Meet
Maddi Davidson
She/Her
Principal
Madison Davidson (Maddi) uses data analytics to support life sciences companies in market access, product commercialization, and reimbursement strategy.
In recent projects, Maddi has advised life sciences clients on episodic payment model strategies, for example by helping oncology drug makers understand differences between the Oncology Care Model (OCM) and the new Enhancing Oncology Model (EOM). She has analyzed how the EOM will likely impact client product portfolios and practice performance metrics and has helped clients update their segmentation, prioritization, and provider engagement strategies for the EOM transition. She has also recently helped manufacturers prepare for changes in key market segments (e.g., new competitors) by analyzing claims data and conducting strategic readiness assessments with clients’ market access teams.
Before joining Avalere, Maddi served as a manager at the Lewin Group, where she evaluated the OCM, gaining expertise in evaluation methods and OCM program rules, comparison-group selection, and performance-based payment methodology.
Maddi holds a bachelor’s degree in health science from the University of Florida and a Master of Public Health in epidemiology from Drexel University.
Authored Content
Sixty-nine percent of 340B contract pharmacies were associated with a PBM through vertical integration (53%) or contractual arrangement (16%).
Newly developed HCPCS codes will support increased access to oncology navigation services, which have been shown to improve patient outcomes.
Manufacturers impacted by the Part B discarded drug refund policy should assess claims billing and adjudication patterns to inform mitigation strategy.
Physician reimbursement for some services under Medicare FFS has declined, while payment increased for the same services in the hospital outpatient setting.
Manufacturers should adjust commercial and evidence generation strategies in response to the shifted incentives under the IRA and Enhancing Oncology Model.
The CMMI’s EOM began on July 1 with 44 participants. A recent OCM evaluation report described net losses to CMS and lessons that can be applied to EOM.
Amid stakeholder speculation for the future of the EOM, CMMI continues to plan for July 2023 implementation and released key payment methodology details.
Avalere expert Maddi Davidson discussed key EOM methods changes that will impact practice decision making.
The EOM prediction model and benchmarking methodology are more precise than that of the OCM, which will heighten the ability of participants to directly manage costs, including oncolytic spend.
Assessing barriers that impact patient access to obesity care and educating stakeholders on how to mitigate them can advance solutions toward improving care.
With EOM’s immediate downside risk, the model may appeal more to practices ready to implement care transformation activities and value-driven decision making.
Join us for a live, expert discussion on life sciences industry trends to watch in Q4.
Stakeholders should consider how the Enhancing Oncology Model’s design and incentives will impact cancer care management and treatment selection.
CMS announces long-awaited successor to the Oncology Care Model (OCM), which is scheduled to conclude on June 30, 2022.
An Avalere analysis found that OCM episode spending remained below the benchmark price for prostate cancer and low-risk breast cancer during the COVID-19 public health emergency (PHE). However, spending continued to exceed the benchmark for other cancers. These patterns suggest a differential impact of the PHE on OCM performance and episode service use by cancer type.
On February 2, 2022, President Biden announced a revitalization of the Obama-era Cancer Moonshot Initiative, including updated goals to reduce cancer deaths by at least 50% over the next 25 years and improve the experience of cancer survivorship for patients and their families.
An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.
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 the OCM, a total cost-of-care model, episode-level Part D expenditures include the amount the government pays for low income cost-sharing subsidy and reinsurance for beneficiaries who reach the catastrophic portion of the benefit once they have accumulated sufficient OOP costs. The latter leads to a seasonality effect in how Part D payments are captured in OCM episodes, which may have implications for how trends in OCM performance are assessed over time and how the OCM benchmark price is constructed.
An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.
An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.
As the Oncology Care Model (OCM) approaches its conclusion, stakeholders are anxiously awaiting the details of the Center for Medicare & Medicaid Innovation's (CMMI’s) next oncology episodic payment model, Oncology Care First (OCF).
Avalere analysis finds that success in the first 4 performance periods of the Oncology Care Model (OCM) was correlated with reductions to inpatient expenditure and spend reductions within certain high-cost tumor types. Further, smaller community-based practices and those that had lower per-episode expenditure in the baseline period tended to be more successful.
A new Avalere analysis finds that oncology practices participating in the Oncology Care Model (OCM) treated patients with 2–3% higher Medicare costs per episode, on average, than OCM prediction model estimates during the first two performance periods.
Pressure to lower costs will increase for OCM providers as CMS pushes to 2-sided risk.