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
A new agreement with CMS Virtual Data Research Center will support analysis of more recent Part A, B, and D claims with a focus on the impact of COVID-19.
Avalere analysis finds that the Part D risk adjustment model likely underpredicts expenditures for some high-cost conditions.
Analysis highlights potential access barriers to a broad set of CAR-T therapies
Given increased plan liability under the IRA and uncertainty from late changes to Star Ratings, plans should strategize for their Rebate Reallocation process.
From 2011 to 2021, there was an increase in higher formulary tiering, patient out-of-pocket spending, and negotiated price for a cohort of generics.
Analysis of data in the CMS VRDC shows that MA-PD utilization has steadily increased in therapeutic areas likely to have large increases in plan liability under Part D redesign.
Rates of filled prescriptions for nebulizers in Medicare FFS vary across factors such as age, disability, and race/ethnicity.
Due to increasing the portion of plan payments subject to risk adjustments in 2025, CMS proposed aligning the risk adjustment model with Part D redesign.
Updated Avalere analysis finds MA beneficiaries with chronic conditions had fewer inpatient stays and ED visits than FFS Medicare beneficiaries.
Oxygen expenditures as a share of total Medicare DME expenditures grew from 8.5% in 2018 to 9.8% in 2021, with significant variation across states.
Avalere released a white paper comparing detection, treatment, outcomes, and spending between MA and FFS Medicare for patients with type 2 diabetes.
Telehealth has the potential to expand access to healthcare by allowing people to interact with providers remotely, but disparities affect access to the technology that makes telehealth possible.
Changes in clinical and social risk among Medicare beneficiaries treated in SNFs at the start of the pandemic reflect challenges facing the healthcare sector during a public health emergency.
A new study from Avalere analyzes age, race and ethnicity, and Medicare-Medicaid dual-eligibility status of Medicare Fee-For-Service (FFS) beneficiaries with pneumococcal vaccine claims in 2019 and 2020.
Analysis finds that patients face barriers to cell therapy treatments regardless of proximity to cell therapy treatment sites.
Updated Avalere analysis shows that routine immunization continued to lag in 2021 below pre-pandemic levels, highlighting the continuing effect of COVID-19 on routine vaccination.
The percentage of Medicare enrollees with chronic obstructive pulmonary disease (COPD) in Medicare Advantage (MA) plans is growing (3.1% growth projected between 2020 and 2030), but the majority (60%) of enrollees with COPD are in fee-for-service (FFS) Medicare. Compared to the general FFS Medicare population, more beneficiaries with COPD are dual eligible for Medicaid and fewer beneficiaries with COPD have employer sponsored insurance as a source of supplemental coverage.
In 2020, the total number of emergency department (ED) visits for Medicare fee-for-service (FFS) beneficiaries declined, but patients presenting with non-emergency care sensitive conditions were more likely to be admitted than in 2019.
In light of proposed changes to the ESRD Treatment Choices Model to address health disparities, an Avalere analysis of Medicare claims found gaps in access to and utilization of specific dialysis-related services by patient race, ethnicity, and socioeconomic status.
A new claims-based analysis from Avalere examined vaccine uptake among low-income adolescents enrolled in Medicaid Managed Care and found a 26% decline in routine vaccinations when comparing March–October 2019 to the same period in 2020.
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.