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
TPNIES Adjustment Promotes Access for Innovative ESRD Technologies
Medicare offers an add-on payment to facilities furnishing qualified new and innovative renal dialysis equipment and supplies via the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES).
CMS Introduces Changes to CAR-T Reimbursement in IPPS Proposed Rule
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on policies finalized in last year’s rulemaking. Looking ahead, stakeholders will continue to weigh the appropriateness of payment.
Healthcare Among High-Need, High-Cost Beneficiaries in FFS vs. MA
Avalere experts participated in a pre-release panel session, "Healthcare Utilization, Cost, and Quality Among High-Need, High-Cost Beneficiaries in Medicare Fee-for-Service versus Medicare Advantage," that was presented at the International Society for Pharmacoeconomics and Outcomes Research annual conference May 17–20, 2021.
US Government Continues Investing in Solutions to Combat AMR
As the COVID-19 pandemic draws to a close in the US, another public health concern is once again coming to the fore: antimicrobial resistance (AMR).
Medicare Expansion Could Have a Mixed Impact on Premiums
New Avalere analysis finds that lowering the Medicare eligibility age from 65 to 60 could expand access to Medicare coverage for an additional 24.5 million individuals, but Medicare premiums may be less affordable in some cases than subsidized exchange coverage.
Rare and Orphan Disease Therapies Require New Distribution Strategies
Manufacturers currently in the developmental phase for drug assets targeting rare or orphan diseases should assess the commercialization implications when bringing novel therapies to market and how they may differ from the standard pharmaceutical supply chain and economics.
Advancing Diabetes Care in the Era of CGM: Dialogue Proceedings
As one of the most common chronic conditions in the US—affecting approximately 10.5% of the US population and growing—diabetes (and the optimal management of this condition) remain a persistent healthcare challenge.1
Assessing Changes in Prenatal Care During the COVID-19 Pandemic
COVID-related concerns influenced shifts in utilization and changes to the delivery of major pregnancy-related services. The expanded use of telemedicine in the maternal care continuum increasingly provided expectant patients with access to healthcare services while adhering to social-distancing guidelines.
Accurate COVID-19 Testing to Protect the Military and Support Schools
The US continues to face challenges with managing COVID-19 (SARS-CoV-2) while reopening communities. Accurate COVID-19 diagnostic testing is an effective tool in minimizing the risk of transmission.
Avalere Statement on US Support of TRIPS Waiver for COVID Vaccines
On May 5, the Biden administration announced its support for waiving World Trade Organization (WTO) intellectual property regulations with respect to COVID-19 vaccines, in an effort to increase supply and worldwide access to the vaccines.
President Biden’s Address to Congress Highlights Healthcare Priorities
In his first address to Congress, President Biden signaled that healthcare will continue to be a high priority for his administration, specifically highlighting pandemic response, drug pricing priorities (e.g., Medicare negotiation), and Affordable Care Act (ACA) enhancements.
Removing Low-Risk Cancers Has Variable Impact on OCM Performance
An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.
New Data-Sharing and Interoperability Mandates Create New Challenges
Digital health will continue to be a focus under recently confirmed Secretary Becerra‘s leadership at the Department of Health and Human Services. As the Biden administration looks to enforce compliance across a range of data interoperability and price transparency rules, as well as usher in new Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) coverage policies for medical technologies and digital health tools, the industry is responding with a range of innovations.
AI in Healthcare: Raise the Evidence Bar Now or Be Forced to Later
In 2012, experts predicted that artificial Intelligence (AI) would eventually replace as much as 80% of current clinical practice by physicians. While AI has certainly expanded in healthcare—especially during the COVID-19 pandemic—the last few years have included some eventful setbacks in the use of AI across several sectors of the economy, including healthcare.
Pending ASP Changes Impact Payments & May Shape Future FDA Filings
Beginning July 1, 2021, average sales price (ASP) calculations for Part B drugs with an additional non-covered self-administered formulation could alter Medicare reimbursement.
Part D LIS Patients Have Lower Rates of Specialist-Prescribed Drugs
For prescription drug fills across 4 therapeutic areas, Avalere analysis finds that Medicare Part D beneficiaries who receive the Low-Income Subsidy (LIS) have those drugs prescribed by a specialist less frequently than those who do not receive LIS.
Exchange Operational Models for 2021
In 2021, most states are relying on the federal government for some or all exchange operational functions.
Advancements in Cell Therapies Require New Patient Support Solutions
Manufacturers seeking Food & Drug Administration (FDA) approval for cell therapies will need to assess the financial and logistical burden on patients and develop novel solutions to help alleviate these challenges.
The Need for a Centralized Immunization Information System
Immunization Information Systems (IIS), or immunization registries, are used across the US to provide consolidated and complete accounts of patient immunization history in a given city, state, or region.
PACHA Highlights Need to Address HIV PrEP Coverage Disparities
On March 8–9, the Presidential Advisory Council on HIV/AIDS (PACHA) discussed avenues to achieving equitable access to HIV prevention products for at-risk populations as well as next steps in revising the National Strategic Plan to End the HIV Epidemic.