News
Health Plans with More Restrictive Provider Networks Continue to Dominate the Exchange Market
Narrow network plans comprise nearly three-quarters of the exchange market.
2.7 Million People Could Gain Access to Medicaid Coverage Based on Outlook for State Elections
New analysis from Avalere finds that 2.7 million individuals from states that have not expanded Medicaid could gain Medicaid coverage should their newly elected governors decide to expand the program or states pass expansion referenda on their ballots.
Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People
New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.
Medicare Advantage Beneficiaries Will See a Jump in New Supplemental Benefit Offerings in 2019
MA plans expand coverage of supplemental benefits following administration’s policy change.
Rheumatoid Arthritis Patients Could Face Access Barriers Under Proposal to Address Drug Prices
New research from Avalere finds that Medicare patients with rheumatoid arthritis (RA) may face higher out-of-pocket costs under a proposal to move Medicare Part B drugs into Part D, absent additional policy change to lower cost sharing in the Part D program.
Provider Performance Under Oncology Care Model Varies by Cancer Type
Clinicians who treat certain types of cancer may be better positioned to earn performance-based payments under the Oncology Care Model.
Experienced Medicare Accountable Care Organizations Generate Savings
Assuming risk appears to be a less important factor than experience in predicting ACO success.
2019 Premium Increases Lowest on Average Since 2015
Average premiums projected to grow 3.1% heading into next year.
Health Plan Interest in Outcomes-Based Contracts Increasing
Outcomes-based contracts most common in cardiovascular disease, infectious disease, and oncology.
Medicare Advantage Achieves Better Health Outcomes and Lower Utilization of High-Cost Services Compared to Fee-for-Service Medicare
New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.
Final Rule Lowers Barriers to Forming and Joining Association Health Plans
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
Double-Digit Premium Increases Expected in the Exchange Market in 2019
2019 rate filings suggest increased competition and plan choice
Opioid Supply Levels Decline in Most States
Maine had the greatest decline at 25% compared with the national average of 11%.
More than 1 in 5 Medicare Cancer Patients Receive Care from Oncology Care Model Doctors
More than 25% of patients with breast and lung cancers have been treated by a participating Oncology Care Model doctor. Participation trends could accelerate the transformation of treatment for some cancers, according to Avalere experts.
Seniors Pay More for Medicare Part D Generics Despite Stable Prices
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.
Avalere Analysis Highlights Complexities of Transitioning Medicare Part B Drugs into Part D
Moving certain Part B drugs to Part D, a proposal being evaluated by the Trump administration, would have disparate financial impacts on patients.
The Complexities of Transitioning Medicare Part B Drugs into Part D
Moving certain Part B drugs to Part D, a proposal being evaluated by the Trump administration, would have disparate financial impacts on patients.
More Medicare Part D Enrollees Are Reaching Catastrophic Coverage
Patient out-of-pocket costs continue to grow despite policies to increase affordability for beneficiaries.
Registries Continue to Give More Opportunities for Clinicians to Meet Reporting Requirements
The number of CMS-approved Qualified Clinical Data Registries grew by 40% in 2018, allowing specialties to have more opportunities to report on meaningful quality measures.
Medicare ACOs Have Increased Federal Spending Contrary to Projections That They Would Produce Net Savings
Incentive payments in upside-only Medicare ACOs have increased federal costs, but data suggest that ACO experience and adoption of two-sided risk could constrain future Medicare costs.