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.
Featured Content
Hospital Willingness to Assume Risk Growing
Majority of hospitals in BPCI Advanced, the second iteration of CMS’ largest bunded payment initiative, have no prior experience with risk in the original BPCI program.
Access to Abuse-Deterrent Opioid Formulations Tied to Reduced Risk of Opioid Abuse and Overdose
New Avalere research finds that health plan members enrolled in plans that cover abuse-deterrent formulations (ADFs) of opioids have a lower risk of opioid abuse (OA) and overdose (OD) and lower opioid abuse-related hospitalizations than people in plans that do not offer coverage of ADF opioids.
Trends in Opioid Use: History, Background, and Origins of the Epidemic
Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.
Summary: What’s on the Horizon for US Drug Pricing Policy in 2019 and Beyond?
On October 25, Avalere experts came together to discuss the latest policy developments related to drugs.
Alternative Financing Models for Durable Cures
Transformative medicines, like gene and cell therapies, are beginning to be approved in the US, and more are expected to come.
The Data Behind Social Determinants of Health Research
New Avalere study entitled “Using Aggregate Data to Proxy Individual-Level Socioeconomic Characteristics in Research on Medication Adherence: 9-Digit ZIP Code vs. Census Block Group” selected for the AMCP Foundation Best Poster Award at AMCP Nexus 2018.
Impact of CMS Changes to the Medicare Advantage Risk-Adjustment Models
Our analysis finds there will be winners and losers at the plan level under the new models.
Avalere Observations: 2018 Election Cycle and the Outlook for Health Policy
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
CMS 2019 Star Ratings Remain Stable for MA-PD Plans, Shift for PDPs
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
Multidisciplinary Workgroup Publishes Appropriate Use Criteria for LP and CSF Testing for the Diagnosis of Alzheimer’s Disease
Today, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association published appropriate use criteria (AUC) to guide the use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis for use in the diagnosis of Alzheimer’s disease.
California Becomes the 6th State to Restrict Short-Term Plans in 2018
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
Mental Illness Research Wins Award
Findings from a new Avalere study, titled “Prevalence and Likelihood of Hospital Admission and Readmission in Patients with Serious Mental Illness,” were presented at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Asia Pacific conference on Sunday, September 9, 2018.
Key Considerations for Medicare Advantage Plans Evaluating New Part B Step Therapy Flexibility
Following its recent announcement to grant Medicare Advantage (MA) plans the flexibility to use step therapy techniques for Part B drugs beginning in January 2019, the Centers for Medicare & Medicaid Services (CMS) released an FAQ with additional guidance on its implementation.
CMS Announces New Flexibilities in Medicare Part D
Under an indication-based formulary design approach, Part D plans will be able to tailor the drugs that are on their formulary by indication.
Eliminating Drug Rebates Requires Complex Solutions
Reforms to “eliminate rebates” could have varying impacts based on features of their design.
CMS Grants Medicare Advantage Plans Flexibility to Use Step Therapy for Part B Drugs
Beginning in January 2019, Medicare Advantage (MA) plans will have the flexibility to use step-therapy techniques for Part B drugs, according to a CMS memo released on August 7.
CMS Proposal Would Alter Office Visit Payments
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
CMS Proposal Encourages Advanced Alternative Payment Model Participation
Early adoption and participation in an AAPM can provide a higher incentive payment to Medicare clinicians than MIPS.
FDA Seeks Stakeholder Input on How to Enhance Biosimilars and Interchangeable Biologics Market
Earlier this week, the Food & Drug Administration (FDA) released a Part 15 public hearing announcement and request for comment on how the FDA can facilitate greater availability while balancing competition and innovation for all biologics.
Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions
Although malnutrition can lead to greater risk of chronic disease, frailty, and disability, and increases healthcare costs, patients’ nutrition status is rarely evaluated and managed as they transition across care settings.
