News
Katherine Steinberg, MPP, MBA Joins the Avalere Center for Payment and Delivery Innovation™
Katherine Steinberg comes to Avalere Health with more than 15 years’ experience in the healthcare arena.
Outpatient Services Are the Largest Driver of 2017 Premium Increases
Prescription drugs are not outsized contributors to rate increases.
Most Health Plans Do Not Use Existing Value Frameworks to Make Coverage Decisions
The plans are waiting to see how frameworks will evolve and if physicians embrace them before relying on them to decide which prescription drugs to cover.
Leading Stakeholders Identify Need for Tools to Manage Post-Acute Network Quality
Data show gaps in care integration across provider settings following hospital discharges.
UPDATE: Early Analysis Finds 2017 Proposed Exchange Premiums for Low Cost Silver Plans Increasing 8 Percent on Average
Rates vary widely by state; popular low cost options see smaller increases.
Avalere Welcomes Senior Healthcare Advisor
Wendy Everett, ScD, joins Avalere as a senior advisor.
Providers Across the US Express Interest in Moving to New Cancer Payment Model to Control Medicare Costs
Earlier today, the Centers for Medicare and Medicaid Services (CMS) released participation information for its new Oncology Care Model (OCM) slated to begin July 1.
Health Plans Are Interested in Tying Drug Payments to Patient Outcomes
Hepatitis C and Oncology Are Top Therapeutic Area Targets
MedPAC Proposes Changes for 42 Million Medicare Beneficiaries Enrolled in Part D
Cost-sharing changes could increase costs for many beneficiaries.
Inovalon Announces Agreement with Bristol-Myers Squibb to Focus on Real World Outcomes & Value-Based Contracting Initiatives
Avalere and Inovalon recently entered into an agreement with Bristol-Meyers Squibb (BMS) to support the manufacturer's innovative initiatives using real-world outcomes data to design and test value-based contracting models. The agreement brings together Avalere's deep expertise on manufacturer and payer contract negotiation and Inovalon's significant data assets to meet the complex challenges around ensuring value and access while addressing growing healthcare costs concerns.
13 Million Adults Could Be Eligible to Purchase Medicare Coverage Under Proposed Clinton Plan
A new Avalere analysis finds that nearly 13 million Americans age 50 or over who are currently uninsured or have individual coverage purchased through the private market-inside and outside the exchange- could be eligible to buy-in to the Medicare program under a plan proposed by Democratic presidential candidate Hillary Clinton.
Christie Teigland Receives AMCP Platinum Award
Christie Teigland, PhD, vice president, Advanced Analytics, recently received the Academy of Managed Care Pharmacy’s (AMCP) prestigious Platinum Award for her research entitled “Association of Socioeconomic and Clinical Factors with Rates of High-Risk Medication Use in Medicare Advantage Plans.”
Medicare Beneficiaries Will Pay More for Biosimilars than for Their Biologic Reference Products in Part D
Two Potential Policy Changes Would Reduce Out-of-Pocket Costs for Consumers
Proposed Medicare Part B Rule Would Reduce Payments to Hospitals and Some Specialists, While Increasing Payments to Primary Care Providers
Rule Would Decrease Medicare Reimbursement for Drugs That Cost More than $480 per Day; Seven of the 10 Most Affected Drugs Treat Cancer
Only 33 Percent of Exchange Enrollees in 2016 Kept Their Same Plan from 2015
One third of those who enrolled in a health insurance plan on Healthcare.gov this year picked the same plan as last year, according to a new analysis from Avalere. In total, 3.2 million of the 9.6 million exchange shoppers in 2016 kept their previous plan.
Sixty Percent of Hospitals Must Reduce Care for Joint Replacement (CJR) Costs Under New Medicare Demo or Face Penalties
Hospitals should focus on care after discharge, which drives more than 39 percent of spending.
Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans
Percentage of drugs in Part D plans that require coinsurance increased significantly since 2014. Medicare Advantage plans require coinsurance far less often than Part D plans.
Kindred Partners with Avalere and Inovalon to Support Value-Based Payment in Post-Acute Care
Avalere and Inovalon have entered into a multi-year agreement with Kindred Healthcare, Inc., the nation’s largest provider of post-acute care (PAC) services, to deploy the power of data and analytics to engage payers. The combined solutions will result in a data-driven platform that will support Kindred in improving clinical outcomes and promoting coordinated, efficient care under new value-based payment models.
Medicare Has the Potential to Avoid Preventable Illnesses by Encouraging Broader Coverage for Adult Vaccines
A new analysis by Avalere finds that, despite efforts by policymakers to encourage broader vaccination rates, Medicare enrollees have limited access to a set of 10 recommended vaccines without having to pay out-of-pocket (e.g., co-payments).
Avalere’s Take: President Obama’s FY2017 Healthcare Budget
President Obama released his budget for the 2017 fiscal year today. Avalere offers the following observations on the healthcare proposals: