Meet
Caroline F. Pearson

Caroline Pearson formerly oversaw the firm’s content generation across consulting services, research products, and public visibility.

She previously led Avalere’s Health Reform & Policy Practice. In Caroline’s 12 years at the firm, she focused on implementation of the Affordable Care Act (ACA), prescription drug pricing, and public and private insurance benefit design. She was regularly quoted in national and trade press and continues to be a frequent presenter to audiences seeking to understand the health policy landscape. In 2009, Caroline contributed to a report, led by Senators Tom Daschle and Bob Dole, at the Bipartisan Policy Center, which advanced a comprehensive, bipartisan health reform proposal. She graduated Magna Cum Laude from Harvard University with a BA in Government.

Authored Content


On March 6, Avalere experts came together to discuss the latest Medicaid developments.

Avalere experts discuss an evolving Medicaid program supported by a new administration and novel state approaches.

New research from Avalere Health finds 11 states and DC lack an adequate number of providers certified to prescribe buprenorphine, a medicine used to prevent relapse in people with opioid dependence.

Avalere experts provide their insights on what the impact of coverage gap discount changes in budget agreement.

Beneficiaries show signs of pent-up demand with acute healthcare needs early in their enrollment, but over time costs increase substantially and shift toward chronic care.

On January 4, the Department of Labor (DOL) issued a proposed rule to allow certain self-employed individuals, small businesses, and large businesses, including as part of a professional/trade organization or chamber of commerce, to band together to provide health insurance for their employees and their dependents.

2018 will bring change from all parts of the healthcare system.

Avalere experts expand on significant priorities for 2018.

At 100% of the OEP, we are at 96% of total Healthcare.gov enrollment compared to 2017 (8.8M n 2018 compared to 9.2M in 2017).

Resource presents trends in opioid painkiller prescriptions and deaths due to misuse and abuse.

New analysis by Avalere examines the impact of two market stabilization proposals-funding the cost-sharing reductions (CSRs) and implementing a federal reinsurance program-on individual market premiums and enrollment.

Deductibles remain high, nearing $4,000 on average for silver plans.

If federal government permits states to expand Medicaid to only 100% of poverty, nearly 4M people could shift from Medicaid to exchanges, and 7M could be newly eligible for coverage.

New analysis from Avalere finds that nearly 98% of counties with exchanges operated by HealthCare.gov will have free bronze plan options for low-income consumers aged 50 earning 150% of poverty or less ($18,090 for an individual or $36,900 for a family of four).

Avalere experts preview the 2018 ACA open enrollment season

New analysis from Avalere finds that the 2018 exchange market will see silver premiums rise by an average of 34%. According to Avalere's analysis of filings from Healthcare.gov states, exchange premiums for the most popular type of exchange plan (silver) will be 34% higher, on average, compared to last year.

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).

Affordable Care Act-compliant plan market would see 39% higher premiums, while non–ACA-compliant plans would have much lower premiums

The Better Care Reconciliation Act (BCRA) would cap Medicaid funding to states. In this analysis, Avalere worked with The SCAN Foundation to examine how BCRA Medicaid changes would impact dual-eligible beneficiaries. We compare these outcomes to the impact of the House-approved American Health Care Act.

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.

All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.

Avalere experts review proposed drug pricing policies from each stakeholder's perspective across the industry and the implications each might carry.

Capping Medicaid funding could also shift costs to Medicare

Avalere experts examine proposed key reforms to the ACA and its potential impacts.

New research from Avalere finds that under the American Health Care Act (AHCA), large states as well as those states with fewer insurers offering plans in the individual and small group markets could receive the most money from the federal government to help stabilize their markets.

Low-income and older individuals would incur higher penalties for failing to purchase health insurance, compared to current individual mandate.

Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).

Today, the Trump administration released a proposed rule for market stabilization of the Affordable Care Act (ACA).

Analysis shows Medicaid block grants and per capita caps could result in state budget gaps.

Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).

Plans sold in exchange markets in 2017 feature higher premiums, growing consumer out-of-pocket costs, and more restricted access to providers and hospitals than in previous years, according to a new analysis from Avalere.

Avalere experts discuss the top priorities to focus on as you navigate the new landscape.

This year will be the start of major environmental changes for the healthcare industry following a shift in the balance of power in Washington, DC, and the states.

2017 will be the start of major environmental changes for the healthcare industry following a shift in the balance of power in Washington and the States. Listen to moderator Caroline Pearson set the stage for our 2017 Healthcare Industry Outlook.

While 31 states and D.C. expanded Medicaid under the ACA, the future of expansion is uncertain.

In addition to Donald Trump's presidential win earlier this week, Republicans also won big in the House and Senate.

As 2017 exchange open enrollment begins, Avalere examined marketplace changes in plan choice and premiums at the county level.

With expanded administrative authority and flexibility to advance policy priorities through entities such as CMMI and IPAB, the new administration will shape the future of the Affordable Care Act, potential drug pricing reforms, and potential action on tax and/or entitlements.

New analysis from Avalere finds that 1.2 million individuals from non-expansion states could gain Medicaid coverage in 2017 should a newly elected governor decide to expand the program.

2017 exchanges struggle to address challenges with enrollment, risk management, and consumer choice.

A new analysis from Avalere finds that consumers with a range of common health conditions could reduce their spending between $8,800 and $90,020 by purchasing insurance through the Affordable Care Act (ACA).

While we can't make any promises as to whether or not Clinton or Trump will bring up healthcare in Sunday's town hall, the odds of it happening are looking better.

In preparation for tonight's vice presidential debates, we thought that we'd take a look at both candidates' health policy positions in addition to Exchange and Part D data for Virginia and Indiana.

While we technically have a few weeks of summer left, we decided to take a look back at the stories that were catching people's attention based on our website hits.

Recently, Avalere worked with the Council for Affordable Health Coverage to examine enrollment trends for the Affordable Care Act (ACA).

Prescription drugs are not outsized contributors to rate increases.

Between now and November, Avalere will to bring election content, including podcasts to the public dialogue. Our experts provide a quick glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail


Recently, Avalere took a look at the gubernatorial elections happening this year, their outlooks, and where they stand on the Exchanges and the Medicaid expansion.

Between now and November, Avalere will to bring election content—including podcasts—to the public dialogue. Our experts provide a glimpse into the role healthcare will play in the 2016 elections and hot topics you can expect to hear about on the campaign trail.

Cost-sharing changes could increase costs for many beneficiaries.


As we near the July conventions and the November election, the dialogue continues to ramp up on the latest policy proposals from the presumptive presidential nominees - Hillary Clinton and Donald Trump.

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.

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.

As the discussion intensifies, one of Avalere's experts provides keen observations on what you need to know about this topic.

An analysis from Avalere shows that more health insurance plans offered through the Affordable Care Act exchanges are making some drugs used to treat complex diseases—such as HIV, cancer, and MS—more accessible to patients in 2016 than in the previous years. Specifically, plans were less likely to place all drugs in a class on the highest cost-sharing tier.

Two Potential Policy Changes Would Reduce Out-of-Pocket Costs for Consumers

Rule Would Decrease Medicare Reimbursement for Drugs That Cost More than $480 per Day; Seven of the 10 Most Affected Drugs Treat Cancer

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.

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.

The Centers for Medicare & Medicaid Services (CMS) will release the Advance Notice and Call Letter describing CMS' proposed 2017 payment policies for Medicare Advantage (MA) plan sponsors on February 19. Based on previously released information in the fall of 2015, CMS is likely to propose modifications to the risk adjustment model and the current MA Star Ratings methodology.

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).

President Obama released his budget for the 2017 fiscal year today. Avalere offers the following observations on the healthcare proposals:

Today, the Department of Health and Human Services (HHS) announced that 9.6 million individuals selected a health insurance plan on HealthCare.gov during the recent open enrollment season. Avalere estimates that 2016 year-end enrollment will slightly exceed the Obama administration's goal of enrolling 10 million people.

In an article published in The American Journal of Managed Care, Avalere's Caroline Pearson and Deirdre Parsons examine provider networks and benefit design for oncology care in health insurance exchanges.

A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions.

In 2016, two key themes underlie much of the shift in the healthcare landscape: cost and value. Each of these elements is critical to all sectors of the healthcare system as we attempt to reduce costs and deliver value.

Get a sense of what to anticipate in the 2016 healthcare landscape in our annual 2016 Industry Outlook: Reducing Cost and Demonstrating Value.

As the government considers rules for 2017 insurance plans offered through exchanges, a new analysis by Avalere finds that proposed 2017 benefit designs could increase coverage of certain services and drugs, while lowering out-of-pocket costs for many consumers.

A new Avalere assessment of the quality measures landscape shows that many important medical conditions are not fully represented in Medicare pay-for-quality programs, which limits Medicare's ability to pay for value.

New research from Avalere finds that despite the innovation of abuse-deterrent properties and labeling for branded opioids, Medicare Part D plan coverage for these products is declining rapidly.

To evaluate public program spending on new medications in the drug development pipeline, Avalere projected the fiscal impact of 10 FDA breakthrough therapies to Medicare, Medicaid, and the health insurance exchanges created by the Affordable Care Act (ACA).

Over the past four years, enrollment in Medicaid managed care has increased by 48 percent, with 46 million beneficiaries now receiving coverage through these plans. The government will soon update regulations that direct the plans providing this coverage.

On September 23, HHS released a new report that finds the number of issuers participating in the 2015 exchange market will grow by 25 percent when compared to 2014.

Avalere Health is carefully analyzing the landscape file of health plan offerings on the federally-facilitated marketplace recently released by the Department of Health and Human Services (HHS).

Initial data suggest that exchange plans under the Affordable Care Act (ACA) will include high out-of-pocket costs for enrollees-including deductibles and cost-sharing for medical services and prescription drugs-before consumers reach their out-of-pocket maximum.

To date, 24 states and the District of Columbia have committed to expanding Medicaid sometime in 2014.


One of the most anticipated questions about exchanges has been what the impact of rate shock will be on the market.

The Centers for Medicare and Medicaid Services (CMS) released long-awaited data about the first-year of the Pioneer ACO program.

States, HHS Focus on Final Details as Exchanges Ready for Launch

In 2014, most states are relying on the federal government for some or all exchange operational functions.

CMS plans to revalue the oldest laboratory service codes first. An Avalere analysis found pre-1997 codes accounted for nearly 37% of Medicare Clinical Laboratory Fee Schedule (CLFS) spending in 2011.

New Avalere research found that public and private payers reversed non-coverage policies following a recommendation from a regional CER initiative.


Avalere estimates that exchanges will enroll 8 million individuals and families in 2014, growing to 26 million in the next decade.