Meet
Thomas Kornfield

Tom Kornfield provides analytical support and strategic advice for clients on Medicare Advantage risk adjustment and payment, and on Part D issues.

  He has over 20 years of public and private sector experience in Medicare Advantage and Part D payment policy.   

Prior to joining Avalere, Tom served as a vice president of Medicare policy at America’s Health Insurance Plans (AHIP). During his tenure at AHIP, he led risk adjustment policy discussions with plan members and external stakeholders. Additionally, he oversaw research and analyses about the impacts of Medicare Advantage (MA) payment and risk adjustment policies.  He also helped to lead work looking at the distribution of rebates among Part D plans and contributed to analyses of the impacts of restructuring the Part D benefit.

Tom also spent 10 years working at the Centers for Medicare & Medicaid Services (CMS), where he held a variety of positions focused on MA and Part D payment policy. Specifically, Tom analyzed MA bids and payments and changes in MA payment rates, and he created a policy to allow for 5-star MA plans to market and enroll year-round.

He has also worked for Coventry Health Care, the Alliance of Community Health Plans, and the Senate Finance Committee.

Tom holds a graduate degree from the University of Michigan’s School of Public Policy. His undergraduate degree is from Hamilton College.

Authored Content


Faced with a rapidly evolving healthcare environment, there are a number of important uncertainties that commercial insurers will need to consider when planning for the future

On April 9, Avalere experts came together to discuss the impact of COVID-19 on the health insurance industry.

Oncology practices with a substantial proportion of Oncology Care Model (OCM) episodes in areas with high numbers of COVID-19 cases—such as Connecticut, Louisiana, Massachusetts, New Jersey, New York, and Pennsylvania—may face new challenges in containing total expenditure below target amounts.

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 in the top 25 US counties with highest number of COVID-19 diagnoses, two-thirds of Medicare beneficiaries have 1 or more high-risk medical conditions.

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.

Please join our panel of experts for an in-depth discussion of the rapidly evolving regulatory environment surrounding COVID-19 testing and treatment and the strategic, financial, and operational challenges this disease presents for health insurers.

As plans continue to assess the proposed changes to their liability in the Medicare Part D benefit, understanding variations in spending by enrollee can help elucidate how policy changes might affect their spending. This Avalere analysis examines a subset of MA-PD and PDP plans with at least 75% of their enrollment comprising those with LIS. This analysis aims to quantify spending on drugs within the 6 protected classes for low-income subsidy (LIS) and non-LIS beneficiaries in this subset of PDP and MA-PD plans.

Avalere analysis finds differences in the demographics of patients with End Stage Renal Disease (ESRD) enrolled in Medicare Advantage (MA) compared to ESRD patients in Fee-for-Service (FFS) Medicare

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.

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.

CMS is considering changes to its commercial market Risk Adjustment Data Validation (RADV) program to improve the accuracy of risk adjustment transfers and to increase stability and predictability for issuers. This follows issuer experiences with the 2017 RADV process in which some issuers saw substantial, unforeseen changes to their risk adjustment transfers. These RADV changes have the potential to impact issuer participation and premiums in future years depending on the direction (positive or negative) and magnitude of those transfers.

Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits following administration’s policy changes from a year ago.

Join Avalere experts on our webinar on October 29, 2019, to unpack CMS’ 2020 Star Ratings and look at what’s to come for 2021.

In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.

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

A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions.

Medicare Advantage HMO offerings grow while PPO and PFFS offerings are exiting the market. Analysis also shows significant variation in PDP premiums in 2014; five out of top 10 prescription drug plans have double digit increase