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.
States, HHS Focus on Final Details as Exchanges Ready for Launch
The Joint Commission and the American Medical Association (AMA) Convened Physician Consortium for Performance Improvement® released a report on July 8, which was previously under an embargo, focusing on the overuse of tests, treatments, or procedures that provide zero to negligible benefit and expose patients to risk of harm.
In 2014, most states are relying on the federal government for some or all exchange operational functions.
CMS plans to revalue the oldest laboratory service codes first. An Avalere analysis found pre-1997 codes accounted for nearly 37% of Medicare Clinical Laboratory Fee Schedule (CLFS) spending in 2011.
Welcome to our first issue of Avalere Health Quarterly, a sector-by-sector analysis of major issues and moving parts in healthcare for the coming 3 to 6 months. The Quarterly offers Avalere expert opinion on how major industry catalysts will impact your business decisions.
Overall, implementation of the duals demonstrations is slower than expected and states continue to delay.
New Avalere research found that public and private payers reversed non-coverage policies following a recommendation from a regional CER initiative.
New Avalere research shows market demand for real world evidence (RWE), but a lack of stakeholder consensus on how to define it.
Emerging payment models will demand that hospitals establish tight and narrow networks of high performing post-acute care (PAC) providers.
A new literature review concludes that prescription drugs, when used appropriately, are often the most cost-effective component of the health care delivery system.
An Avalere analysis found that Medicare prescription drug plans (PDPs) had lower levels of coverage and fewer medicines on less expensive formulary tiers than commercial health insurance plans, potentially impacting patients' access to anticonvulsants.
Congress is likely to pass another short term doc-fix for CY2014.
Recent FDA decisions should act as a blueprint for generic and brand manufacturers of innovator products.
Avalere estimates that exchanges will enroll 8 million individuals and families in 2014, growing to 26 million in the next decade.
With DSH cuts looming, hospitals should enroll patients in coverage programs to minimize the burden of uncompensated care.
The growing pressure to manage patient care post-discharge in an efficient manner will drive significant growth in telemedicine over the next few years.
Nowhere are there more opportunities for savings than in post-acute care (PAC) settings.
To drive down costs, focusing exclusively on managing chronic illness misses the boat.
In this new era of payment reform, understanding patient populations and capabilities of providers outside of the hospital will be critical to success.
The number of drugs health plans are required to cover in the individual and small group markets will vary dramatically by state in 2014.