We supported an established health plan in crafting a successful proposal response to retain access to three existing service areas and gain access to two additional Medicaid regions in a state with a large beneficiary population.
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Trusted Partnership
Amidst changing regulatory, technology, and market dynamics, health plans partner with Avalere to ensure their strategy and operations are aligned to achieve long-term goals.
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Health Plans 2030: Evolving Operational Approaches
Plans are increasingly facing operational and regulatory dynamics that will drive up the costs of healthcare administration and services. These dynamics also influence the tools at plans’ disposal to bend the cost curve. To successfully adapt, health plans should rethink their strategic approaches and, in some cases, create new tools or processes to address costs in a way that promotes holistic member health in a financially sustainable way.
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Potential Impacts of IPAY 2026 Maximum Fair Prices on Health Plan Formulary Negotiations
With the release of the IPAY 2026 MFPs, health plans should analyze the impact to formularies and identify opportunities for contracting changes.
More Low-Income Subsidy Enrollees Pay Part D Premiums in 2024
An Avalere analysis finds that from 2023 to 2024 the number of LIS enrollees paying a Part D premium increased by more than 1 million enrollees.
2025 a Unique Year for MA and Part D Plans’ Rebate Reallocation
Given increased plan liability under the IRA and uncertainty from late changes to Star Ratings, plans should strategize for their Rebate Reallocation process.
Health Plans 2030: Shifting Clinical Care Delivery
The second installment of our Health Plan series examines how clinical care will shift in reaction to changes in demographics, technology, and environmental factors.
Mental Health Treatment Integration Can Offer Cost Savings
Adequately treating mental health disorders can cut overall costs, including those from comorbidities, despite access barriers and high comorbidity expenses.
Medicaid Managed Care Rule: Three Things Plans Should Know
CMS’s new Medicaid and CHIP managed care rule will impact wait time standards, In Lieu of Service and Setting usage, and quality rating.
Health Plans 2030: Evolving Operational Approaches
The first installment of our Health Plans series explains how plans can evolve their approaches to provider contracting and utilization management for the future.
Trends in Risk Adjustment Coding Operations
Plans adapt to market changes in risk adjustment coding. Interviews with plan professionals reveal three trends for efficiency, effectiveness, and compliance.
Redefining D-SNP Look-Alikes Would Impact Enrollment
If CMS lowers the dual-eligible enrollment threshold it uses to define D-SNP look-alikes, the demographics in look-alike plan enrollment will likely change.
Decoding the CY 2025 Advance Notice
Join Avalere’s healthcare policy experts as they dissect the Advance Notice of Methodological Changes for CY 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and discuss the future trajectory of Medicare Advantage (MA) in Part D and potential outcomes, headwinds, and tailwinds for health plans.
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