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.
As 2013 comes to a close, Congress and physicians continue to discuss the impeding payment cliff physicians will face Jan. 1, 2014, due to the Sustainable Growth Rate (SGR) formula.
On Nov. 18, CMS opened a national coverage analysis (NCA) for Transcatheter Mitral Valve Repair (TMVR) devices.
On Nov. 14, the U.S. Preventive Services Task Force (USPSTF) released a draft research plan for Public Comment on "Screening for Breast Cancer," which intends to re-evaluate the effectiveness of routine mammography screening in women age 40 and older.
On Nov. 8, HHS and the Departments of Labor and Treasury jointly released a final rule implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Avalere Health says the state of Vermont may need between $1.9 billion and $2.2 billion to finance the single-payer plan contemplated by Act 48 - otherwise known as Green Mountain Care.
Avalere is seeking qualified candidates at the Associate and Senior Associate level as part of its annual recruitment program.
On Nov. 13, HHS released the health insurance exchange enrollment figures for the first month of open enrollment, beginning Oct. 1; only 106,185 individuals have selected and enrolled in exchange plans.
An analysis from Avalere Health finds that 12 state-based exchanges1 have enrolled about 3 percent of their expected 2014 exchange participants. Together, the 12 states have enrolled 49,100 people in exchanges based on data released by the states, as of Nov. 10. By the end of 2014, Avalere projects these states will account for 1.4 million exchange enrollees.
With a population of more than 26 million people, Texas is important to achieving the Obama administration's desired exchange enrollment.
In September, Arkansas received approval from the federal government to expand Medicaid using a premium assistance model or "private option" for 2014 through 2017.
On Oct. 30, CMS released a final decision memo on ventricular assist devices (VADs) used for bridge to transplant (BTT) and for destination therapy (DT).
Avalere experts to present at ISPOR Dublin's Poster and Workshop sessions.
On Oct. 24, CMS released its final program integrity standards rule, detailing: advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs); the premium stabilization programs; issuers offering coverage in the Federally Facilitated Marketplace; and standards for enrollee satisfaction survey vendors.
On Oct. 30, HHS sent a letter to Rep. McDermott, R-Wash., indicating that it does not consider qualified health plans (QHPs) purchased through insurance exchanges to be federal healthcare programs.
On Oct. 28, CMS released the calendar year (CY) 2014 benefit parameters for Medicare Parts A and B, which cover hospital inpatient and all outpatient drugs and services, and begins Jan. 1, 2014.
On October 24, Janet Woodcock, Director of the Center for Drug Evaluation and Research (CDER) at FDA, issued a statement indicating the Agency's intent to recommend reclassifying hydrocodone combination products from Schedule III to Schedule II products.
A new analysis from Avalere Health found that the number of applications submitted to date for exchange coverage exceeded comparable enrollment in Medicare Part D over the same time period during each program's launch.
The share of Medicare Advantage (MA) plans with a star rating of 4 stars or higher in 2014 (43 percent) will increase substantially relative to 2013 (27 percent) according to a new Avalere Health analysis of the Centers for Medicare & Medicaid Services' (CMS) recently released data on 2014 plan quality performance.
In early October, CMS released the Medicare Part D plan formulary and cost-sharing information for the 2014 benefit year.
Prime Therapeutics, America's largest privately held PBM, conducted a study examining member use of cost-sharing assistance programs across a variety of specialty drugs during the first half of 2013.