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
Optimizing Clinical Registries During the COVID-19 Era
Registries have played an important role in furthering our understanding of the diagnosis and treatment of diseases and have specifically proven valuable in the identification and management of pandemic diseases.
New Data Approaches for Novel Curative Therapies and APMs
On June 9, Avalere experts discussed new data analytics and approaches for evaluating value-based topics in healthcare in the “New Data Approaches for Novel Curative Therapies & APMs” webinar. They examined the current approaches to assessing the value of treatments, novel curative therapy affordability and access, and the role of data in healthcare decision-making.
How COVID-19 Could Reduce MA Risk Scores and Payments in 2021
Deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.
COVID-19 Hospitalizations Projected to Cost up to $17B in US in 2020
Avalere analysis of Medicare fee-for-service (FFS) hospital stay claims with associated COVID-19 diagnoses finds that total US healthcare system costs for hospitalizations due to COVID-19 could range from $9.6B to $16.9B in 2020.
Impact of H.R.3 as Passed by the House on Federal Spending and Drug Manufacturer Revenues
Scenario analysis of varying levels of negotiation under H.R.3 (as passed in the House on December 12, 2019) finds that the bill could reduce federal spending by $850B to $1,060B and decrease manufacturer revenues by $1,275B to $1,655B for CY 2020–2029.
Avalere Helps NYSHealth Improve Physician-Patient Cost Conversations
Avalere’s issue brief highlights real-world examples of how cost of care can be woven into physician-patient conversations and how it can improve dialogues.
FDA Approach to Oversight of COVID-19 Therapeutics Has Evolved
While the COVID-19 pandemic continues to spread around the world, FDA has been balancing taking action to accelerate development of COVID-19 therapeutics and vaccines, while concurrently maintaining day to day activities to ensure proper oversight of current and future products on the market for all other unmet medical needs.
Prostate Cancer Patients in Employer Part D Plans Stay in the Coverage Gap Longer Than Those in Non-Employer Part D Plans
New Avalere analysis finds that Medicare Part D patients taking brand prostate cancer drugs enrolled in Employer Group Waiver Plans (EGWPs) have more prescriptions in the coverage gap than patients in non-employer plans.
The State of COVID-19 Vaccine Candidate Development
The novel coronavirus (COVID-19) was first reported in Wuhan, China, on December 31, 2019, and within a month was declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO).
Medicare Spent $106B on Vaccine-Preventable Diseases Over 3 Years
Avalere analysis finds Medicare incurred $106.4 billion in 2016–2018 treating diseases potentially preventable with inline vaccines and select pipeline vaccine candidates. Those diseases also resulted in beneficiary costs of approximately $9.6 billion during the same time period.
Emerging Trends in Oncology Management
As treatment advancements in oncology continue, stakeholders are modifying their approaches to defining value and managing care
Impact of Protected Class Utilization Management in Medicare Part D
Health plans, including Medicare prescription drug plans, commonly apply utilization management (UM) tools to manage spending on prescription drugs.
Utilization and Spending by Medicare Beneficiaries in Employer Part D
An Avalere analysis finds that, on average, non-LIS Medicare beneficiaries in Employer Group Waiver Plans (EGWPs) have higher utilization but lower out-of-pocket (OOP) costs than non-EGWP enrollees.
NTAP Eligibility Criteria Opportunities for Inpatient Reimbursement
Recent CMS rulemaking has expanded the opportunity for new drugs and devices to achieve NTAP status, either through the traditional process or via alternative. Manufacturers that are nearing the launch of new technologies, especially in the antimicrobial space, should assess whether their technology may qualify for NTAP. Applications for NTAPs effective in FY 2022 are due this fall.
Cannabidiol: A Regulatory Snapshot
The US market has seen a recent surge in cannabidiol (CBD) use and sales, despite many of these marketed CBD products being unregulated and untested for most of the claimed indications.
Behavioral Health in Medicaid May Be Unable to Meet Increased Demand
As COVID-19 forces the healthcare system to reprioritize patients and resources, providers delivering behavioral health services may be left with insufficient means to serve the population. Medicaid programs may observe increased demand for behavioral health services but may be ill-equipped to support beneficiaries.
State Medicaid Waivers for SUDs Present Opportunities for Stakeholder Engagement
1115 Waivers approved by CMS allow state Medicaid programs to better address substance use disorders among beneficiaries.
Evolving COVID-19 Impacts on Health Insurance Enrollment
On May 13, Avalere experts discussed key issues and considerations for the healthcare industry as millions of Americans shift in and out of new sources of coverage due to COVID-19.
Geographic Disparities in Mental Health Access Highlight Challenges
Over half of counties in the US (52%) do not have any mental healthcare providers.
COVID-19 Compass
COVID-19 continues to spread nationwide, and individuals with social risk factors and underlying chronic conditions are at highest risk for severe illness.