Tomorrow is opening day for the Federal Benefits Open Season, and federal employees will have a holiday to think things over.  As the FEHBlog has noted, OPM FEHB plan comparison tool has been running at least since last weekend and the Consumers’ Checkbook’s FEHB plan comparison tool geared up for 2019 this weekend.  OPM’s tool is publicly available. Consumers Checkbook charges a fee for its tool although many federal agencies and the Postal Service offer the tool to their employees at no cost.

Federal News Network also offers a few words of wisdom to folks who are eligible for the Open Season. The FEHBlog noticed today that OPM is updating its Facebook page more frequently than the news section its own website.

The current FEHB Open Season will end “at 11:59pm, per the location of your electronic enrollment system, on Monday December 10, 2018.”

Congress returns to Washington DC this week.

While it comes as no surprise to the FEHBlog, Modern Healthcare reports on early successes for association health plans which the Trump Administration made available earlier this year so that small employers can opt for coverage under the ACA’s more flexible, but not too flexible rules for large employers. One of those early successes is a self-funded association health plan created by the Land O Lakes farm cooperative (yes the same company that sells butter.) The Land O Lakes association health plan which Minnesota law authorized in 2017 has been extended to Nebraska under the Trump Administration rule.

Also last week, the Leapfrog Group released its Fall 2018 hospital patient safety grades.

Of course, as we know, the mid-term elections resulted in divided government with the executive branch and the Senate remaining in Republican hands and the House of Representatives moving to  Democrat hands. The new Congress assumes office in early January 2019. The current Congress will be holding a lame duck session beginning next week.

In Tuesday’s Tidbits the FEHBlog highlighted a Healthcare Dive interview with Geisinger Health Systems’s CEO David Feinberg. The Wall Street Journal reports tonight that Dr. Feinberg who was wined and dined by the new Amazon healthcare operation, has decided to take a top healthcare position with Google. “Geisinger said that current chief medical officer Jaewon Ryu, an emergency-room physician and former executive at health insurer Humana Inc., will become the system’s acting president and CEO on Dec. 1. Dr. Feinberg will aid with the transition and depart Jan. 3.”

Last Friday, the FEHBlog pointed out an Oliver Wyman study finding the people trust their own doctors over their insurance companies. Hardly surprising. The FEHBlog was not intended to know health insurers but rather to point out that the quality oriented messaging of health insurers is  presented by their members’ doctors. In that regard, MedPage Today reports on recent remarks from the HHS Secretary Alex Azar. The FEHBlog was struck by fact that the Secretary “highlighted the role of physicians and other clinicians not as ‘gatekeepers’ but as ‘navigators’ of the healthcare system.” Bingo. The Secretary also noted that his department intends to start experimenting with mandatory bundling of oncology for Medicare patients.

MedPage Today also reports on a panel discussion looking at patient safety nearly twenty years after the landmark report To Err is Human. Our health care system apparently still has a long way to go.

In a recent Health Affairs study, Aiken and colleagues assessed safety at 535 hospitals in four large states during two time points between 2005 and 2016, and reported that the results were “disappointing.” Only 21% of the hospitals showed “sizeable improvements” in “work environment scores” while 7% saw their scores worsen, [Linda] Aiken, PhD, RN, professor and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia] said. 

Another 71% of hospitals “basically remained the same,” she said. 

Aiken also reported a similar lack of improvement in patient safety measures at hospitals that showed little improvement in their work environment. In the study, about 30% of nurses graded their own hospitals “unfavorably” on measures of patient safety and infection prevention and about 31% of nurses had high scores on the Maslach Burnout Inventory.

Finally, Healthcare Dive tells us about a U.S. Department of Agriculture report finding that the fundamental problem with using telehealth in rural communities is the lack of adequate broadband internet coverage. From the USDA report —

“In-home broadband Internet access, whether by choice or happenstance, may not have been a significant factor in 2015 for either rural or urban residents. Many still conducted health activities although they had no Internet subscription,” the report says. “Health providers, however, continue to improve their offerings, so needs for high-quality household broadband service will likely increase if patients are to avail themselves of these new services, especially in rural and poor areas where lower quality broadband Internet service tends to be more common.”

Healthcare Dive reports that “Pharmacy giant CVS Health said the expected close date for its $69 billion megamerger with Aetna will be before Thanksgiving as the deal awaits regulatory approval from five states.”  Both companies are involved with the FEHBP.

Health Payer Intelligence discusses 3rd quarter 2018 earnings reports from Aetna, Cigna, and Centene.

Healthcare Dive also offers an interview with the CEO of the  Pennsylvania-based Geisinger Health System which also participates in the FEHBP.

Yesterday, the Internal Revenue Service announced an adjustment to the Patient Centered Outcomes Research Institute funding fee imposed on health insurance issuers and self funded health plan sponsors including all FEHB plans. The PCORI fee for policy years and plan years that end on or after October 1, 2018, and before October 1, 2019, is $2.45 per covered life. That’s up six cents from last year’s rate of $2.39 per covered life. 

Health IT Security discusses the HHS Office for Civil Rights October newsletter with HIPAA Privacy and Security Rule compliance tips. 

In an interesting development, TRICARE, the military healthcare program for dependents and retirees, will be holding its first open season beginning next week according to Federal News Network (previously Federal News Radio). “In addition to healthcare, dental and vision care for TRICARE retiree beneficiaries will be transferred to the Federal Employees Dental and Vision Insurance Program (FEDVIP). Retirees will be able to choose from 10 different dental carriers and four vision carriers. Signing up for vision and dental is a completely separate open season and not through the TRICARE system.”

Congress is out of town until early next week following Tuesday’s mid-term elections. The lame duck session will last until mid-December. 

Check it out. The Federal Benefits Open Season begins next Monday, November 12.

Fedweek has a story that follows up on yesterday’s FEHBP significant changes post

CMS has finalized two big Medicare rules for 2019:

• The CY 2019 physician fee schedule and quality payment program rule.  Becker’s Hospital Review summarizes the rule here, and Healthcare Dive analyzes the rule here, and
• The CY 2019 Outpatient Prospective Payment System rule.  Healthcare Dive analyzes the rule here. The American Hospital Association plans a lawsuit over the rule’s effort to level out the payments between hospital outpatient clinics and other clinics. 

St. Louis Today reports that “Cigna Corp. said on Thursday its $52-billion acquisition of pharmacy benefits manager Express Scripts Holding Co was on track to close by the end of the year.”  (Express Scripts is headquartered in St. Louis.)

MedPage Today expects that Congress will reauthorize the Patient Centered Outcomes Research Institute with “a few tweaks.”

Health Payer Intelligence reports on a Oliver Wyman survey finding increasing consumer dissatisfaction with high deductible plans combined with health savings accounts. The conclusion of the article is striking:

The [Wyman] team said that HDHPs don’t offer the ability to address key consumer satisfaction concerns. Payers trying to tailor benefits to consumers may need to consider new ways to redesign health plan options and to garner trust with beneficiaries. 

The survey found that consumers have extremely little trust in their insurers, rating payers a zero on a scale of 0 to 100.  Consumers are more likely to place their trust with providers.  Eighty percent of consumers said they believe providers work to assist in consumers’ healthcare goals 

“The key lies in understanding the balance consumers perceive between what they already trust, what they might learn to trust, and the incentives – not just in cost and convenience, but in solving pressing concerns health organizations have not addressed,” the team concluded. 

“The new health services landscape becomes much more attractive if it provides new benefits for consumers. We need to spend much more time figuring out what those benefits need to be.” 

Thanks to Fedsmith and surprisingly not to OPM.gov. the FEHBlog ran across this OPM list of significant FEHB Program changes.

OPM’s online organization chart has disappeared from its website, but a reasonable substitute can be found in the agency’s online contact list.

Kaiser Health News offers an interesting article on a large scale allergy test for which Stanford charged a state employee patient over $48,000. The insurer paid around $11,000 to this in-network provider which left the patientwith about $3,000 in coinsurance. She was able to negotiate the coinsurance down to about  $1,500.  The article advises that

Insurers often tell patients to “shop around” for the best price and to make sure they choose in-network providers to avoid surprises. [The patient] did everything right and still got caught out. As a state employee, she had great insurance and Stanford was an in-network provider.  [The patient] said her doctor warned her the test would be expensive, but she never anticipated that could mean close to $50,000. So don’t be afraid to ask for specific numbers: “Expensive” and “cheap” can have hugely different meanings in the high-priced U.S. health system.

Well put.

Drug Store News tells us about a Walgreen’s survey on American attitudes toward the flu shot. 70% of those survey plan to get the vaccination. Get a load of this though —

The survey also found that despite the severity of last year’s flu season — one of the worst in recent years — some 37% of respondents said they had gone to work while suffering from the flu. Additionally, 2-in-5 of those surveyed said they stay home to protect themselves from the flu.

No bueno.

To cap off cybersecurity month, the Department of Health and Human Services today announced  the official opening of the Health Sector Cybersecurity Coordination Center (HC3) at HHS headquarters in Washington, DC.  “The HC3’s role is to work with the sector, including practitioners, organizations, and cybersecurity information sharing organizations to understand the threats it faces, learn the bad guys’ patterns and trends, and provide information and approaches on how the sector can better defend itself.”

Congress remains on the campaign trail this week.

Healthgrades created a national health index ranking major U.S. cities by factors such as access to care, population health, hospital quality, and local specialists. Rochester Minnesota is number one on the index. Healthcare Dive offers its analysis of the index here.

The Health Care Cost Institute created a healthy marketplace index. Healthcare Dive explains that the index “documents variations in healthcare prices across 112 metro areas in the United States found that overall prices are lowest in Baltimore, where rates were 33% below the national average in 2016, and highest in Anchorage, Alaska, and San Jose, California, where rates were 65% above the national average in 2016.” Baltimore ranked fifth on the Healthgrades index.

The FEHBlog has been writing for the American Bar Association’s health law section this year. Here’s a link to his latest article on Association Health Plans.  The FEHBlog is pleased with the Administration efforts to give more healthcare choices to employers and consumers.

On the cybersecurity front:

• The Department of Health and Human Services Office for Civil Rights has rolled out a new version 3.0 of its information technology security assessment tool. 
• The Federal Trade Commission has released cybersecurity tools for non-profits and small and midsized businesses.

On the surveys front —

• OPM released its latest Federal Employee Viewpoint Survey results yesterday. Federal News Radio offers a useful overview of those results here. 
• USA Today reports that the Blue Cross Blue Shield Association released “a first-of-its-kind metric for measuring Americans’ health from birth to age 64: The Blue Cross Blue Shield Health Index. The BCBS Health Index highlights which illnesses — from major depression to substance use disorder —are lowering the quality of life of people across the nation.” Hypertension is the most predominant chronic illness affecting the U.S. population
• Health Data Management informs us that “Artificial intelligence, 3D printing and robotic surgery are among the up-and-coming technologies selected for the Cleveland Clinic’s list of the top 10 medical innovations for 2019.” Keep your sunny side up. 

The Medicare payment for separately payable Part B drugs is typically based on the average sales price (ASP) of a given Part B drug, plus 6 percent of the ASP as an add-on.  For the potential [International Pricing Index or] IPI Model, CMS is considering testing an alternative payment for included drugs that would apply when ASP is higher than an international price. Instead of paying based on ASP, CMS would pay for the drug based on a Target Price derived from international price index and designed to draw down Part B drug prices toward international prices over the course of the model. We estimate that relying on an international price index and setting a Target Price rather than using ASP would result in roughly a 30 percent savings in total spending for the selected Part B drugs in the model. 

CMS would phase-in this Target Price over five years of the model. CMS seeks comment in the ANPRM on several aspects of the model payment, including calculation of the target and the international pricing data.

The comment deadline is December 11, 2018. Most Medicare cost reductions shift costs onto FEHB and private sector plans unless they can implement the same approach.

• The Drug Channels blog tells us

This week, Express Scripts announced an innovative pharmacy benefit contracting model for members of the National Drug Purchasing Coalition (NDPC), a group of 18 large employers. Click here to read the fully-titled press release. You should pay close attention to this b.i.g. news. It is structured so that Express Scripts will not profit from the flow of funds from a brand-name manufacturer to a plan sponsor. What’s more, the PBM’s compensation will be fully delinked from drug list prices. Instead, Express Scripts will earn only fixed management fees plus additional at-risk compensation tied to clinical outcomes. 

Have a good weekend.