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.
Featured Content
Podcast: Get Ready to Excel in Direct Contracting
Tune into another episode of Start Your Day with Avalere. In this segment, experts from our Policy team and the Center for Healthcare Transformation discuss distinct features and frequent questions for CMS direct contracting payment model and its future outlook.
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.
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.
Understanding Success Among OCM Participants
Avalere analysis finds that success in the first 4 performance periods of the Oncology Care Model (OCM) was correlated with reductions to inpatient expenditure and spend reductions within certain high-cost tumor types. Further, smaller community-based practices and those that had lower per-episode expenditure in the baseline period tended to be more successful.
Comparing Part B and D Treatment Patterns of ACO and Non-ACO Providers
New analysis from Avalere finds that Medicare beneficiaries are more likely to receive Part D autoimmune drugs and less likely to receive Part B autoimmune drugs from providers who are part of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) compared to non-ACO providers.
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.
Webinar: What’s Next for Oncology Care Management and Payment?
Avalere experts took a closer look at emerging oncology trends, innovative approaches to payment and delivery, and what these changes will mean for patient access.
Measuring the Effectiveness of Cost-of-Care Conversations
With support from the Robert Wood Johnson Foundation, Avalere assesses opportunities to normalize cost-of-care conversations through measurement.
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.
Podcast: Clinical Pathways in Oncology, Part 2
Tune into another episode of Start Your Day with Avalere. In this segment, experts from Avalere’s Market Access continue their discussion on clinical pathways in oncology, exploring how they are developed and what cancers and treatment modalities are included.
COVID-19 Therapies Could Benefit from NTAP Reimbursement Opportunity
Therapies currently being developed to treat COVID-19 in the inpatient setting have opportunity for additional Medicare reimbursement.
New ESRD Analytics Featured in Kidney 360
On August 25, “Calcimimetic Use in Dialysis-Dependent Medicare Fee-for-Service Beneficiaries and Implications for Bundled Payment” was published in Kidney 360. The article featured research and analytics conducted by Avalere experts.
5 Activities to Make the Most of the HEDIS® Off-Season
While the HEDIS® collection season lasts for a limited time, the focus on initiatives that impact HEDIS results is a year-round priority. The period between submission and HEDIS season ramp-up, known as the “off-season,” offers an opportunity for health plans to elevate the member experience, amplify quality improvement activities, and improve HEDIS submission effectiveness.
Webinar: Market Access Enablement Strategies, Part 1: Launching in a Virtual World
Join Avalere experts for Part 1 of our Market Access Enablement Strategies webinar series to learn about how life sciences companies are pivoting with pre-/post-new product launch strategies, including differential investments to inform market access execution.
Podcast: Clinical Pathways in Oncology, Part 1
Tune into another episode of Start Your Day with Avalere. In this segment, experts from Avalere’s Market Access practice discuss clinical pathways as they relate to value in oncology.
Webinar: Market Access Enablement Strategies, Part 2: Navigating Policy and Marketplace Developments
Join Avalere experts for Part 2 of our Market Access Enablement Strategies webinar series to learn about the policy changes and market factors that could impact the future relationships between manufacturers, health plans, and pharmacy benefit managers.
Omar Hafez Joins Avalere Health, Expands West Coast Footprint
Hafez expands Avalere's market access capabilities with deep expertise in strategy, operations, commercialization, and analytics.
Research Agenda for Health Equity Released in Collaboration with RWJF
Avalere is releasing a new research agenda to guide evidence generation for health system models of care that advance the intersection of social and clinical needs of Medicaid-eligible individuals.
Avalere Helps NYSHealth Improve Physician-Patient Cost Conversations
Avalere’s issue brief highlights real-world examples of how cost of care can be woven into physician-patient conversations and how it can improve dialogues.
Emerging Trends in Oncology Management
As treatment advancements in oncology continue, stakeholders are modifying their approaches to defining value and managing care