| Federal Health Update | |
| Feb. 3, 2012 | |
| Welcome
to Federal Health Update. This newsletter, produced by
Kate Connelly Theroux in collaboration with the Institute of Federal
Health Care, is a compilation of the latest news in the federal health
care sector. Sponsored
by Additional
sponsorship by: Executive and Congressional News
Since the launch of the Community Challenge last July, hundreds of submissions were received in three months, all of which captured innovative ways Americans have stepped up to show their gratitude and support for our military families. Five additional winners will be chosen with input from a panel of distinguished judges, including:
The First Lady and Dr. Biden launched Joining Forces last year as a way to encourage all Americans to support our troops and serve our nation's military families. For more information and to find opportunities to serve, go to www.joiningforces.gov. The 20 finalists are profiled at http://joiningforces.
During the hearing VA officials admitted to illegally purchasing pharmaceuticals off-contract through its Pharmaceutical Prime Vendor (PPV). A PPV contract, when executed correctly and with proper oversight, allows VA medical facilities to receive needed pharmaceuticals at a competitive price and in a timely manner. VA, however, illegally conducted open market purchases off their PPV contract. The House Committee on Veterans' Affairs has partnered with the House Oversight and Government Reform Committee to further investigate the extent of these activities. The Committee's investigation, leading to the hearing, revealed that VA officials knowingly purchased pharmaceuticals and other medical supplies off-contract. VA confirmed that senior leadership knew of the PPV contracting problems at least in early 2011, and possibly back to 2009, but did not order the illegal practice be stopped until November 2011. "Federal acquisition regulations outline clear procedures on how agencies can acquire items not on contract, VA officials for years have ignored those procedures when purchasing supplies," said Rep. Jeff Miller, Chairman of the House Committee on Veterans' Affairs. "VA's practices also willfully ignored required competition, thereby potentially compromising patient safety and compromising best value to taxpayers." A subpoena to request all documents and communications from VA related to this matter was issued in conformance with Clause 2 (m) of Rule 11 of the House of Representatives. Military Health Care News
Baker served as president and chief executive officer of Humana Military Healthcare Services for the past 12 years. Following a distinguished 27-year active duty career in the United States Air Force Medical Service, Baker joined Humana in 1996 and launched Humana's start-up TRICARE operations in the Southeast. Under his leadership, Humana's TRICARE market share doubled. To ensure a smooth transition, Baker will continue to serve in an advisory capacity to Humana Military through June 30. Tim McClain, president and CEO of Humana Veterans Healthcare Services, has been named president, Government and Other Business -- which includes all Humana military lines of business. He will report to Jim Murray, executive vice president and chief operating officer. McClain has 35 years' experience in executive leadership and management positions. He served as general counsel for the U.S. Department of Veterans Affairs (VA) from 2001-2006, a Senate-confirmed Presidential appointment position, serving two Cabinet secretaries and managing an office comprising nearly 400 attorneys. He joined Humana in 2009. McClain is a graduate of the U.S. Naval Academy, Annapolis, Maryland, and California Western School of Law, San Diego. He is a retired Naval officer, having served as a Surface Warfare Officer and in the Navy's Judge Advocate General's Corps. The company also announced that Orie Mullen will replace Baker as the leader of Humana Military Healthcare Services, reporting to McClain. Mullen is currently the chief operating officer of Humana Military. After joining Humana in 1986 as a Senior Systems Engineer, he held a number of successive roles in management information systems and claims administration before transitioning to Humana Military to lead claims oversight. A newly created group within Government
and Other Business, Government Ventures will focus on new venture opportunities
that complement the company's Humana Military core business and expand
Humana's capabilities in the government sector. Ray Pryor will lead
Government Ventures, also reporting to McClain. Pryor joined Humana
in 1990 and was an original founding member of Humana Military. He has
served as Humana Military chief financial officer since its inception
and in 2000 assumed additional responsibilities as vice president.
Niemyer is currently serving as director
of the nurse corps/deputy chief of staff for installations and logistics,
M4, Bureau of Medicine and Surgery, Bethesda, Md.
In his remarks, Woodson said a Pentagon task force examined the question of a unified command in 2011 — a topic that has been studied "16 times in the last 40 years" — and found that realignment itself would not produce great savings. But it would "create a more agile, responsive and efficient mechanism for making decisions," he said. "We could eliminate our headquarters entirely if it were possible, and it would hardly make a dent in our overall budget. Our major opportunities for cost control lie in optimizing the use of our purchase and direct care systems to manage care," Woodson said. House lawmakers had proposed creating a unified command to oversee all Defense Department medical operations in the Defense Authorization Act for fiscal year 2012. The proposal, which was dropped from the final legislation, would have created a four-star command with three subcommands — one overseeing military treatment facilities; another responsible for training, education, research and development; and a third to oversee Tricare. In addition to considering the implications of a unified health command, the military health system in the next two years will focus on four initiatives, Woodson said:
For more information about the 2012
MHS Conference, please visit: http://www.health.mil/
The report entitled "Healthcare to Health" gives a snapshot of the accomplishments achieved over the past year by Military Health System. In addition, the MHS outlines strategic initiatives for the coming year aligned with the Quadruple Aim platform: Readiness, Population Health, Experience of Care, Per Capita Cost and Learning and Growth. To view previous reports, please
visit: http://www.health.mil/About_
The joint letter to the department was signed by Reps. Walter Jones, R-N.C.; Joe Courtney, D-Conn.; Mo Brooks, R-Ala.; Bill Owens, D-N.Y.; Martha Roby, R-Ala.; Mike Rogers, R-Ala.; and Austin Scott, R-Ga. The lawmakers noted that the merger would leave the DoD with just two national PBMs to choose from. "We are concerned these limitations would undermine Tricare's negotiating leverage and limit Tricare's ability to demand a quality prescription drug benefit," the Congress leaders stated. For a copy of the letter, click here.
URAC accreditation establishes and measures key industry standards for health care management and improvement, as well as consumer protection. As the managed care support contractor for the TRICARE North Region, Health Net Federal Services provides services for up to 3 million uniformed service beneficiaries, including active duty and retired service members, National Guard and Reserve members, family members, survivors and other TRICARE-eligible beneficiaries. The TRICARE North Region includes: Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia and Wisconsin. In addition, the contract covers portions of Tennessee, Missouri and Iowa. URAC, an independent, nonprofit organization,
is a leader in promoting health care quality through accreditation and
certification programs. Through its broad-based governance structure
and an inclusive standards development process, URAC ensures that all
stakeholders are represented in setting meaningful standards for the
health care industry.
The contract was originally awarded in 2009 and subsequently re-awarded in June 2011 but still remains under protest. The directive to proceed is a result of the U.S. Court of Federal Claims' resolution of protest issues associated with the original contract awards. Located in Fairfax and Dumfries, Va., the Family Health Centers are extensions of the new Fort Belvoir Community Hospital (FBCH), in Ft. Belvoir, Va. Targeted for completion on or before July 1, 2012, the Family Health Centers will serve approximately 47,000 active and retired U.S. Military personnel and their dependents with primary care, laboratory, radiology and specialty healthcare services and pharmacies for the exclusive use of eligible patients. Under its contract, Spectrum expects
to complete construction of the new clinics on or before June 30 before
beginning a five-year engagement to provide patient care services. More
than 300 physicians, nurses, allied health professionals and administrative
employees will staff these new clinics, and Spectrum will prioritize
recruiting staff from FBCH's current FHCs to transition with the patients
to the new facilities. Upon the completion of the clinic construction
and commencement of clinical staffing and management services, annual
revenues under the contract are estimated to be approximately $43 million. Veterans Affairs News
Newborn care includes routine post-delivery care and all other medically necessary services that are in accord with generally accepted standards of medical practice. The effective date of the rule is Dec. 19, 2011, but the regulation applies retroactively to newborn care provided to eligible women veterans on or after May 5, 2011. VA has women veterans program managers
at every VA medical center to help women veterans learn more about the
health care benefits they have earned with their service. For more information
about VA healthcare for women veterans, visit http://www.womenshealth.va.gov
The number of pending claims before VA stood at 853,831 on Jan. 27, an increase of nearly 100,000 from last year and nearly 500,000 from three years ago. Although VA has processed nearly a million claims over the past year, another 1.3 million new claims were filed during the same period. Of the approximately 2.2 million veterans of the wars in Iraq and Afghanistan, 624,000 have filed disability claims and many more are expected. In addition, more than 200,000 Vietnam War veterans have filed claims based on new regulations adopted in 2010 making it easier to get compensation for health problems caused by exposure to defoliants such as Agent Orange. VA Secretary Eric Shinseki launched a department-wide effort to break the backlog, according to agency officials. The budget for the Veterans Benefits Administration reached $2 billion in 2012, a 20 percent increase over the previous year, which VA says will accelerate services for veterans. But some members of congressional oversight committees question whether there is much to show for the additional money. The VA is preparing a new paperless claim processing system that officials say will help the department reduce the backlog by taking months out of the process. The system, which VA says uses cutting-edge information technology, has been tested in Rhode Island and Utah, and will be rolled out nationwide beginning this summer and continuing through 2013. VA also renewed its efforts to reform
the complex disability rating system, which has not been comprehensively
revised since it was created at the end of World War II. General Health Care News
The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall. Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012. In addition to today's enrollment and premium numbers, there is more evidence that the Medicare Advantage program remains strong:
In 2012, Medicare Advantage plans will start receiving incentives to achieve high quality scores through the use of quality bonus payments. As an extra incentive for high quality performance, CMS is allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year. To find the most recent publicly
available MA and Part D contract and enrollment data, visit: http://www.cms.gov/
This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non–fatal, for a 12–month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at $159,846 or type-2 diabetes, which is estimated between $181,000 and $253,000. The costs of each death due to child maltreatment are even higher. Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity. This CDC study found these negative effects over a survivor′s lifetime generate many costs that impact the nation′s health care, education, criminal justice and welfare systems. The estimated average lifetime cost per victim of nonfatal child maltreatment includes:
The estimated average lifetime cost per death includes:
Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide. Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver′s behavior is influenced by a range inter–related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community. Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society. The article, "The
Economic Burden of Child Maltreatment in the United States and Implications
for Prevention," is available at http://www.sciencedirect.com/
Implementing the Medicaid prescription drug provisions of the Affordable Care Act, will increase transparency in drug pricing and ensure taxpayers and States are not overpaying for prescription drugs. The proposed regulation reduces costs through a number of improvements, including:
Several states have implemented similar initiatives to inject fairness into prescription drug pricing. Alabama, for example, estimates a savings of $30 million in one year alone from an initiative to better understand and align reimbursements with the prices pharmacies pay for prescription drugs. In 2009, Medicaid spent $15.8 billion on prescription drugs. This proposed rule will implement initiatives designed to save the program $17.7 billion over five years. The Medicaid Pharmacy Regulation
notice of proposed rulemaking can be found in the Federal Register
at: http://www.ofr.gov/OFRUpload/ Stakeholders will have 60 days from
the publication date to submit public comments. CMS plans to issue a
final rule in 2013.
The recommendations would authorize the FDA to collect $595 million in user fees over five years, plus adjustments for inflation. Details of the agreement, such as the fee structure, are expected to be finalized soon. Under a user fee program, industry agrees to pay fees to help fund a portion of the FDA's device review activities while the FDA agrees to overall performance goals such as reviewing a certain percentage of applications within a particular time frame. The agreement in principle would result in greater accountability, predictability and transparency through such improvements as a more structured pre-submission process and earlier interactions between FDA and applicants. With the additional funding, the FDA would be able to hire over 200 full-time equivalent workers by the end of the five-year program. The FDA and industry expect that the agreement in principle would result in a reduction in average total review times. The industry associations who have reached an agreement in principle with the FDA include the Advanced Medical Technology Association, the Medical Device Manufacturers Association and the Medical Imaging and Technology Alliance. Congress first established the user fee program 10 years ago with the Medical Device User Fee and Modernization Act of 2002 (MDUFA I), prompted by growing concerns about the capacity and performance of the medical device review program. The five-year program was reauthorized with the Medical Device User Fee Act of 2007 (MDUFA II) and is set to expire on Sept. 30, 2012. MDUFA II authorized FDA to collect user fees for certain medical device applications, for the registration of certain medical device establishments, and for certain other purposes. Small businesses may qualify for a waiver from fees on certain submissions or may qualify for a reduced fee. Once the final details of the agreement
with industry is completed, FDA will develop a package of proposed recommendations
and give the public an opportunity to comment before they are submitted
to Congress.
The drug is intended for use in patients with locally advanced basal cell cancer who are not candidates for surgery or radiation and for patients whose cancer has spread to other parts of the body (metastatic). Erivedge, reviewed under the agency's priority review program, is the first FDA-approved drug for metastatic basal cell carcinoma. Erivedge was reviewed under the FDA's priority review program that provides for an expedited six-month review of drugs that may offer major advances in treatment. The drug is being approved ahead of the March 8, 2012 prescription user fee goal date. Basal cell carcinoma is generally a slow growing and painless form of skin cancer that starts in the top layer of the skin (epidermis). The cancer develops on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation. Erivedge, marketed by South San Francisco based-Genentech, is being approved with a BOXED WARNING alerting patients and health care professionals of the potential risk of death or severe birth effects to a fetus (unborn baby). Pregnancy status must be verified prior to the start of Erivedge treatment. Male and female patients should be warned about these risks and the need for birth control.
According to the new report, the average person with Medicare will save nearly $4,200 by 2021 because of the new law. The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14percent discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics. In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs. Data also show that women especially benefitted from the law's provision with 2.05 million women saving $1.2 billion on their prescription drugs. By 2020, the donut hole will be closed completely. The report also stated that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000 The savings are a product of provisions in the Affordable Care Act and other cost trends that:
For state-by-state savings figures
for today's donut hole announcement, visit: http://www.cms.gov/Plan- Guard/Reserve
. Reports/Policies
Hill Hearings
Legislation
Meetings
If you need further information on any of the items in the Federal Health Update, please contact Kate Theroux at (703) 447-3257 or by e-mail at dhakat@aol.com. |
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