Josh Seidman advises clients on health delivery and payment innovation with a focus on using information technology to guide value-based care models.

He applies his background in quality, health IT, and patient engagement to accountable care delivery system transformation and new payment models.

Prior to joining Avalere, Josh was a managing director at Evolent Health, where he supported large delivery system clients in quality measurement and performance improvement around clinical transformation, patient engagement, and population health management programs. Prior to that, Josh was a director of Meaningful Use at the Department of Health and Human Services in the Office of the National Coordinator for Health Information Technology, the founding president of the Center for Information Therapy, and director of Measure Development at NCQA.

Josh holds a PhD and an MHS in health policy and management from The Johns Hopkins Bloomberg School of Public Health and a BA from Brown University. Josh is a past president of the Society for Participatory Medicine and was a William B. Ziff Fellow for patient engagement with the Center for Advancing Health.

Authored Content


Despite recognition that providers should implement shared decision making (SDM) as standard practice, integration of SDM into regular care delivery remains elusive.

Avalere used a human-centered design approach structured around patient preferences to help guide advanced breast cancer patients.

Today, Avalere published a technical appendix to the PPVF Version 1.0 methodology report, outlining a quantitative method for incorporating patient preferences into value assessments and healthcare decision making.

On April 24, 2018, Avalere experts were joined by Aledade CEO, Farzad Mostashari, MD, to discuss the latest developments coming out of the Center for Medicare & Medicaid Innovation (CMMI).

Avalere experts are joined by Aledade CEO, Farzad Mostashari, MD, discussing the latest developments coming out of the Center for Medicare & Medicaid Innovation (CMMI).

MSSP and CMMI demonstrations vary in budgetary impact but generally show quality improvement.

Incentive payments in upside-only Medicare ACOs have increased federal costs, but data suggest that ACO experience and adoption of two-sided risk could constrain future Medicare costs.

While clinicians have been hesitant to assume risk, bonus payments would result in 9 out of 10 ACOs and their participants achieving a net positive financial impact.

Avalere experts expand on significant priorities for 2018.

Evidence suggests that shared decision-making can play a role in advancing a value-based care delivery system.

Avalere simulation finds that more ACOs will be eligible for earnings if they take on two-sided risk.

Tune in as our experts discuss the key differences making the the Patient-Perspective Value Framework 1.0 (PPVF) unique compared to value frameworks currently in the market.

Blog post features key learnings from the Patient-Perspective Value Framework.

As the industry continues to see a shift from volume to value, Avalere experts examine the future of Medicare's Quality Payment Program under a new administration.

Today, Avalere and FasterCures published Version 1.0 of the Patient-Perspective Value Framework (PPVF).

This week, FasterCures provided Avalere with a second round of seed funding to test, refine and validate the PPVF.

On January 18, 2017, the Centers for Medicare & Medicaid Services (CMS) announced the new Accountable Care Organization (ACO) participants in the Medicare Shared Savings Program (MSSP) for 2017.

Today, the Institute for Clinical and Economic Review (ICER) released an updated version of its Value Assessment Framework.

Avalere and the Robert Wood Johnson Foundation Launch Eight Grants to Improve Cost-of-Care Conversations Between Patients and Clinicians.

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

Avalere and FasterCures released the first deliverable of the Patient-Perspective Value Framework (PPVF) Initiative at the annual Partnering for Cures Conference.

This summer, the Institute for Clinical and Economic Review (ICER) opened a national call for suggestions on how to improve its value assessment framework. In response, ICER received over 50 comments. On October 4, ICER made 46 of those comment letters public.

In June 2016, in collaboration with FasterCures, Avalere launched the Patient-Perspective Value Framework (PPVF) Initiative to develop a value framework that appropriately incorporates the patient's perspective on value.

Avalere experts say that the impact for most hospitals will be modest.

Last Tuesday, August 2, the Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS final rule

Katherine Steinberg comes to Avalere Health with more than 15 years’ experience in the healthcare arena.

The plans are waiting to see how frameworks will evolve and if physicians embrace them before relying on them to decide which prescription drugs to cover.

Data show gaps in care integration across provider settings following hospital discharges.

Earlier today, the Centers for Medicare and Medicaid Services (CMS) released participation information for its new Oncology Care Model (OCM) slated to begin July 1.

Avalere Supports the Robert Wood Johnson Foundation in Issuing Two Calls for Proposals

On June 1, Josh Seidman participated in a panel discussion hosted by FasterCures to discuss Avalere's collaboration with FasterCures to develop a patient-centric value framework.

One year after Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in a landslide, the Department of Health and Human Services is implementing this legislation to transform physician payment.

The passage of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI) to help advance new payment and delivery models.

With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.

HHS confirms continued movement away from traditional FFS payments, yet significant work remains to move more providers away from upside-risk models and into downside-risk models.

On behalf of The Pew Charitable Trusts, Avalere conducted research to identify current barriers to interoperability and some of the best potential solutions in the current political and business environments.

FasterCures and Avalere partner to develop a patient-perspective value framework.

Hospitals should focus on care after discharge, which drives more than 39 percent of spending.

To what extent do patients currently have access to their own data in their providers’ electronic health records, and what does the future hold for consumer access to their digital health data? Listen to Avalere's Josh Seidman share how far we’ve come with providing patients access to their health data, where there is still room for improvement, and what patients can expect to see in the future.

A new analysis by Avalere examines differences in Medicare spending for episodes of care before and after cardiovascular imaging, colonoscopy, and evaluation and management services. Avalere applied a risk adjustment methodology to account for differences in patient demographics and patient severity across settings. The findings suggest when care is initiated in the typically higher-paying HOPD setting than in physicians' offices and ambulatory surgical centers, the services that follow also result in higher spending relative to when care is initiated in the office setting.

With growing out-of-pocket spending for care, patients are increasingly interested in knowing, upfront, how much their care will cost them, and how it relates to the quality and appropriateness of their care. Yet, various barriers often prevent these conversations from occurring during routine clinical encounters.

The Centers for Medicare & Medicaid Services (CMS) announced that 121 new Medicare Accountable Care Organizations (ACOs) have joined the Medicare Shared Savings Program (MSSP) and Next Generation (Next Gen) ACO models. In addition, 147 MSSP ACOs renewed their contracts. The increase in risk-bearing ACOs and the recently released proposed benchmark rule mark CMS' commitment to shifting from volume to value.

Our experts and McKnight's Long-Term Care News explore the current value-based purchasing landscape for post-acute care.

A new analysis by Avalere Health estimates that three proposed policy changes to expand Medicare reimbursement of telehealth and remote patient monitoring (RPM) would collectively decrease federal spending by $1.8 billion between FY2017 and FY2026.

According to a new analysis by Avalere, a prescription requirement for pseudoephedrine-containing products also fuels the growing shortage of primary care physicians, thereby increasing the cost, time, and difficultly of obtaining the treatment for legitimate users.

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.

How can you position your organization for new payment models that emphasize quality of care over quantity of services performed or therapies sold? Engage patients. In this short video, Josh Seidman, Avalere Payment & Delivery Innovation, defines the key imperatives to creating a successful patient engagement strategy that will bring your organization to the forefront of the industry's transition from fee-for-service to value-based care.

A new analysis from the National Health Council (NHC) and Genetic Alliance, with research and analytic support from Avalere Health, identifies critical barriers hindering the advancement of meaningful patient engagement and outlines tactical next steps for actionable solutions.

The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a "patch" that they regularly deployed through a "doc fix" for nearly two decades.

Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.

Avalere analyses show that more than 700 ACOs already operate in the U.S.

By the end of 2016, HHS plans to make 30% of fee-for-service payments through alternative payment models, such as accountable care organizations and bundled payments, and tie 85% of all fee-for-service payments to quality or value. This places increasing urgency on healthcare organizations to make a fundamental shift in their approach to care delivery.

As healthcare leaders and policymakers look to curb spending and improve quality, they should examine models like the Alternative Quality Contract (AQC), according to a new paper by Avalere.

Avalere hosted its 2015 Outlook webinar last week, which featured Tanisha Carino, Lindy Hinman, Ellen Lukens and Josh Seidman.

In 2014 the healthcare industry saw fundamental change in how health plans approach the market, provider consolidation in many areas, a focus on quality-based payments, unprecedented growth in consumer liability for the cost of chronic illness, and a slowing in the rise in healthcare costs.

In the payment and delivery reform landscape, bundled payments are emerging as a promising model. Medicare, Medicaid, and commercial payers are adopting bundled acute and post-acute care payments to align cost and quality incentives across an entire episode of care.

Avalere Health and The SCAN Foundation partner to understand the interplay between medical and non-medical issues. Listen to Avalere’s Sally Rodriguez detail September’s white paper release.

The long waiting game for ACO stakeholders is no more after CMS finally released their much-anticipated proposed ACOs Rule 2.0 on December 1, 2014. Listen to Josh Seidman dive into the most recent CMS Medicare Shared Savings Program (MSSP) Rule.

With the rise in state-based and regional comparative effectiveness research (CER), local CER programs like the New England Comparative Effectiveness Review Public Advisory Council (CEPAC) have become increasingly influential in payer decision making.

As stakeholders across the healthcare spectrum continue to wait for CMS’ ACOs Rule 2.0, Avalere’s Josh Seidman takes a crack at pinpointing the much anticipated ACO policy changes.

Patient engagement has become a new buzz word in drug development. Nevertheless, much uncertainty still exists among stakeholders on how and when to best engage patients in the product development and approval processes.

With something as complex and as political as shared savings models in healthcare, there will always be push-back. But according to Avalere’s Josh Seidman, now is a unique opportunity for ACOs to finally succeed. Josh explains that the current healthcare infrastructure makes ACOs attainable thanks to recent changes, including increased electronic health record use, more provider comfort with comparative performance reporting, enhanced centrality of patient engagement and new incentives that reward accountability and value.

On Feb. 21, CMS enhanced the Physician Compare website to include the addition of quality measures to indicate the performance achieved on a set number of specific metrics.

Emerging payment models will demand that hospitals establish tight and narrow networks of high performing post-acute care (PAC) providers.

Congress is likely to pass another short term doc-fix for CY2014.

The growing pressure to manage patient care post-discharge in an efficient manner will drive significant growth in telemedicine over the next few years.