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Pressure to lower costs will increase for OCM providers as CMS pushes to 2-sided risk.
Providers in the Bundled Payments for Care Improvement Advanced initiative began to assume financial risk on March 1, 2019.
Christie Teigland, PhD, has been invited to serve on the Pharmacy Quality Alliance (PQA) Executive Research Advisory Council (ERAC).
New analysis from Avalere finds that states with their own reinsurance programs reduce individual market premiums by 19.9% on average in their first year.
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.
Yesterday, the Department of Health and Human Services Office of Inspector General released a proposed rule redefining the current safe harbor for pharmaceutical manufacturer discounts and rebates to entities like health plans and pharmacy benefit managers (PBMs).
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.
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 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.
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therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.
MA plans expand coverage of supplemental benefits following administration’s policy change.
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.
Clinicians who treat certain types of cancer may be better positioned to earn performance-based payments under the Oncology Care Model.
Assuming risk appears to be a less important factor than experience in predicting ACO success.
Average premiums projected to grow 3.1% heading into next year.
Outcomes-based contracts most common in cardiovascular disease, infectious disease, and oncology.
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.
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).