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.
Recurring episodes of clostridioides difficile (c diff) create significant added healthcare burden and costs to society and lead to avoidable adverse outcomes in the Medicare population
Recent regulatory changes have eased restrictions for providers delivering care across state lines during the COVID-19 public health emergency. However, state and federal cooperation on extended licensure expansion would help address long-term provider access issues.
In a recent webinar, experts from Avalere and the National Patient Advocate Foundation discussed the value of shared decision-making (SDM) and preparing patients and families for navigating their care journeys.
The evolution of the US influenza vaccine market offers insights into the potential barriers and opportunities for successful rollouts of novel COVID-19 vaccines.
On February 27, Avalere experts discussed the latest policy, pricing, and reimbursement challenges for prescription drugs in Medicaid in the “What’s Next for Medicaid Drug Pricing?” webinar. They reviewed the ways prescription drugs are managed in Medicaid, what innovative medicines may mean for the program, and potential implications of CMS’ Healthy Adult Opportunity (HAO).
Major catastrophes, like natural disasters, global pandemics, and sudden economic downturns require rapid interventions to protect the American public from long-term health and financial damage. Because there is significant momentum and political will during and immediately following a catastrophe, promising innovations may be fast-tracked.
Although COVID-19 is introducing new challenges within the global pharmaceutical supply chain, the current situation also creates opportunities for stakeholders to evaluate drug security and implement risk-mitigation strategies around shortages and required stockpiles.
On April 9, Avalere experts came together to discuss the impact of COVID-19 on the health insurance industry.
Avalere analysis finds that Medicare fee-for-service (FFS) patients with an RA diagnosis and conditions associated with undermanaged disease have 121% higher medical costs than other RA patients. Part D costs were 30% higher for those with undermanaged disease than for other RA patients.
The kidney care payment and delivery landscape was poised for change in 2020 due to existing policies and market trends. Given the specific risk COVID-19 poses to these patients, the pandemic is creating new challenges and potentially accelerating existing trends in the kidney care space.
On April 15, President Trump announced his intention to halt funding to the World Health Organization (WHO), pending an investigation into WHO’s response to the COVID-19 pandemic. WHO first declared the outbreak a Public Health Emergency of International Concern on January 30 and a global pandemic on March 11. A reduction in funding from the US could limit WHO’s COVID-19 response activities as well as its regular vaccine programming, including product prequalification, global surveillance, and ongoing efforts to strengthen health systems.
Sickle cell disease (SCD) is a severe red blood cell disorder that disproportionately affects African-American and Hispanic populations. In the United States, there are approximately 100,000 individuals living with SCD (although there is a lack of accurate reporting and the exact number is unknown).
As the novel coronavirus (COVID-19) spreads throughout the United States, media and policy focus on the rollout of diagnostic testing for the disease has greatly increased. Understanding the role of testing and screening is key to the control of this outbreak.
As the economic and social impact of COVID-19 change how patients access and receive care, manufacturers and third-party suppliers must consider how to evolve their patient support programs to meet the shifting access and affordability needs of patients.
Oncology practices with a substantial proportion of Oncology Care Model (OCM) episodes in areas with high numbers of COVID-19 cases—such as Connecticut, Louisiana, Massachusetts, New Jersey, New York, and Pennsylvania—may face new challenges in containing total expenditure below target amounts.
To protect the public’s health during the COVID-19 pandemic, the Food & Drug Administration (FDA) released guidance expanding the availability of digital health therapeutic devices and applications for psychiatric disorders by clarifying which regulatory requirements it does not plan on enforcing as well as which products do not necessitate FDA oversight. This guidance intends to limit extraneous contact between patients (users) and providers by providing regulatory flexibility for low risk products. The policies will last until the national public health emergency ends.
As COVID-19 deaths increase, the FDA is evaluating and considering approval of treatments more quickly, but the rush to find treatment options is creating new access considerations for patients and providers.
As COVID-19 continues to stress the US healthcare system, pharmacists and retail pharmacies may help respond to the pandemic.
Approximately ⅓ of physician services payments are eligible for telehealth reimbursement under Medicare (fee-for-service) FFS through existing Center for Medicare and Medicaid Services (CMS) guidance as of January 2020, in addition to temporary coding guidance specific to COVID-19 effective as of March 1, 2020. Avalere’s analysis highlights the immediate potential for specific physician specialties to utilize telehealth based on temporary flexibilities regarding which procedures are eligible for telehealth reimbursement.
As of 2018, almost 70% of hospitals in the United States are not-for-profit entities according to the American Hospital Association (AHA).