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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.

Assessing Changes in Prenatal Care During the COVID-19 Pandemic

COVID-related concerns influenced shifts in utilization and changes to the delivery of major pregnancy-related services. The expanded use of telemedicine in the maternal care continuum increasingly provided expectant patients with access to healthcare services while adhering to social-distancing guidelines.

Madison Davidson

Removing Low-Risk Cancers Has Variable Impact on OCM Performance

An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.

Andrew Van Ostrand

New Data-Sharing and Interoperability Mandates Create New Challenges

Digital health will continue to be a focus under recently confirmed Secretary Becerra‘s leadership at the Department of Health and Human Services. As the Biden administration looks to enforce compliance across a range of data interoperability and price transparency rules, as well as usher in new Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) coverage policies for medical technologies and digital health tools, the industry is responding with a range of innovations.

AI in Healthcare: Raise the Evidence Bar Now or Be Forced to Later

In 2012, experts predicted that artificial Intelligence (AI) would eventually replace as much as 80% of current clinical practice by physicians. While AI has certainly expanded in healthcare—especially during the COVID-19 pandemic—the last few years have included some eventful setbacks in the use of AI across several sectors of the economy, including healthcare.

2021 State Drug Pricing Legislation: The Evolution Beyond Transparency

The majority of state legislatures are currently in session, and many states are taking steps to address prescription drug spending and prices through a range of legislative proposals. While states have historically focused on price transparency, state policymakers are now moving beyond those measures to more directly control prescription drug prices through reference pricing, affordability review boards setting upper payment limits, and other price control mechanisms.

OPPS 340B Policy Reversal Lowers Hospital Payment and Increases Copays

A new analysis from Avalere estimates the impact of reverting back to the Calendar Year (CY) 2017 Medicare Outpatient Prospective Payment System (OPPS) payment policy that reimbursed all separately payable drugs at average sales price (ASP) plus 6%. Key findings suggest beneficiary cost sharing for separately payable drugs at 340B OPPS hospitals would increase by $472.8 million. Also, 82% of all OPPS hospitals—specifically 89% of rural, 80% of urban, and 49% of 340B hospitals—would see net total payment decreases.

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