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
ICER’s Use of FDA Approval Volume to Calculate Budget Impact Thresholds: A Scenario Analysis
ICER’s reliance on the average number of FDA drug approvals to calculate budget impact thresholds leads to significant variability.
Fewer Seniors Get Vaccinated as Their Out-of-Pocket Costs Increase
New research shows higher cost sharing for vaccines under Part D leads to fewer seniors getting vaccines. Immunization rates are higher for vaccines covered by Part D plans with lower cost sharing.
Strategic Imperatives for Skilled Nursing Facilities Preparing for New Payment System
In August 2018, CMS is expected to finalize a proposed new payment methodology for skilled nursing facilities (SNFs) that would shift the focus from resource use to patients’ clinical needs.
CMS Rejects Massachusetts’ Medicaid Closed Formulary Proposal
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
Reforming Medicare Vaccine Coverage to Reduce Barriers to Access
On June 14, Avalere experts came together with Cynthia Tudor, former Deputy Center Director of the Center for Medicare and Senior Advisor to Avalere, to discuss vaccine coverage and access challenges under Medicare.
Shifting Drugs from Medicare Part B to Part D: Learnings from Medicare Coverage of Vaccines
A proposed shift of Part B drugs into Part D could affect patient access and increase the burden on providers.
CMS Expands Benefit Flexibilities in Medicare Advantage
Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.
Developing a Shared Decision-Making Tool in Collaboration with Patients and Clinicians
Avalere used a human-centered design approach structured around patient preferences to help guide advanced breast cancer patients.
Medicare Trustees Report Triggers Program Funding Warning
In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.
HTA Oncology Recommendations Have Grown More Restrictive Over Time
Of the 329 oncology HTAs analyzed from the period 2013–2017, 29% resulted in positive recommendations without restrictions.
Avalere Releases Patient-Perspective Value Framework Scoring Methodology Report
Today, Avalere published a technical appendix to the PPVF Version 1.0 methodology report, outlining a quantitative method for incorporating patient preferences into value assessments and healthcare decision making.
Readmission Rates Are 6 Times Higher for Some Conditions in Medicare’s New Bundled Payment Program
As the deadline approaches for providers to make decisions on their participation in BPCI Advanced, Avalere analysis shows that certain conditions may provide greater opportunity for success.
Trump Administration Releases Drug Pricing Blueprint
The Department of Health and Human Services is seeking public input on a variety of proposals related to drug costs, providing stakeholders with an unprecedented opportunity to shape the administration's drug pricing policies.
CMS Takes Steps to Advance the “Meaningful Measures” Initiative
CMS removes 25 existing hospital quality measures in the Proposed FY2019 Inpatient Prospective Payment System (IPPS) Rule as part of its broader effort to focus on measures that matter.
State-Level Policies Can Play Key Role in Improving Adult Immunization Rates
States can pursue various policy opportunities to encourage vaccination and increase access to vaccines.
The Medicare Advantage Factor in Assisted and Senior Living Facilities
Avalere's founder and president, Dan Mendelson, recently sat down with Senior Housing News editors to discuss opportunities for senior living providers to leverage data to facilitate synergistic partnerships with payers.
Use of Step Through Policies for Competitive Biologics Among Commercial US Insurers
Avalere evaluated payer policies for biologics when biosimilars are available.
Emerging Opportunities to Drive Adult Immunization Through Quality
Quality measurement in the adult vaccine space has evolved rapidly. Recent advancements continue to propel efforts to drive adult immunization uptake.
The Future of the Center for Medicare & Medicaid Innovation
On April 24, 2018, Avalere experts were joined by Aledade CEO, Farzad Mostashari, MD, to discuss the latest developments coming out of the Center for Medicare & Medicaid Innovation (CMMI).
The Opioid Crisis: An Ongoing Legislative Priority
The House and Senate are advancing legislative packages aimed at mitigating the crisis.
