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.
The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies.
The COVID-19 pandemic response has increased investment in vaccine innovations, but also exposed gaps in US and global vaccine access and delivery.
Avalere’s white paper draws on recommendations from a multi-stakeholder workshop to look at roadblocks and solutions for scaling sustainable solutions to address the diagnosis of rare disease.
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
The Patient Centered Outcomes Research Institute (PCORI) recently announced an open comment period for a new set of proposed national priorities to inform its research agenda. Avalere analysis finds that from March 2019 to September 2020, PCORI directed roughly $259 million to comparative effectiveness research (CER) awards with an increasing share of new projects focused on drugs.
An Avalere survey of 37 decision-makers at risk-bearing payer entities identified shifting trends and focus for coverage of and access to behavioral health treatments and services.
Crises often drive change at a pace not thought feasible in normal times. The COVID-19 pandemic has been no exception, bringing the accelerated development and emergency approval of vaccines, the wide implementation of telehealth, and potentially permanent changes to the way that global business is conducted.
Reducing health disparities is critical to advancing health equity, and each stakeholder has a role to play.
An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.
As the Centers for Medicare & Medicaid Services (CMS) consider what, if any, changes to propose to Medicare Advantage (MA) through fall rulemaking, stakeholders should consider where the Biden administration’s priorities may differ from the previous administration’s. Topics that may be addressed—either in regulation or via legislation—include health equity, supplemental benefit flexibility, star ratings, payment and risk adjustment, and end-stage renal disease (ESRD).
The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.
Digital health solutions continue to advance the way healthcare is delivered. Through research and development as well as stakeholder partnerships, life science companies can leverage digital health technologies to optimize access along the patient care journey.
In 2020, the COVID-19 pandemic resulted in nationwide lockdowns and restrictions with a well-documented impact on utilization of routine healthcare services.
While access to insurance has increased for millions, mid-year plan switching can have unforeseen consequences for patients.
As Congress renews focus on drug pricing reforms, an Avalere analysis examines recent trends in the Part D program’s subsidy payments and implications on stakeholder liabilities in the program.
In November 2020, the Food and Drug Administration (FDA) granted Emergency Use Authorization (EUA) to COVID-19 monoclonal antibodies for treatment of mild-to-moderate COVID-19 infection.
Medicare offers an add-on payment to facilities furnishing qualified new and innovative renal dialysis equipment and supplies via the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES).
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on policies finalized in last year’s rulemaking. Looking ahead, stakeholders will continue to weigh the appropriateness of payment.
Avalere experts participated in a pre-release panel session, "Healthcare Utilization, Cost, and Quality Among High-Need, High-Cost Beneficiaries in Medicare Fee-for-Service versus Medicare Advantage," that was presented at the International Society for Pharmacoeconomics and Outcomes Research annual conference May 17–20, 2021.
As the COVID-19 pandemic draws to a close in the US, another public health concern is once again coming to the fore: antimicrobial resistance (AMR).