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.
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.
Healthcare spending is expected to represent 19.4% of US GDP in 2027.
In February 2012, the Centers for Medicare & Medicaid Services (CMS) announced a final payment error calculation methodology for its contract-level Risk-Adjustment Data Validation (RADV) audits of Medicare Advantage (MA) plans.
As CMS continues to transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS) for Medicare Advantage (MA) risk score calculation, plans must evaluate operations and close gaps to minimize the impact of risk score differences using this claims data source.
In a new analysis, Avalere examines the implications of CMS’ potential new requirement that Part D plans place generics only on generic tiers.
Beginning in 2019, CMS will reimburse for 5 codes relating to virtual care delivery and remote monitoring
In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.
New analysis from Avalere finds that exchange plan sign-ups could decline by 1.1 million, while premiums could increase by 6.3%, by 2025 should HHS finalize recently proposed changes to auto-reenrollment in the exchange and the calculation of tax credit subsidies.
Former U.S. Congressman Jason Altmire has joined Avalere Health as a senior advisor, offering his deep understanding of the policy-making process to inform business strategy.
The Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. The rule could limit exchange plan enrollees' access to certain brand name drugs and increase the out-of-pocket costs within plans.
Listen to Avalere experts discuss the implications for a recent decision ruling the Affordable Care Act is Unconstitutional.
A proposed rule released by the Treasury Department, Department of Labor, and Department of Health and Human Services would expand the allowed uses of employer-sponsored Health Reimbursement Arrangements (HRA). Comments on the rule can be submitted until December 28, 2018.
New analysis from Avalere finds that over 95% of counties with exchanges operated by HealthCare.gov have free plan options for low-income consumers.
Narrow network plans comprise nearly three-quarters of the exchange market.
New Avalere analysis finds that beneficiaries enrolled in Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for select drugs than beneficiaries enrolled in other types of Part D plans.
Tune in to the last episode of our mid-term elections series to hear Avalere experts Chris Sloan and Elizabeth Carpenter discuss potential implications on health policy.
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law on October 24, 2018, takes aim at the opioid crisis from multiple angles.
Tune in to hear the first episode in our 3-part series covering the mid-term elections and potential implications on health policy. Avalere expert, Chris Sloan, discusses potential implications of the mid-term elections on health policy. To kick off the series Avalere Founder, Dan Mendelson, covers pre-existing conditions.
New Avalere research finds that health plan members enrolled in plans that cover abuse-deterrent formulations (ADFs) of opioids have a lower risk of opioid abuse (OA) and overdose (OD) and lower opioid abuse-related hospitalizations than people in plans that do not offer coverage of ADF opioids.
Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.