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.
On June 16, MedPAC issued a letter to CMS, advising the agency to make critical changes to its two accountable care organization (ACO) programs-the Pioneer demonstration and Medicare Shared Savings Program (MSSP).
In this week's edition of McKnight's Long-Term Care, Jeff Terkowitz wrote a guest column discussing new payment models, and the opportunities they present for SNFs.
New analysis from Avalere Health finds that average proposed premiums for individual market exchange plans will increase modestly in 2015, based on initial rate filings in nine states.
As the laboratory testing community continues to weather recent policy changes in both regulatory and reimbursement areas - there has been yet another development.
A new analysis from Avalere Health finds that proposed rate increases for 2015 exchange plans in Washington state were lowest among carriers with the smallest share of the 2014 market.
On May 28 WellPoint/Anthem BlueCross BlueShield announced the launch of the WellPoint Cancer Care Quality Program - a new pay-for-adherence initiative which incentivizes physicians to follow certain evidence-based WellPoint Cancer Treatment Pathways.
In a June 2014 analysis, Avalere analyzed 123 silver exchange plan formularies to evaluate tier placement.
On June 2, CMS announced that it will not finalize the Average Manufacture Price (AMP) based Federal Upper Limits (FULs) for reimbursement of multiple source drugs in Medicaid in July 2014, as expected.
On May 30, CMS released results from the March week of ICD-10 acknowledgement testing.
A new analysis from Avalere Health finds that consumers in exchanges receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose.
Avalere’s experts will be presenting several posters at AcademyHealth’s Annual Research Meeting in San Diego.
On May 23, the U.S. District Court for the District of Columbia issued a decision striking down the 340B orphan drug rule that was finalized by the Health Services and Resources Administration (HRSA) in July 2013 and took effect Oct. 1, 2013.
In this month's edition of McKnight's Long Term Care News & Assisted Living, Avalere's Sally Rodriguez wrote a guest blog discussing value-based payment strategies for post-acute care (PAC) providers, given the Affordable Care Act's (ACA) current focus on value over volume.
On May 19, CMS released the Final Rule on policy changes to the Medicare Advantage (MA) and Medicare Part D programs for Contract Year (CY) 2015.
A new analysis from Avalere Health finds that individuals choosing an exchange plan based on premiums are most likely to consider plans from Coventry (acquired by Aetna in 2013), Humana, and WellPoint in regions where they participate.
On May 16, HHS released the final Exchange and Insurance Market Standards for 2015 and Beyond rule.
More and more, pharmacists are forging expanded roles in healthcare delivery to ensure optimal drug therapy and improve patient outcomes.
On May 14, CMS released a proposed national coverage determination (NCD) for Transcatheter Mitral Valve Repair (TMVR), and proposed to cover TMVR under its Coverage with Evidence Development (CED) program.
On May 13, FDA released a draft guidance describing the clinical pharmacology data needed to support a demonstration of biosimilarity to a reference product.
On April 9, HHS made public CMS reimbursement data for 880,000 Medicare providers for the first time in the Agency's history; but the bigger story was the social media response that followed.