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 Dec. 12, CMS released an interim final rule (IFR) codifying recently announced changes that permit consumers to enroll in health insurance coverage through an exchange as late as Dec. 23 for coverage effective Jan. 1, 2014.
Join Avalere, Armada and SPAARx for an educational series that examines the potential role of specialty pharmacies within Accountable Care Organizations (ACOs).
As of Dec. 11, 1.99 million individuals were determined or assessed eligible for Medicaid or the Children's Health Insurance Program (CHIP).
NEWS RELEASE: An analysis by Avalere Health finds that consumers who enroll in exchange plans will, on average, face dramatically different deductibles based on the metallic level plan (i.e., bronze, silver, gold, platinum).
On Dec. 6, CMS and the Office for the National Coordinator for Health Information Technology (ONC) proposed a one-year extension for Stage 2 of Meaningful Use for eligible providers who began attesting in 2011 or 2012.
An analysis by Avalere Health addresses key issues faced by various high-need groups that must enroll in exchanges by Dec. 23 to secure coverage by Jan. 1, 2014, including those facing individual market cancellations, individuals in high-risk pools, some Medicaid beneficiaries and uninsured HIV/AIDS patients.
NEWS RELEASE: An analysis from Avalere Health finds that most individuals in exchanges who reach their maximum out-of-pocket (OOP) cap will be underinsured, despite reduced OOP caps for those below 250 percent of poverty. The Commonwealth Fund defines underinsurance as OOP costs greater than 10 percent of income for those earning more than twice the poverty level and OOP costs greater than 5 percent of income for those earning less than twice the poverty level.
On Nov. 27, FDA released three draft guidances on the regulation of compounding pharmacies following the enactment of the Drug Quality and Security Act (DQSA).
NEWS RELEASE -- Today Avalere Health, a private data analysis firm, released a study that refutes past claims that commercial plans pay lower rates for lab services than Medicare. Instead, the study found that Medicare rates are almost always lower than average rates paid by private plans.
On Nov. 27, CMS announced a yearlong delay of online enrollment for small business employers seeking health insurance through the federally-facilitated small business health options program (FF-SHOP).
On Nov. 25, HHS released the Proposed Notice of Benefit and Payment Parameters for 2015 that provides technical details and policy parameters related to the advance payments of the premium tax credits (APTC), cost-sharing reductions (CSRs) and premium stabilization programs.
Nowhere are there more opportunities for savings than in post-acute care (PAC) settings.
On Nov. 22, CMS released its final Calendar Year (CY) 2014 End Stage Renal Disease (ESRD) PPS rule, finalizing a 2014 base per treatment rate of $239.02, reduced slightly from $240.36 in CY 2013.
On Nov. 22, FDA issued a warning letter to 23andMe, Inc., asking them to immediately discontinue the marketing of their saliva collection kit and Personal Genome Service (PGS) Kit.
Since Avalere last discussed Investigational Device Exemptions (IDEs), IDE regulatory and reimbursement policy landscape at FDA and CMS have issued some predicted changes; FDA has issued new draft guidance documents while CMS included many of these changes in their 2013 proposed physician payment rule.
NEWS RELEASE -- A new Avalere Health analysis shows that, as of November 2, 30 percent of exchange applicants are eligible for federal subsidies to reduce their monthly insurance premiums and out-of-pocket costs for medical care, far below the 84 percent of enrollees who are ultimately expected to qualify for financial assistance.
On Nov. 18, the Senate passed the Drug Quality and Security Act, roughly two months after it passed the House in September, seeking to clarify laws related to human drug compounding and to strengthen the prescription drug supply chain by creating a national system.
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.