skip to Main Content

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.

Home-Based Care Leaders Offer Solutions to Access Hurdles

To fully realize the benefits of home-based care, including improved outcomes, inpatient hospital capacity, and patient experience, state and federal regulators may consider formalizing regulatory flexibilities, removing current barriers to participation in models such as Acute Hospital Care at Home, and testing the impacts of these waivers under the Center for Medicare & Medicaid Innovation (CMMI).

Emily Gillen

Medicare Enrollees with COPD Compared to the General Population

The percentage of Medicare enrollees with chronic obstructive pulmonary disease (COPD) in Medicare Advantage (MA) plans is growing (3.1% growth projected between 2020 and 2030), but the majority (60%) of enrollees with COPD are in fee-for-service (FFS) Medicare. Compared to the general FFS Medicare population, more beneficiaries with COPD are dual eligible for Medicaid and fewer beneficiaries with COPD have employer sponsored insurance as a source of supplemental coverage.

Matt Kazan

ESRD Enrollment in MA Now Exceeds 30 Percent of all Dialysis Patients

New analysis finds that just over 40,000 Medicare Fee-for-Service (FFS) patients with end-stage renal disease (ESRD) elected to enroll in Medicare Advantage (MA) during the 2021 open enrollment period—the first time all ESRD patients had access to an MA plan. This enrollment shift increased the proportion of ESRD patients enrolled in MA from 23% to 30%.

Timothy Epple

Treating Depression Reduces Medicare Costs; Provider Challenges Remain

A recent Avalere analysis of Medicare Fee-for-Service (FFS) data illustrates that treating major depressive disorder (MDD) in Medicare-eligible beneficiaries results in a 4% reduction in total cost compared to untreated patients, highlighting the importance of incentivizing adequate provider supply and payment in the geriatric psychiatry market.

Madison Davidson

High-Intensity Prostate Cancer Costs Consistently Below OCM Benchmark

An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.

Nathan Markward

Home Care Services Reduce Medicare Spending for 30 Chronic Conditions

An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management.

Ryan Urgo

Part D Redesign Impact on Manufacturer Discounts in Protected Classes

New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.

Sign up to receive more insights about Federal Policy
Please enter your email address to be notified when new Federal Policy insights are published.

Back To Top