Emily M. Gillen

Emily Gillen provides clients with data-driven policy analytics and strategic insights.

She applies her expertise in value-based care and healthcare delivery innovation to support payers, providers, and life sciences companies in understanding complex payment and regulatory issues.

Prior to joining Avalere, Emily was a research economist at RTI International working on evaluations of large Center for Medicare & Medicaid Services demonstrations, such as the Financial Alignment Initiative for dually eligible individuals and the State Innovation Models. She also led implementation of the All Payer Option of the Quality Payment Program, reviewing Medicaid, Medicare Advantage, and commercial contracts. Emily also worked at Blue Cross of Blue Shield of North Carolina where she focused on selection and benefit design of Affordable Care Act plans and utilization management for members across the business. Recent experience also includes work at a software-as-a-service company providing a data platform to life science companies.

Emily has a BS from Washington University in St. Louis, a MS in applied economics from the Johns Hopkins University, and a PhD In health policy from the University of North Carolina – Chapel Hill.

Authored Content

The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.

In 2020, the COVID-19 pandemic resulted in nationwide lockdowns and restrictions with a well-documented impact on utilization of routine healthcare services.

The Kidney Care Choices (KCC) model, a new alternative payment model launched by the Center for Medicare and Medicaid Innovation (CMMI), is scheduled to begin on January 1, 2022. This model will provide population-based payments for beneficiaries with both advanced-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD) to improve patient health outcomes and lower Medicare fee-for-service (FFS) spending.

Avalere analysis finds healthcare utilization among Medicare Fee-for-Service (FFS) beneficiaries decreased in the spring of 2020 compared to the spring of 2019.

An Avalere analysis finds that Medicare Part D plans allow $0 cost-sharing for select vaccines just 4% of the time, likely affecting immunization uptake.