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.
CMS and ONC Propose One-Year Meaningful Use Extension
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.
Analysis: Dec. 23 Exchange Coverage Deadline Crucial For High-Need Enrollees
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.
Analysis: Despite Subsidies, Chronically Ill Individuals Will Be Underinsured In Exchanges
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[1] defines underinsurance as OOP costs[2] 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.
FDA Solicits Comments on Draft Guidances Regarding Compounding Facilities
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).
Release: Study Shows Medicare Receives Lower Rates For Clinical Laboratory Services
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.
Notice of Benefit and Payment Parameters 2015 Proposed Rule
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.
CMS Postpones SHOP Online Enrollment Until 2015 Plan Year
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).
Avalere Identifies Three Ways To Reduce Post-Acute Care Spending
Nowhere are there more opportunities for savings than in post-acute care (PAC) settings.
CMS to Phase In Drug Utilization Payment Cut in Final ESRD Rule; Net Update to Base Rate 0.0% in CY 2014
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.
FDA Issues Warning Letter to 23andMe Genomic Service; Other LDTs on the Radar?
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.
Centralized Review of Investigational Device Exemptions at CMS-An IDEa Whose Time Has Come
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.
Avalere Analysis Projects Potential for Increased Subsidized Exchange Enrollment
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.
Congress Passes Drug Quality and Security Act; Includes Both Compounding and Track & Trace Provisions
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.
SGR Repeal Momentum Increases, Path Forward Remains Unclear
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.
CMS Opens NCA for Transcatheter Mitral Valve Repair Procedures; Comments Due Dec. 18
On Nov. 18, CMS opened a national coverage analysis (NCA) for Transcatheter Mitral Valve Repair (TMVR) devices.
USPSTF Revisits Controversial Mammography Screening Recommendations
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.
Final Rule on 2008 Mental Health Parity Law Finally Released, Affecting Individual and Small Group Plans and Codifying Consumer Protections
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 Suggests Vermont May Need to Increase Funding For Single-Payer Plan
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.
2014 Associate/Senior Associate Recruitment Program
Avalere is seeking qualified candidates at the Associate and Senior Associate level as part of its annual recruitment program.
Fewer Than 27,000 Federal Exchange Enrollees at End of First Month of Open Enrollment, HHS Reports
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.