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Value-Based Care

The healthcare system is transitioning to value-based care. We can help you navigate the alphabet soup: APM, ACO, MSSP, EPM, MACRA, OCM, OBC. Count on us to guide you through the transition.

Jack Fagan

How the Transitional Drug Add-On Payment Adjustment (TDAPA) Works

The TDAPA supports payment and patient access to new therapies introduced to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). While no major TDAPA revisions were finalized in the Calendar Year (CY) 2021 ESRD PPS Final Rule, stakeholders should continue to monitor this payment adjustment policy, as it has evolved since its introduction and may continue to change in future rulemaking cycles.

Liquid Biopsies: What You Need to Know

Liquid biopsies test blood samples for circulating tumor DNA (tumor derived cell-free DNA), circulating tumor cells, cell-free tumor DNA, proteins, metabolites, exosomes, messenger RNA, and microRNAs. The promise of liquid biopsies is a new modality that screens for cancer in ways that complement and, in some cases, improve existing tests, and allow testing for early detection, cancer diagnosis, and monitoring of minimum residual disease and recurrence, without the need for invasive biopsies.

Brigit Kyei-Baffour

Cell and Gene Therapy Pipeline Patient Affordability Opportunities

With a number of cell and gene therapies (CGTs) expected to obtain Food & Drug Administration (FDA) approval in the next 3 years, stakeholders must consider the unique patient access and affordability barriers that may limit patient ability to receive these novel treatments. Stakeholders should explore affordability solutions that can optimize access, or they risk excluding patients from obtaining potentially life-saving treatments.

Heather Flynn

Avalere Analysis Shows Home Care Services Reduce Medicare Spending

Avalere analysis determined that Medicare Fee-for-Service (FFS) patients receiving home-based care services experienced a decrease in Medicare spending over time when compared to a statistically balanced, matched control group who do not appear to have received home care services. The spending differential was also found to be higher among Medicare beneficiaries with functional limitations and multiple chronic conditions.

Dan Mendelson

Dan Mendelson Commentary on Health Equity Featured in Forbes

The COVID-19 pandemic and a summer of focus on racial justice has finally begun to intensify government interest in reducing racial disparities in healthcare. Understanding that healthcare providers and systems tend to respond to the economic incentives that are presented to them, current government decisions on payment options around renal dialysis present an important test case for the Trump Administration.

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