Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
This past spring, Avalere and MITRE experts presented “Implementation of the Core Quality Measures Collaborative (CQMC) Core Measure Sets by Public Payers: Successes and Opportunities” at the Pharmacy Quality Alliance (PQA) annual meeting.
Avalere experts published a supplement in the June 2019 American Journal of Managed Care entitled “Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy.”
Health plans today have a range of strategic opportunities that align well with emerging policy themes for 2020.
To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision-making by embedding shared decision-making (SDM) as a routine part of clinical practice.
Avalere supports development of the Inflammatory Bowel Disease (IBD) Care Referral Pathway, which aims to coordinate care and optimize referral practices among different clinicians that treat patients with IBD.
New Avalere analysis evaluates the trends in baseline patient characteristics among Medicare fee-for-service beneficiaries with stand-alone Part D coverage who initiated a direct oral anticoagulant during the period 2013–2017.
Avalere analysis of 1,375 Medicare Advantage plans’ 2019 medical benefit drug coverage policies finds that 672—covering approximately 14.3 million lives—apply step therapy to at least 1 of the rheumatoid arthritis biologic drugs covered under Medicare Part B in 2019.
In January 2018, Avalere Health partnered with the Society of Cardiovascular and Angiography Interventions to launch the development of the Heart Valve Initiative.
Avalere experts recently presented “Risk Adjusting Medicare Advantage Plan Performance Measures for Social Determinants of Health: Are Dual Eligibility and Disability Status Enough?” at the Academy Health 2019 Annual Research Meeting.
New Avalere analysis finds that shifting Part B-covered rheumatoid arthritis (RA) drugs to Part D benefit would increase the share of prescriptions occurring in the catastrophic phase for impacted beneficiaries by more than 5 times.
As policymakers increasingly consider policy options to reform Medicare Part D and reduce program expenditures, an Avalere analysis examines spending across classes with various availability of brand and generic drugs.
As health plans evaluate more efficient ways to engage and retain members, they should focus on existing high-touch points to improve healthcare access and the overall experience. Augmenting these efforts can generate more evidence-based patient management thus improving overall health outcomes.
Paper details recent developments in leading value frameworks, including Avalere’s Focus on Patient Orientation in Value Assessment.
As policymakers explore opportunities to reform Medicare Part B, a tiered average sales price (ASP) add-on payment may be under consideration to align system incentives and curb spending.
While the Department of Health & Human Services (HHS) did not intend for proposed changes to Anti-Kickback Statute (AKS) regulations to impact commercial market drug negotiations, some state laws may indirectly lead to commercial market implications.
Avalere experts recently presented “A Comprehensive Analysis of Influenza Vaccine Uptake in Medicare” at the National Adult and Influenza Immunization Summit in Atlanta, GA.
Avalere published a white paper outlining global recommendations to increase the patient centricity of value assessment framework methodology and application.
On May 24, Avalere policy experts published a piece on the Health Affairs blog highlighting opportunities to leverage quality measurement tied to payment to drive adult immunization uptake and achieve national population health targets.
In 2018, Avalere partnered with CancerCare and Gabrielle Rocque, an oncologist at the University of Alabama Birmingham School of Medicine, to develop the Preparation for Shared Decision Making (PFSDM) tool.
Avalere experts will present “Comparing Utilization, Cost and Quality in Dual Eligible Medicare Advantage and Fee-For-Service Medicare Beneficiaries” at the International Society for Pharmacoeconomics and Outcomes Research meeting on May 21.