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 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IDE regulatory and reimbursement policy landscape at FDA and CMS have issued some predicted changes; FDA has issued new draft guidance documents while CMS included many of these changes in their 2013 proposed physician payment rule.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.
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 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.
Avalere is seeking qualified candidates at the Associate and Senior Associate level as part of its annual recruitment program.
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.
An analysis from Avalere Health finds that 12 state-based exchanges1 have enrolled about 3 percent of their expected 2014 exchange participants. Together, the 12 states have enrolled 49,100 people in exchanges based on data released by the states, as of Nov. 10. By the end of 2014, Avalere projects these states will account for 1.4 million exchange enrollees.
In September, Arkansas received approval from the federal government to expand Medicaid using a premium assistance model or "private option" for 2014 through 2017.
On Oct. 30, CMS released a final decision memo on ventricular assist devices (VADs) used for bridge to transplant (BTT) and for destination therapy (DT).
With a population of more than 26 million people, Texas is important to achieving the Obama administration's desired exchange enrollment.
Avalere experts to present at ISPOR Dublin's Poster and Workshop sessions.
On Oct. 24, CMS released its final program integrity standards rule, detailing: advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs); the premium stabilization programs; issuers offering coverage in the Federally Facilitated Marketplace; and standards for enrollee satisfaction survey vendors.
On Oct. 30, HHS sent a letter to Rep. McDermott, R-Wash., indicating that it does not consider qualified health plans (QHPs) purchased through insurance exchanges to be federal healthcare programs.
On Oct. 28, CMS released the calendar year (CY) 2014 benefit parameters for Medicare Parts A and B, which cover hospital inpatient and all outpatient drugs and services, and begins Jan. 1, 2014.