prescription drug rebates from the prescription drug plan to consumer at the point of sale.  It strikes the FEHBlog that this change, if implemented, will encourage consumer compliance with prescription drug manager formularies and will be a big help to people in high deductible plans.  The rule would apply to Medicare and Medicaid but not to the commercial market including the FEHBP or the ACA marketplace. However, once the Medicare dam breaks, commercial plans will follow the same practice in the FEHBlog’s view. Of course, some commercial plans do so because the prescription drug managers can accommodate this practice already.

Speaking of PBMs, Fierce Healthcare reports that

Anthem is planning to begin moving members into its new PBM, IngenioRx, in the second quarter of 2019, bumping up the projected launch from 2020. Anthem announced the change as part of its fourth-quarter earnings (PDF), saying it moved up IngenioRx’s launch because Cigna closed its acquisition of Anthem’s current pharmacy benefit manager, Express Scripts.  Anthem’s contract with Express Scripts will end on March 1, with the yearlong process of migrating members to IngenioRx beginning the next day, it said.

This week, the Centers for Medicare and Medicaid Services have been holding its annual Quality Conference in Baltimore MD.  The conference is a hot (and free) ticket. A friend tells the FEHBlog that nearly 3,000 people were in attendance. You can watch the plenary sessions on the conference’s website. Here’s a link to an AJMC report on CMS Administrator Seema Verma’s keynote speech. “As she has in other recent speeches, she also criticized the idea of Medicare for All, saying, ‘we can barely afford the program that we have.’” Bear in mind commercial health plans, including the FEHBP, pay more to providers who can’t survive solely on Medicare’s low reimbursements. Ms. Verma also announced that Medicare is now making available on the Apple and Google stores a Medicare what’s covered app.