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New analysis from Avalere finds that the administration's decision last week to end federal funding for the cost-sharing reduction (CSR) payments could lead to substantial losses for health plans-ranging from -$1.2M in North Dakota to -$200M in Florida through the end of 2017 (Figure 1).
New analysis from Avalere finds that payments to certain physician specialists could increase or decrease by as much as 16% for their 2018 performance under the Merit-based Incentive Payment System (MIPS).
Compared to beneficiaries with diabetes who are enrolled in other Medicare Advantage plans, enrollees in special needs plans experience better outcomes, after adjusting for demographic and clinical factors.
Avalere has updated its previous analysis to reflect the September 25 version of the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA).
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a substantial reduction in federal Medicaid funding to states of $713B through 2026 and more than $3.5T over a 20-year period if block grant funding is not reauthorized (Figure 1).
New analysis from Avalere finds that the Graham-Cassidy-Heller-Johnson (GCHJ) bill to repeal and replace the Affordable Care Act (ACA) would lead to a reduction in federal funding to states by $215B through 2026 and more than $4T over a 20-year period (Table 1).
Market stabilization efforts could also lead to higher enrollment in exchanges.
Benefit designs do not vary widely based on insurer competition, except for deductibles that are lower in areas with three or more insurers.
Affordable Care Act-compliant plan market would see 39% higher premiums, while non–ACA-compliant plans would have much lower premiums
Avalere simulation finds that more ACOs will be eligible for earnings if they take on two-sided risk.
New research from Avalere finds that most health plans are covering at least one of the two biosimilar products currently on the market.
New analysis from Avalere finds that states could see federal funding for their Medicaid programs decline by between 6% and 26% under the Better Care Reconciliation Act (BCRA) by 2026.
More than 40% of counties could see only one exchange plan in 2018, with risk that some counties may have no commercial options.
The number of CMS-approved QCDRs tied to payment grows by more than 60% in 2017.
Avalere experts say use of outcomes-based contracts could further goals to improve patient outcomes and manage drug costs
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
The elimination of cost-sharing reductions could lead to low-income individuals facing higher deductibles and maximum out-of-pockets.
Today, Avalere and FasterCures published Version 1.0 of the Patient-Perspective Value Framework (PPVF).
New analysis from Avalere finds that Medicare Advantage (MA) patients use fewer post-acute care services after being discharged from the hospital compared to traditional Medicare fee-for-service (FFS) patients.
Funding earmarked for high risk pools in the American Health Care Act will cover five percent of the total number of enrollees with pre-existing chronic conditions in the individual market today.