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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.

Mandatory Kidney Care Model Introduces Financial Incentives and Risks

The ESRD Treatment Choice model demonstrates an increased focus on improving health outcomes for Medicare patients receiving dialysis by realigning incentives to favor the adoption of home dialysis and increasing the rate at which patients receive kidney transplants. This mandatory model could lead to significant disruption for stakeholders in the coming years. Understanding the risk and opportunities associated with this model will be critical for patients, providers, and manufacturers alike.

Emily Belowich

The COVID-19 Impact on US Routine and Seasonal Vaccine Administrations

Avalere conducted a national survey of more than 200 independent primary care providers concerning the impacts of the COVID-19 pandemic on their ability to support continued vaccination programs for patients. Over 90% of respondents indicated the COVID-19 pandemic has increased operating costs and led to revenue loss. Eighty-two percent indicated that an increase in vaccine administration fees would aid sites in overcoming barriers arising from the COVID-19 pandemic, and 75% expressed interest in implementing new care delivery arrangements to facilitate immunizations during the COVID-19 pandemic.

Heather Flynn

Avalere Analysis Shows Home Care Services Reduce Medicare Spending

Avalere analysis determined that Medicare Fee-for-Service (FFS) patients receiving home-based care services experienced a decrease in Medicare spending over time when compared to a statistically balanced, matched control group who do not appear to have received home care services. The spending differential was also found to be higher among Medicare beneficiaries with functional limitations and multiple chronic conditions.

COVID-19 Provider Relief Funding and Future Allocation Considerations

The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion for the Public Health and Social Services Emergency Fund—known as the Provider Relief Fund (PRF)—and subsequent legislation appropriated an additional $75 billion through the Paycheck Protection Program and Health Care Enhancement Act.

Milena Sullivan

“Most Favored Nation” EO Creates New Questions on International Prices

On September 13, the Trump Administration released the much-anticipated “Most Favored Nation” (MFN) Executive Order (EO), calling for models that would cap the price Medicare pays for select Part B and D drugs. The President’s EO underscores the administration’s continued focus on reducing prescription drug price disparities between the US and other developed countries.

Dan Mendelson

Dan Mendelson Commentary on Health Equity Featured in Forbes

The COVID-19 pandemic and a summer of focus on racial justice has finally begun to intensify government interest in reducing racial disparities in healthcare. Understanding that healthcare providers and systems tend to respond to the economic incentives that are presented to them, current government decisions on payment options around renal dialysis present an important test case for the Trump Administration.

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