Shalini Parekh

Shalini Parekh supports clients with market access and reimbursement strategy related to the Centers for Medicare & Medicaid Services (CMS)'s alternative payment models and other federal programs.

She leverages her experience in Medicare data analytics, payment policy, and quantitative program evaluation.

Prior to joining Avalere, Shalini was a vice president at The Lewin Group, where she managed the quantitative evaluation of the CMS’s Oncology Care Model (OCM), an alternative payment model focused on episodes of care initiated by chemotherapy. Shalini led a team of economists and data analysts in assessing the impact of OCM practice transformation requirements and financial incentives on claims-based payment, utilization, and quality of care outcome measures. Before that, Shalini spent several years at Acumen, LLC, directing CMS contracts focused on the Medicare Part D prescription drug program. This work included building analytic and reporting tools to measure and monitor Part D drug plan performance across dimensions such as patient safety and benefit administration, in addition to supporting Part D payment reconciliation and implementation of the coverage gap discount program.

Shalini has an MA in economics from the University of California, San Diego, and a BS in economics/mathematics from the University of Southern California.

Authored Content

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.

On July 19, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 OPPS/ASC Proposed Rule, which includes a number of proposals to modify the timing and design of the Center for Medicare & Medicaid Innovation’s forthcoming Radiation Oncology (RO) Model. The design proposals include changes to the set of included modalities and cancer types, reduction of the CMS discount factors applied to the prospective payments, and adoption of an extreme and uncontrollable circumstances policy. Looking ahead, stakeholders should continue to assess the model payment methodology and design in the context of evolving care delivery and practice patterns.