Nelly Ganesan

Nelly Ganesan advises clients on the implications of quality-related healthcare policies, including but not limited to public and private quality reporting programs, value-based care, and payment and delivery models.

Nelly has special expertise in care models focused on CMS’ Triple Aim—better care, better health, and lower costs—and the use of patient-reported outcomes.

Nelly has been with the firm since 2011. Prior to joining Avalere, Nelly spent 6 years at the Institute for Healthcare Improvement, focused on population health and hospital-based quality improvement.

Nelly has an MPH in epidemiology and international health from Boston University and a BS in economics from the University of Oregon.

Authored Content

Avalere’s white paper draws on recommendations from a multi-stakeholder workshop to look at roadblocks and solutions for scaling sustainable solutions to address the diagnosis of rare disease.

Reducing health disparities is critical to advancing health equity, and each stakeholder has a role to play.

The COVID-19 public health emergency, new policy changes, and existing unmet patient needs will pressure the evolving payer, provider, and reimbursement landscape for kidney care in 2021.

With support from the Robert Wood Johnson Foundation, Avalere assesses opportunities to normalize cost-of-care conversations through measurement.

Tune into our second episode in the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH). In this segment, Avalere experts from the Center for Healthcare Transformation and Market Access practices discuss the strategies for SDOH solutions, specifically in the manufacturer space.

The impact of COVID-19 goes beyond the disease and produces additional strain on the healthcare system, including managing patients and meeting cost and quality drivers.

Avalere will serve as the RWJF Health Systems Transformation Research Coordinating Center to meet patients’ interrelated clinical and social needs.

In January 2018, Avalere Health partnered with the Society of Cardiovascular and Angiography Interventions to launch the development of the Heart Valve Initiative.

CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.

In early February, Avalere attended the annual Centers for Medicare & Medicaid Services (CMS) Quality Conference, an annual gathering that brings stakeholders together to address challenges in healthcare quality improvement and discuss ways to spread these solutions locally and nationally.

Avalere is excited to join the CQMC as quality measurement experts in an effort to further inform a discussion focused on core measure sets to assess the quality of American healthcare.

To better understand key motivations and barriers to using PROs in clinical care, Avalere conducted a literature review, identified existing PRO-PMs in use by payers through our proprietary quality measures database, and conducted interviews with early adopters of PROs. In this paper, we provide our findings and recommendations for next steps.

CMS removes 25 existing hospital quality measures in the Proposed FY2019 Inpatient Prospective Payment System (IPPS) Rule as part of its broader effort to focus on measures that matter.

The number of CMS-approved Qualified Clinical Data Registries grew by 40% in 2018, allowing specialties to have more opportunities to report on meaningful quality measures.

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes changes to the second year of the Quality Payment Program (QPP) for 2018. The QPP was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Today, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule that makes changes to the Quality Payment Program (QPP) for 2018, the second year of the program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The number of CMS-approved QCDRs tied to payment grows by more than 60% in 2017.

In the final episode of our QPP podcast series, Nelly Ganesan, one of our MACRA experts, talks about the Merit-Based Incentive Payment System (MIPS) optimization.

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 ACA is built on a foundation of improving the quality of care for all patients and includes a number of provisions to help consumers make decisions about where to receive their care as well as how to increase the transparency of services through value-based purchasing efforts and private sector programs. Listen in as Nelly Ganesan discusses the trend of using value-based systems in quality reporting programs which will require physicians to focus on outcomes versus processes.

In recognition of National Healthcare Quality Week, we sat down with Avalere expert Nelly Ganesan to discuss upcoming trends and developments for physician quality measurement.

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.

A new white paper from Avalere finds wide variation in how organizations develop and use clinical pathways (CPs)-multidisciplinary plans that provide specific guidance on the sequencing of care steps and the timeline of interventions. While CPs have the potential to improve quality and reduce cost, their growing use prompts a range of questions and concerns from patient advocates and healthcare providers. Specifically, Avalere's new work examines the lifecycle of a CP and explores the potential implications of growing use of these tools for payers, providers, and patients.

Avalere Health led the Pharmacy Quality Alliance's February 2015 Quality Forum Lecture entitled: A Look Ahead at 2015.

Avalere released its latest white paper on patient-reported outcomes (PROs) today in collaboration with leaders from patient, payer, health information technology, product development and research communities.

In 2015, Avalere Health and the Center for Medical Technology Policy will work together to develop the Partnership for Enhanced Recovery to promote broader adoption of proven protocols in the surgical space across a number of US hospitals.

In the Calendar Year (CY) 2015 End Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule released on October 31, the Centers for Medicare & Medicaid Services (CMS) finalized a 2015 base per treatment rate of $239.43, up slightly from $239.02 in CY 2014.

"On June 10, 2014, the Center for Medical Technology Policy (CMTP) in collaboration with Avalere Health hosted a multi-stakeholder forum in Baltimore, Maryland, to discuss potential challenges and opportunities to accelerate the adoption of enhanced recovery protocols (ERPs) in the U.S.

In the Calendar Year (CY) 2015 End Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule released on July 2, CMS proposes a 2015 base per treatment rate of $239.33, up slightly from $239.02 in CY 2014.