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
SCOTUS Overturn of the ACA May Invalidate Biosimilar Pathway
The 351(k) biosimilars pathway was legally established under the Biologics Price Competition and Innovation Act (BPCIA) provision of the Patient Protection and Affordable Care Act (ACA) of 2010. Since the passage of the ACA, 28 biosimilars have been approved by the Food & Drug Administration (FDA) along with the promulgation of policy that also applies to all biologics, including the creation of a suffix within the nonproprietary name of these products. Additionally, substantial case law has been made with respect to intellectual property pertaining to biologics. With the legality of the ACA currently under scrutiny, the future of BPCIA and biosimilars is uncertain.
A Data-Driven Approach to Identifying Patients with AAD
On November 4, Avalere experts presented “Development of a Claims-Based Algorithm to Identify Patients with Agitation in Alzheimer’s Dementia” at the Gerontological Society of America Annual Scientific Meeting.
Healthcare Implications of the 2020 Election Results
The 2020 presidential election will have significant implications for the US healthcare system and Americans’ healthcare options.
States Mitigate Potential Coverage Losses Ahead of ACA SCOTUS Ruling
With the US Supreme Court (SCOTUS) set to hear arguments starting November 10 in California v. Texas and the swearing in of Justice Amy Coney Barrett on October 26, questions remain regarding the future of the Affordable Care Act (ACA) and its impact on laws passed in at least 18 states creating coverage protections for essential health benefits (EHB) and coverage of pre-existing conditions.
Understanding Success Among OCM Participants
Avalere analysis finds that success in the first 4 performance periods of the Oncology Care Model (OCM) was correlated with reductions to inpatient expenditure and spend reductions within certain high-cost tumor types. Further, smaller community-based practices and those that had lower per-episode expenditure in the baseline period tended to be more successful.
COVID-19 and Influenza Vaccine Distribution Stakeholder Considerations
The convergence of the seasonal influenza and the current COVID-19 vaccines will merge several distribution considerations for a diverse group of stakeholders.
Comparing Part B and D Treatment Patterns of ACO and Non-ACO Providers
New analysis from Avalere finds that Medicare beneficiaries are more likely to receive Part D autoimmune drugs and less likely to receive Part B autoimmune drugs from providers who are part of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) compared to non-ACO providers.
COVID-19 Impacts on Cancer Care
Avalere research was published online in the Journal of Clinical Oncology Clinical Cancer Informatics, showing a considerable drop in cancer screening, diagnosis, and treatment for Medicare beneficiaries as a result of the ongoing COVID-19 pandemic.
MA Enrollees Can Access COVID-19 Supplemental Benefits in 2021
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits, including services related to the pandemic.
Step Therapy Can Lead to Higher OOP Costs for Crohn’s Disease Patients
Avalere analysis finds that patients with Crohn’s disease who experience a negative outcome when required to step through a plan’s preferred product may face higher upfront out-of-pocket (OOP) costs and could increase costs to payers.
Election Outcome Will Play Pivotal Role in State Healthcare Priorities
The outcomes of the 2020 elections will hold implications for state policymaking on key healthcare issues that could impact patients’ health insurance coverage status and how they access care.
How Do Biden’s and Trump’s Public Health Platforms Compare?
The November 2020 election is widely anticipated to have important implications for how the US responds to COVID-19.
SCOTUS Ruling on ACA Could Impact Coverage and Policy Outlook
With the US Supreme Court set to hear arguments starting November 10 on California v. Texas, and Judge Amy Coney Barrett’s nomination under consideration in the Senate, questions remain regarding the future of the law.
Mandatory Kidney Care Model Introduces Financial Incentives and Risks
The ESRD Treatment Choice model demonstrates an increased focus on improving health outcomes for Medicare patients receiving dialysis by realigning incentives to favor the adoption of home dialysis and increasing the rate at which patients receive kidney transplants. This mandatory model could lead to significant disruption for stakeholders in the coming years. Understanding the risk and opportunities associated with this model will be critical for patients, providers, and manufacturers alike.
Expanding Patient Access to Digital Mental Health Services & Products
The COVID-19 pandemic is driving greater demand for digital mental health products and services. Stronger scientific evidence is necessary to determine value and increase payer reimbursement.
The COVID-19 Impact on US Routine and Seasonal Vaccine Administrations
Avalere conducted a national survey of more than 200 independent primary care providers concerning the impacts of the COVID-19 pandemic on their ability to support continued vaccination programs for patients. Over 90% of respondents indicated the COVID-19 pandemic has increased operating costs and led to revenue loss. Eighty-two percent indicated that an increase in vaccine administration fees would aid sites in overcoming barriers arising from the COVID-19 pandemic, and 75% expressed interest in implementing new care delivery arrangements to facilitate immunizations during the COVID-19 pandemic.
Avalere Analysis Shows Home Care Services Reduce Medicare Spending
Avalere analysis determined that Medicare Fee-for-Service (FFS) patients receiving home-based care services experienced a decrease in Medicare spending over time when compared to a statistically balanced, matched control group who do not appear to have received home care services. The spending differential was also found to be higher among Medicare beneficiaries with functional limitations and multiple chronic conditions.
ESRD Patient Spending Differences Between Puerto Rico and the 50 States
Avalere analysis finds End Stage Renal Disease (ESRD) spending in Puerto Rico varies substantially, and most spending is related to outpatient dialysis and inpatient services.
COVID-19 Provider Relief Funding and Future Allocation Considerations
The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion for the Public Health and Social Services Emergency Fund—known as the Provider Relief Fund (PRF)—and subsequent legislation appropriated an additional $75 billion through the Paycheck Protection Program and Health Care Enhancement Act.
Measuring the Effectiveness of Cost-of-Care Conversations
With support from the Robert Wood Johnson Foundation, Avalere assesses opportunities to normalize cost-of-care conversations through measurement.
