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.
Express Scripts Inc., the world's largest PBM for employers and health plans, recently released a list of 44 drugs that they will now exclude from coverage beginning January 1, 2014.
As molecular diagnostics become more common in treating certain diseases - especially cancer - their reimbursement will be an important part of value messaging for many drug therapies.
Health insurance exchange marketplaces opened on October 1 for enrollment across the country, as well as premium subsidies for those with limited incomes.
Avalere Health is carefully analyzing the landscape file of health plan offerings on the federally-facilitated marketplace recently released by the Department of Health and Human Services (HHS).
Initial data suggest that exchange plans under the Affordable Care Act (ACA) will include high out-of-pocket costs for enrollees-including deductibles and cost-sharing for medical services and prescription drugs-before consumers reach their out-of-pocket maximum.
The 2014 market will be characterized by challenge and transformation across payers, providers, and patients which will create pressures for the pharmaceutical and medical device industries to:
To date, 24 states and the District of Columbia have committed to expanding Medicaid sometime in 2014.
Medicare Advantage HMO offerings grow while PPO and PFFS offerings are exiting the market. Analysis also shows significant variation in PDP premiums in 2014; five out of top 10 prescription drug plans have double digit increase
Comparative effectiveness research (CER) has the potential to inform many decisions. While a common threshold for determining whether a CER finding should be disseminated to the public is its methodological quality, a study with high methodological quality is not necessarily one that patients and providers will find usable for their decision making.
Today, the Centers for Medicare & Medicaid Services (CMS) released the 2014 landscape files containing data on plan participation, premiums and benefit designs for the Medicare Part D and Medicare Advantage (MA) markets.
Avalere examines states participating in the ACA expansion that may reduce eligibility levels for some current beneficiaries.
One of the most anticipated questions about exchanges has been what the impact of rate shock will be on the market.
The Centers for Medicare and Medicaid Services (CMS) released long-awaited data about the first-year of the Pioneer ACO program.
States, HHS Focus on Final Details as Exchanges Ready for Launch
The Joint Commission and the American Medical Association (AMA) Convened Physician Consortium for Performance Improvement® released a report on July 8, which was previously under an embargo, focusing on the overuse of tests, treatments, or procedures that provide zero to negligible benefit and expose patients to risk of harm.
In 2014, most states are relying on the federal government for some or all exchange operational functions.
CMS plans to revalue the oldest laboratory service codes first. An Avalere analysis found pre-1997 codes accounted for nearly 37% of Medicare Clinical Laboratory Fee Schedule (CLFS) spending in 2011.
Welcome to our first issue of Avalere Health Quarterly, a sector-by-sector analysis of major issues and moving parts in healthcare for the coming 3 to 6 months. The Quarterly offers Avalere expert opinion on how major industry catalysts will impact your business decisions.
Overall, implementation of the duals demonstrations is slower than expected and states continue to delay.
New Avalere research found that public and private payers reversed non-coverage policies following a recommendation from a regional CER initiative.