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.
Avalere is releasing a new research agenda to guide evidence generation for health system models of care that address the intersection of social and clinical needs of Medicaid-eligible individuals.
Dually eligible beneficiaries in Pennsylvania with end-stage renal disease (ESRD) are more often people of color and have higher costs compared to non-duals, but their utilization patterns are similar.
Affordable Care Act (ACA) exchanges have seen a significant uptick in enrollment, especially from those losing employer-sponsored coverage or who were previously uninsured. However, different approaches to special enrollment periods (SEPs) leave many with limited opportunities to enroll.
She deepens the firm’s post-acute and policy analytics capabilities, bringing nearly 15 years' worth of policy analytics experience to Avalere with a specific focus on the provider sector.
As our healthcare industry rapidly evolves to address the COVID-19 pandemic, keep track of new resources and policies affecting patients and providers with the COVID-19 guide below.
After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.
An analysis of CMS’s Hierarchical Condition Category (HCC) model shows that fully dual-eligible beneficiaries have the highest risk scores.
Though Americans have been encouraged to physically distance themselves to minimize transmission of COVID-19, individuals who are homeless or living in institutional settings may not be able to adhere to these guidelines, putting them at higher risk of contracting and transmitting the virus.
In December 2019, Avalere Health and Endocrine Society launched the first quality measurement set designed to help providers assess how well they identify and care for older adults at greater risk of hypoglycemia – low blood sugar that can be a dangerous complication of diabetes.
CMS proposes to alleviate drug price reporting barriers that have hindered the adoption of innovative contracting models for prescription drugs. Stakeholders should contemplate the details and implications of CMS’ proposals—including how the changes would impact current contracting—as well as remaining areas of ambiguity.
On June 11, Avalere experts explored the future of telehealth and how organizations can help shape and take advantage of its increased utilization.
With the release of the 2021 Medicare Advantage (MA) and Part D Final Rule, the details of the upcoming policy change that allows beneficiaries with end-stage renal disease (ESRD) to enroll in MA are set. Stakeholders need to adapt quickly to be prepared.
Registries have played an important role in furthering our understanding of the diagnosis and treatment of diseases and have specifically proven valuable in the identification and management of pandemic diseases.
On June 9, Avalere experts discussed new data analytics and approaches for evaluating value-based topics in healthcare in the “New Data Approaches for Novel Curative Therapies & APMs” webinar. They examined the current approaches to assessing the value of treatments, novel curative therapy affordability and access, and the role of data in healthcare decision-making.
Deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.
Avalere analysis of Medicare fee-for-service (FFS) hospital stay claims with associated COVID-19 diagnoses finds that total US healthcare system costs for hospitalizations due to COVID-19 could range from $9.6B to $16.9B in 2020.
Scenario analysis of varying levels of negotiation under H.R.3 (as passed in the House on December 12, 2019) finds that the bill could reduce federal spending by $850B to $1,060B and decrease manufacturer revenues by $1,275B to $1,655B for CY 2020–2029.
Avalere’s issue brief highlights real-world examples of how cost of care can be woven into physician-patient conversations and how it can improve dialogues.
While the COVID-19 pandemic continues to spread around the world, FDA has been balancing taking action to accelerate development of COVID-19 therapeutics and vaccines, while concurrently maintaining day to day activities to ensure proper oversight of current and future products on the market for all other unmet medical needs.
New Avalere analysis finds that Medicare Part D patients taking brand prostate cancer drugs enrolled in Employer Group Waiver Plans (EGWPs) have more prescriptions in the coverage gap than patients in non-employer plans.