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Federal Policy

As the largest, single US healthcare payer, the government plays a dominant role in shaping the healthcare marketplace. Our experts track, interpret, and model federal policies that affect insurance coverage, access, and consumer choice so you can see around the bend.

Home-Based Care Leaders Offer Solutions to Access Hurdles

To fully realize the benefits of home-based care, including improved outcomes, inpatient hospital capacity, and patient experience, state and federal regulators may consider formalizing regulatory flexibilities, removing current barriers to participation in models such as Acute Hospital Care at Home, and testing the impacts of these waivers under the Center for Medicare & Medicaid Innovation (CMMI).

Matt Kazan

ESRD Enrollment in MA Now Exceeds 30 Percent of all Dialysis Patients

New analysis finds that just over 40,000 Medicare Fee-for-Service (FFS) patients with end-stage renal disease (ESRD) elected to enroll in Medicare Advantage (MA) during the 2021 open enrollment period—the first time all ESRD patients had access to an MA plan. This enrollment shift increased the proportion of ESRD patients enrolled in MA from 23% to 30%.

Madison Davidson

High-Intensity Prostate Cancer Costs Consistently Below OCM Benchmark

An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.

Video: HIV/AIDS Prevention and Treatment, Part II

Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.

Podcast: HIV/AIDS Prevention and Treatment, Part II

Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome leaders from the National Alliance of State & Territorial AIDS Directors (NASTAD) to discuss how HIV state policies have changed in light of advancements in prevention and treatment, and the key to ending the HIV and viral hepatitis epidemics in the US.

Nathan Markward

Home Care Services Reduce Medicare Spending for 30 Chronic Conditions

An Avalere analysis determined that Medicare Fee-for-Service (FFS) patients who received personal care services experienced a decrease in Medicare expenditures over time when compared to a statistically comparable control group comprising patients who did not receive the same level of personalized care. The reduction in spend was specific to a subset of chronic conditions that were targeted operationally for intervention and case management.

Video: World AIDS Day: HIV/AIDS Prevention and Treatment

Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.

Podcast: World AIDS Day: HIV/AIDS Prevention and Treatment

Tune into another episode of Avalere Health Essential Voice. In this segment, we welcome Carl Schmid, Executive Director at the HIV + Hepatitis Policy Institute, to discuss how HIV prevention and treatment policy influence broader health policy issues as we commemorate World AIDS Day on December 1.

Ryan Urgo

Part D Redesign Impact on Manufacturer Discounts in Protected Classes

New Avalere analysis finds that 3 proposals to redesign the Part D benefit would lead to larger increases in mandatory manufacturer discounts on brand drugs within the Part D “6 protected classes” compared to brand Part D drugs overall. Mandatory manufacturer discounts within the protected classes would increase by 661%, 301%, and 409% across the 3 proposals evaluated, compared to 153%, 63%, and 64% for Part D drugs overall.

Video: Medicare Part D, Part V: What’s Next for CMMI?

Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.

Podcast: Medicare Part D, Part V: What’s Next for CMMI?

Tune into the fifth and final episode of the Avalere Health Essential Voice miniseries focused on Medicare Part D. In this segment, our experts discuss the Center for Medicare & Medicaid Innovation (CMMI) and its strategic direction for the coming year, particularly as it relates to the Part D program.

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