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
3 Trends to Watch in this Medicare Open Enrollment Season
As Medicare Advantage enrollment grows and benefits continue to evolve, beneficiaries must keep pace with these changes and investigate plan options amidst current healthcare debates.
Understanding ICER’s Evolving Influence on Drug Pricing and Negotiation
ICER is eager to position itself as the primary comparative and cost-effectiveness research body in the US. While their activity has been traditionally more limited to product-specific reviews, the Institute is increasingly looking to shape the broader debate around value and drug pricing.
Avalere’s Home Health Expertise Featured in AHHQI Chartbook
For the last several years, Avalere has worked with the Alliance for Home Health Quality and Innovation (AHHQI) to analyze the ever-changing home health landscape.
Issue Brief: OOP Costs Among Medicare Part D Enrollees Reaching the Catastrophic Threshold
As policymakers consider reforms to the Part D benefit to address rising out-of-pocket (OOP) costs by adding a maximum OOP cap, an Avalere analysis examines the types of beneficiaries mostly likely to be helped by such a policy.
What’s Next for Biologics Under USMCA?
The USMCA’s intellectual property provisions add additional layers of ambiguity to the already complex issues surrounding biological product exclusivity and its future in US law.
SFC Drug Pricing Proposal Would Increase Part D Manufacturer Discounts for Some Therapeutic Areas
Avalere analysis finds that tying Medicare Part D manufacturer discounts to utilization in the catastrophic phase instead of in the coverage gap would have differential impacts by disease area.
Location of Measles Cases Linked to Geographies Where Non-Medical Exemptions for Vaccines Are Clustered
Since the 1980s, all 50 states have used immunization requirements as a condition of school entry to protect the public’s health from vaccine-preventable diseases.
4 Compelling Use Cases for Blockchain in Healthcare
While emerging blockchain technology is expected to impact a range of businesses in the years ahead, its strengths seem particularly well suited for the complex data-sharing demands of the pharmaceutical and healthcare industries.
7 State Policy Trends that May Shape Cancer Care in 2020
State healthcare legislation often holds important implications for high-value and high-cost drugs, such as those used to treat cancer patients.
Takeaways from NASHP: What’s Next in the States in 2020
Avalere’s state policy team recently attended the National Academy for State Health Policy’s (NASHP) Annual Conference for 3 days of interactive state health policy discussions and the facilitation of a roundtable on the direction of telehealth in the states.
New Innovations in Healthcare Aim to Address Social Determinants of Health
A wide variety of health plans, provider networks, and national corporations have recently developed and announced innovations and strategies to expand access to healthcare and to address needs that promote health across communities.
CMMI Program Savings Fall Below CBO’s 2016 Projections
CMMI’s impact on Medicare spending has so far not reached earlier projections by the Congressional Budget Office, demonstrating the difficulty in projecting savings from new and unknown alternative payment models.
Avalere Experts Discuss 2020 Regulatory Changes to the Insulin Market
On August 6, Avalere’s regulatory experts published an article in BioDrugs highlighting upcoming regulatory changes for insulin.
Maximizing Access in an Evolving Policy and Payer Landscape
Manufacturers currently face an almost-unprecedented level of uncertainty in developing contracting strategies for the coming plan years. Avalere’s combination of policy and commercialization expertise, paired with its data capabilities, allow us to support life sciences companies understand this challenging landscape to ensure access to innovative therapies for their patients.
3.7M Part D Beneficiaries Are Projected to Reach the Catastrophic Phase in 2020
As policymakers consider reforms to Part D, new Avalere analysis shows that congressional proposals to cap out-of-pocket (OOP) costs in the catastrophic phase are likely to reduce OOP for many beneficiaries
Avalere’s Malnutrition Initiative Featured in the Journal of the Academy of Nutrition and Dietetics
Avalere’s efforts to advance the national Malnutrition Quality Improvement Initiative featured in newly published supplement of the Journal of the Academy of Nutrition and Dietetics.
States Explore Increasing Access to Telehealth as New Opportunity for Quality Care
States are increasingly seeking to improve access and health outcomes for their underserved, rural, or homebound populations, and many are turning to telehealth as a solution.
Impact of Proposed CMS Methodology for Calculating Payment Errors May Vary Based on Plan Enrollee Characteristics
In 2018, CMS proposed to revise its Risk Adjustment Data Validation (RADV) methodology to exclude the FFS Adjuster in its payment recoupment calculations. New analysis from Avalere finds that the payment impact associated with fee-for-service (FFS) Medicare coding discrepancies would be greater for certain subgroups of beneficiaries (e.g., dual-eligible, those with certain common and potentially serious health conditions) enrolled in the MA program.
The Evolving Newborn Screening Landscape
On August 21, Avalere policy experts published a piece on the Health Affairs blog highlighting the impact of advancements in treatment and screening technology on the newborn screening landscape.
How a New Technology Add-On Payment (NTAP) Works
Additional Medicare payment options available for new, high-cost technologies used in the inpatient setting.
