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
Impact of Proposed CMS Methodology for Calculating Payment Errors May Vary Based on Plan Enrollee Characteristics
In 2018, CMS proposed to revise its Risk Adjustment Data Validation (RADV) methodology to exclude the FFS Adjuster in its payment recoupment calculations. New analysis from Avalere finds that the payment impact associated with fee-for-service (FFS) Medicare coding discrepancies would be greater for certain subgroups of beneficiaries (e.g., dual-eligible, those with certain common and potentially serious health conditions) enrolled in the MA program.
The Evolving Newborn Screening Landscape
On August 21, Avalere policy experts published a piece on the Health Affairs blog highlighting the impact of advancements in treatment and screening technology on the newborn screening landscape.
How a New Technology Add-On Payment (NTAP) Works
Additional Medicare payment options available for new, high-cost technologies used in the inpatient setting.
The VA National Formulary for Top Medical Benefit Drugs Is Narrower than Current Medicare Part B Drug Coverage
Avalere analysis finds that 24 of the top 50 non-vaccine Part B drugs are not on the U.S. Department of Veterans Affairs’ National Formulary.
Avalere Partners with Industry Leaders to Address Hypoglycemia in Older Adults
Avalere collaborates with the Endocrine Society and Pottstown Medical Specialists to launch a quality improvement intervention study aimed at addressing care gaps in the identification and management of hypoglycemia in older adults with type 2 diabetes.
Digital Health Guidelines Seek Evidence for Innovative Solutions
It is no surprise that innovation in the world of digital health is transforming the way healthcare is delivered.
States Taking Action to Ensure Coverage Protection Should the ACA Be Overturned
While the majority of state legislative sessions have adjourned for 2019, at least 11 states (CT, FL, LA, IN, MD, ME, NH, NM, NV, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions and coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).
1 in 5 Medicare Beneficiaries Taking a Part D Cancer Therapy Reached Catastrophic Level in 2017
Avalere analysis finds that a larger proportion of beneficiaries taking a Part D cancer therapy reached catastrophic compared to all Part D enrollees.
Getting Ready for Primary Care First: Ambitious CMMI Initiative Aims to Redefine Primary Care
Announced in late April, the Center for Medicare & Medicaid Services’ (CMS) Primary Care First initiative marks a critical step forward in the long and complex journey toward a fundamentally transformed healthcare system.
Methodology and Analysis of the Center for American Progress’s Medicare Extra Policy Proposal
The Center for American Progress (CAP) commissioned Avalere to evaluate ‘Medicare Extra’ as a package of reform polices implemented and phased in over time across the US healthcare system.
Quality Summit Provides Industry Opportunity to Shape Quality Programs
On July 9, Health & Human Services (HHS) announced the formation of the Quality Summit (QS), as directed by a recent executive order aimed at improving price and quality transparency.
Note on Avalere’s Recent Biosimilars Policy Modeling
Avalere was recently commissioned to project how policy proposals related to biosimilars would impact government spending and patient costs, including modeling and scoring analyses created for 3 proposals publicly released by the Biosimilars Forum in May 2019.
Identifying Payer and Provider Opportunities for Quality Measures Alignment
This past spring, Avalere and MITRE experts presented “Implementation of the Core Quality Measures Collaborative (CQMC) Core Measure Sets by Public Payers: Successes and Opportunities” at the Pharmacy Quality Alliance (PQA) annual meeting.
Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy
Avalere experts published a supplement in the June 2019 American Journal of Managed Care entitled “Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy.”
Strategic Opportunities for Health Plans: 2020 and Beyond
Health plans today have a range of strategic opportunities that align well with emerging policy themes for 2020.
Avalere Publishes Viewpoint on Personalizing Value in Cancer Care
To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision-making by embedding shared decision-making (SDM) as a routine part of clinical practice.
Avalere Oversees Development of Care Referral Pathway for Inflammatory Bowel Disease
Avalere supports development of the Inflammatory Bowel Disease (IBD) Care Referral Pathway, which aims to coordinate care and optimize referral practices among different clinicians that treat patients with IBD.
More Medicare Beneficiaries Are Initiated on Direct Oral Anticoagulants According to a Recent Avalere Analysis
New Avalere analysis evaluates the trends in baseline patient characteristics among Medicare fee-for-service beneficiaries with stand-alone Part D coverage who initiated a direct oral anticoagulant during the period 2013–2017.
Over Half of Medicare Advantage Beneficiaries Enrolled in Plans that Require Step Therapy for New Starts of Part B RA Biologics in 2019
Avalere analysis of 1,375 Medicare Advantage plans’ 2019 medical benefit drug coverage policies finds that 672—covering approximately 14.3 million lives—apply step therapy to at least 1 of the rheumatoid arthritis biologic drugs covered under Medicare Part B in 2019.
Avalere Participates in Initiative to Advance the Identification and Management of Heart Valve Disease
In January 2018, Avalere Health partnered with the Society of Cardiovascular and Angiography Interventions to launch the development of the Heart Valve Initiative.
