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.
CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.
The Centers for Medicare & Medicaid Services (CMS) is currently reviewing a new payment rule, which could impact coverage of innovative procedures like transcatheter aortic valve replacement for the treatment of severe aortic stenosis.
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.
The Centers for Medicare & Medicaid Services (CMS) is embracing digital health and virtual care in many ways.
On April 9, Avalere policy experts published a piece in the Health Affairs blog about the administration’s recently launched “Ending the HIV Epidemic: A Plan for America” initiative.
Avalere experts recently presented their research, “Comparison of Healthcare Utilization Among Managed Medicaid Individuals Diagnosed with Multiple Sclerosis Treated with Emergent vs. Established Disease-Modifying Therapy in the US.”
Healthcare spending is expected to represent 19.4% of US GDP in 2027.
In the coming months, Avalere experts will be presenting new data and research at major conferences, featuring insights derived from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®).
The interaction of recently announced drug pricing reforms will have differential implications for stakeholders.
With the number of measles cases rising across the country, FDA Commissioner Scott Gottlieb raised the prospect of federal intervention over exemptions to state-level immunization school-entry requirements. While not specifying what role the federal government would play, Gottlieb stated, “You could mandate certain rules about what is and isn’t permissible when it comes to allowing people to have exemptions.”
As former federal officials, Dan Troy, David Beier, and I share our perspectives on the call by former FDA officials representing both political parties to make the FDA an independent agency separate from its parent, HHS.
Avalere served as the document manager for the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease, released on March 17 at the ACC.19 Scientific Session. This guideline includes practical and concise evidence-based guidance for clinicians on the primary prevention of cardiovascular disease (CVD).
In February 2012, the Centers for Medicare & Medicaid Services (CMS) announced a final payment error calculation methodology for its contract-level Risk-Adjustment Data Validation (RADV) audits of Medicare Advantage (MA) plans.
As CMS continues to transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS) for Medicare Advantage (MA) risk score calculation, plans must evaluate operations and close gaps to minimize the impact of risk score differences using this claims data source.
Today continues a steady diet of healthcare cost hearings with committees on both sides of Capitol Hill digging into the issue.
In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.
Beginning in 2019, CMS will reimburse for 5 codes relating to virtual care delivery and remote monitoring
In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.
In early February, Avalere attended the annual Centers for Medicare & Medicaid Services (CMS) Quality Conference, an annual gathering that brings stakeholders together to address challenges in healthcare quality improvement and discuss ways to spread these solutions locally and nationally.
The swift proposed implementation timeline will require stakeholders to evaluate quickly operational requirements, behavioral responses, cross-program implications, and impact on contractual arrangements.