Meet
Robin Duddy-Tenbrunsel
Principal
Robin Duddy-Tenbrunsel provides policy analysis and strategic advice to stakeholders across the healthcare continuum, with focuses on Medicare Advantage and social determinants of health.
Prior to joining Avalere, Robin worked in the impact investing field, where she researched cost-saving, evidence-based health interventions, and at Partners in Health. Robin also has graduate internship experience with the White House Office of Management and Budget’s Health Division and the Henry J. Kaiser Family Foundation.
She holds an MPP from Georgetown University and a BA from Tufts University.
Authored Content
The first installment of our Health Plans series explains how plans can evolve their approaches to provider contracting and utilization management for the future.
If CMS lowers the dual-eligible enrollment threshold it uses to define D-SNP look-alikes, the demographics in look-alike plan enrollment will likely change.
Join Avalere’s healthcare policy experts as they dissect the Advance Notice of Methodological Changes for CY 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and discuss the future trajectory of Medicare Advantage (MA) in Part D and potential outcomes, headwinds, and tailwinds for health plans.
Updated Avalere analysis finds MA beneficiaries with chronic conditions had fewer inpatient stays and ED visits than FFS Medicare beneficiaries.
Conflicting court rulings regarding FDA approval of mifepristone, part of the regimen for medication abortion, may set a new precedent for product approvals.
Due to changes proposed in the CY 2024 Advance Notice, enrollees in Medicare Advantage could have higher premiums and fewer benefits in 2024 than 2023.
Policy changes included in the final MA RADV rule will substantially affect the MA program, plan benefit design, and operations.
Proposed technical changes to the MA risk adjustment model would have major implications if finalized.
CMS is expected to publish a final MA RADV rule by February 1. Policy changes could have a substantial impact on 2024 bids, plan benefit design, and operations.
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.
The end of the public health emergency (PHE) raises policy questions around implications for reimbursement, patient access, and operationalization of telehealth service delivery.
On October 6, CMS published the 2023 star ratings for Medicare Advantage (MA) plans ahead of the start of open enrollment on October 15.
If finalized as proposed, the changes to the Risk Adjustment Data Validation process could have a substantial impact on Medicare Advantage plans and enrollees.
In 2022, nearly 4.5 million beneficiaries are in Medicare Advantage (MA) plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI), compared to 1.2 million in 2020, the first year these benefits were available.
New analysis from Avalere finds that in 2022 more Medicare Advantage plans will offer non-medical supplemental benefits, such as meals, nutrition, transportation, and in-home support services, at a $0 premium.
As the Centers for Medicare & Medicaid Services (CMS) consider what, if any, changes to propose to Medicare Advantage (MA) through fall rulemaking, stakeholders should consider where the Biden administration’s priorities may differ from the previous administration’s. Topics that may be addressed—either in regulation or via legislation—include health equity, supplemental benefit flexibility, star ratings, payment and risk adjustment, and end-stage renal disease (ESRD).
Digital health will continue to be a focus under recently confirmed Secretary Becerra‘s leadership at the Department of Health and Human Services. As the Biden administration looks to enforce compliance across a range of data interoperability and price transparency rules, as well as usher in new Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) coverage policies for medical technologies and digital health tools, the industry is responding with a range of innovations.
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.
Over 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
The COVID-19 pandemic has created significant challenges for all Americans, particularly for its most vulnerable populations, including the elderly and people with disabilities in Medicare. The Centers for Medicare & Medicaid Services (CMS) recently reported that 21% of fee-for-service (FFS) Medicare enrollees have stated they are forgoing non-COVID-19 related care due to the pandemic. Avalere conducted analyses to determine if a similar decrease in utilization is occurring in Medicare Advantage (MA) and assess the potential impact of deferred care on MA enrollees and plans.
Avalere analysis finds End Stage Renal Disease (ESRD) spending in Puerto Rico varies substantially, and most spending is related to outpatient dialysis and inpatient services.
Avalere analysis finds that at least 5 million Black and Hispanic people may lose their health insurance as a result of the pandemic.
Dually eligible beneficiaries in Pennsylvania with end-stage renal disease (ESRD) are more often people of color and have higher costs compared to non-duals, but their utilization patterns are similar.
With the release of the 2021 Medicare Advantage (MA) and Part D Final Rule, the details of the upcoming policy change that allows beneficiaries with end-stage renal disease (ESRD) to enroll in MA are set. Stakeholders need to adapt quickly to be prepared.
Deferral of care during the COVID-19 pandemic is resulting in fewer claims and diagnoses among Medicare Advantage (MA) enrollees, which could lead to a 3%–7% reduction in 2021 risk scores and lower plan payments in 2021.
The COVID-19 pandemic will have ongoing, market-wide implications as Medicare Advantage (MA) plans contend both with responding to the virus and the disruption to their normal activities.
Medicare Advantage (MA) plans are using new flexibilities to provide additional supplemental benefits to beneficiaries with chronic illnesses.
Avalere analysis finds that many CA beneficiaries enrolled in D-SNP look-alike plans may not be able to a transition to a D-SNP.
This month, the Centers for Medicare & Medicaid Services (CMS) proposed changes to Medicare Advantage (MA) through the annual Advance Rate Notice and Proposed Rule. These proposals impact MA in many ways, including changes to quality bonus payments, network adequacy requirements, coverage of End Stage Renal Disease (ESRD), plans targeting dual eligibles, and supplemental benefit offerings. Stakeholders should examine each of these areas closely as they respond to CMS.
CMS is set to release its annual proposed changes to Medicare Advantage (MA) this week. Some of the topics that may be addressed include End-Stage Renal Disease (ESRD), network adequacy requirements, payment to MA plans that offer the hospice benefit, and the MA quality bonus program.
In a recent post on the RISE website, Sean Creighton examines the methodology and evidence behind CMS’s proposal to eliminate the Fee-for-Service (FFS) Adjuster from Risk Adjustment Data Validation (RADV) audit methodology.
Avalere analysis finds that payment to Medicare Advantage (MA) plans for end-stage renal disease (ESRD) patients in highly populated regions may be significantly below actual patient costs.
In 2018, CMS proposed to revise its Risk Adjustment Data Validation (RADV) methodology to exclude the FFS Adjuster in its payment recoupment calculations. New analysis from Avalere finds that the payment impact associated with fee-for-service (FFS) Medicare coding discrepancies would be greater for certain subgroups of beneficiaries (e.g., dual-eligible, those with certain common and potentially serious health conditions) enrolled in the MA program.
Avalere analysis of 1,375 Medicare Advantage plans’ 2019 medical benefit drug coverage policies finds that 672—covering approximately 14.3 million lives—apply step therapy to at least 1 of the rheumatoid arthritis biologic drugs covered under Medicare Part B in 2019.
In February 2012, the Centers for Medicare & Medicaid Services (CMS) announced a final payment error calculation methodology for its contract-level Risk-Adjustment Data Validation (RADV) audits of Medicare Advantage (MA) plans.
In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.
The costs of ensuring the safety and efficacy of imported drugs and preventing the entry of counterfeit products are among the many factors that must be weighed against any potential savings from a drug importation program.
Following its recent announcement to grant Medicare Advantage (MA) plans the flexibility to use step therapy techniques for Part B drugs beginning in January 2019, the Centers for Medicare & Medicaid Services (CMS) released an FAQ with additional guidance on its implementation.
Earlier this year, the administration granted Medicare Advantage plans greater flexibility to target benefit designs for individuals with certain high-risk health conditions. These changes are expected to position the program for continued growth.
In late August, CMS released its proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year.
New Avalere report identifies opportunities to refine the risk-adjustment model that could improve the way Affordable Care Act plans are paid
Percentage of Medicare Advantage enrollees in plans with at least four stars continues to grow.
A new analysis from Avalere Health finds that hospitals and health systems are increasingly taking risk for the cost of Medicare patients and the quality of the care they receive.