Mitchell Cole

Mitchell Cole provides a wide variety of healthcare stakeholders, including health plans, pharmaceutical manufacturers, patient groups, and trade associations, with data-driven analyses of the impacts of policy and regulatory changes.

Mitchell applies expertise in quantitative analysis, modeling, and the synthesis of healthcare data to advise clients on the effects of changes to the Medicare and Medicaid programs on patient access to care, the market landscape, and federal and state budgets.

Prior to joining Avalere, Mitchell worked at the U.S. Government Accountability Office, contributing to a review of several federal agencies. Prior to that, Mitchell worked as a policy analyst at The Commonwealth Institute for Fiscal Analysis, where he examined trends in a number of state policy areas, analyzed legislation under consideration, and developed data-driven policy recommendations.

Mitchell has an MPP and a BA in economics and international relations from the College of William and Mary.

Authored Content

At a time when more Americans—particularly people of color—are enrolled in Medicaid, new Avalere analysis finds that provider networks for primary care and certain specialties in Medicaid are narrower on average than those of commercial plans in certain metropolitan areas, ranging from 63% smaller in Miami to 18% in New York.

New Avalere analysis finds that 3 proposals to redesign the Part D benefit—H.R.19/S.3129, Prescription Drug Price Reduction Act (PDPRA), and Elijah Cummings Lower Drug Costs Now Act (H.R.3)—would increase 2023 mandatory manufacturer discounts by 80%, 81%, and 283%, respectively, with significant variation across therapeutic areas.

New Avalere analysis finds that the the Most Favored Nation (MFN) Model would have a significant negative impact on Medicare providers that furnish Part B drugs—especially in oncology and rheumatology—and those in rural areas.

New Avalere analysis finds that most Medicare fee-for-service (FFS) beneficiaries would not see a substantial reduction in their out-of-pocket (OOP) costs as a result of the Most Favored Nation (MFN) model.

Avalere analysis finds that 51% of all drug spending for non-LIS beneficiaries using insulins and enrolled in enhanced plans in 2018 was for products not participating in the model.

As policymakers discuss ways to curb program expenditures and improve patient affordability in Medicare Part D, the role of charitable assistance in helping beneficiaries with out-of-pocket (OOP) costs has garnered interest. To understand the relationship between charitable assistance and various Part D metrics, Avalere examined Part D prescription drug claims for beneficiaries without the Low Income Subsidy (LIS) for 2014 and 2018.

New analysis of trade data finds that 54% of API, in dollars, used in domestically consumed medicines came from the US in 2019.

An analysis of CMS’s Hierarchical Condition Category (HCC) model shows that fully dual-eligible beneficiaries have the highest risk scores.

Scenario analysis of varying levels of negotiation under H.R.3 (as passed in the House on December 12, 2019) finds that the bill could reduce federal spending by $850B to $1,060B and decrease manufacturer revenues by $1,275B to $1,655B for CY 2020–2029.

New Avalere analysis finds that Medicare Part D patients taking brand prostate cancer drugs enrolled in Employer Group Waiver Plans (EGWPs) have more prescriptions in the coverage gap than patients in non-employer plans.

Avalere analysis finds Medicare incurred $106.4 billion in 2016–2018 treating diseases potentially preventable with inline vaccines and select pipeline vaccine candidates. Those diseases also resulted in beneficiary costs of approximately $9.6 billion during the same time period.

An Avalere analysis finds that, on average, non-LIS Medicare beneficiaries in Employer Group Waiver Plans (EGWPs) have higher utilization but lower out-of-pocket (OOP) costs than non-EGWP enrollees.

Avalere analysis finds that Medicare fee-for-service (FFS) patients with an RA diagnosis and conditions associated with undermanaged disease have 121% higher medical costs than other RA patients. Part D costs were 30% higher for those with undermanaged disease than for other RA patients.

The large-scale disruptions resulting from COVID-19 are significantly reshaping how patients receive care. In particular, patients taking infused and injectable drugs administered by a healthcare professional at a physician office, infusion center, or hospital outpatient department now face greater challenges receiving their medications.

Avalere analysis finds that average beneficiary out-of-pocket (OOP) spending for 3 commonly used insulin products remains similar throughout the year, ranging from $95 in December to $136 in June and July.

Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for multiple sclerosis (MS) drugs than beneficiaries enrolled in other types of Part D plans.

New analysis from Avalere finds that states currently covering non-mandatory adult populations who choose to participate in the Healthy Adult Opportunity (HAO) initiative may need to generate up to 8% in Medicaid savings to keep spending below new capped funding levels.

Avalere analysis finds that tying Medicare Part D manufacturer discounts to utilization in the catastrophic phase instead of in the coverage gap would have differential impacts by disease area.

As policymakers consider reforms to Part D, new Avalere analysis shows that congressional proposals to cap out-of-pocket (OOP) costs in the catastrophic phase are likely to reduce OOP for many beneficiaries

Avalere analysis finds that a larger proportion of beneficiaries taking a Part D cancer therapy reached catastrophic compared to all Part D enrollees.

The Center for American Progress (CAP) commissioned Avalere to evaluate ‘Medicare Extra’ as a package of reform polices implemented and phased in over time across the US healthcare system.

New Avalere analysis finds that shifting Part B-covered rheumatoid arthritis (RA) drugs to Part D benefit would increase the share of prescriptions occurring in the catastrophic phase for impacted beneficiaries by more than 5 times.

New Avalere analysis finds that beneficiaries enrolled in Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for select drugs than beneficiaries enrolled in other types of Part D plans.

New analysis from Avalere finds that 102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs if the ACA’s pre-existing condition protections were repealed.