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.
New Avalere analysis finds Part D redesign via PDPRA would reduce average OOP costs by 23% for non-LIS beneficiaries, especially for certain drug classes and beneficiary groups by race and reason for entitlement.
The CDC recommends HBV vaccinations for persons with a history of current or recent injection drug use, but uptake remains low. Avalere research shows an opportunity to leverage alternative care settings to address the growing rates of HBV infection.
As Congress considers the bipartisan infrastructure package and budget reconciliation agenda, the coming months are likely to include debate on what could be the most significant federal healthcare legislation in over a decade. Additionally, the Biden administration is expected to release several important healthcare rules this fall, including the details necessary to implement the new law banning surprise billing and regulations to protect and strengthen Medicaid and the Affordable Care Act (ACA).
The COVID-19 pandemic has brought renewed attention and urgency to mitigating access barriers to recommended vaccines.
Finalized policy for Medicare’s CAR-T inpatient reimbursement builds on policies solidified in last year’s rulemaking. Looking ahead, stakeholders will continue to weigh the appropriateness of payment.
Avalere analysis shows that the COVID-19 pandemic had disproportionate impacts by race and ethnicity on Medicare enrollees.
In light of proposed changes to the ESRD Treatment Choices Model to address health disparities, an Avalere analysis of Medicare claims found gaps in access to and utilization of specific dialysis-related services by patient race, ethnicity, and socioeconomic status.
A new claims-based analysis from Avalere examined vaccine uptake among low-income adolescents enrolled in Medicaid Managed Care and found a 26% decline in routine vaccinations when comparing March–October 2019 to the same period in 2020.
On July 19, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 OPPS/ASC Proposed Rule, which includes a number of proposals to modify the timing and design of the Center for Medicare & Medicaid Innovation’s forthcoming Radiation Oncology (RO) Model. The design proposals include changes to the set of included modalities and cancer types, reduction of the CMS discount factors applied to the prospective payments, and adoption of an extreme and uncontrollable circumstances policy. Looking ahead, stakeholders should continue to assess the model payment methodology and design in the context of evolving care delivery and practice patterns.
Cancer has been the second-leading cause of death in the US for over a decade. Patient survival and quality of life depend to a large degree on stage at diagnosis, making early detection critical. However, most cancers have limited or no early screening technology available, reducing the opportunity to detect them early and leading to worse survival rates.
In the recently released Centers for Medicare & Medicaid Services (CMS) proposed rule for the CY 2022 Medicare Physician Fee Schedule, CMS proposed to include an Avalere-submitted malnutrition-focused improvement activity (IA) in the Merit-based Incentive Payment System (MIPS).
Stakeholders in the COVID-19 pandemic response face regulatory and commercial uncertainties as emergency operations transition and market access of products face both emergency use and full licensure.
Avalere analysis finds that when generics in Part D are placed on the preferred brand tier some patients pay the full cost for their drugs.
Duo joins as principals, bringing years of expertise in health economics and outcomes research.
The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies.
The COVID-19 pandemic response has increased investment in vaccine innovations, but also exposed gaps in US and global vaccine access and delivery.
Avalere’s white paper draws on recommendations from a multi-stakeholder workshop to look at roadblocks and solutions for scaling sustainable solutions to address the diagnosis of rare disease.
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
The Patient Centered Outcomes Research Institute (PCORI) recently announced an open comment period for a new set of proposed national priorities to inform its research agenda. Avalere analysis finds that from March 2019 to September 2020, PCORI directed roughly $259 million to comparative effectiveness research (CER) awards with an increasing share of new projects focused on drugs.
An Avalere survey of 37 decision-makers at risk-bearing payer entities identified shifting trends and focus for coverage of and access to behavioral health treatments and services.