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.
Avalere Survey: Over Half of Health Plans Use Outcomes-Based Contracts
In September 2021, Avalere conducted an online survey of 51 US-based health plans and pharmacy benefit managers (PBMs), representing roughly 59 million covered lives. The survey indicates that 56% of payers have executed an outcomes-based contract (OBC) as of September 2021.
Video: Cell and Gene Therapy in Oncology, Part III
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the final in our series on cell and gene therapies, experts from our Market Access practice discuss the need for patient support in cell and gene therapies, and the role that manufacturers and other stakeholders can play in providing it.
Podcast: Cell and Gene Therapy in Oncology, Part III
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the final in our series on cell and gene therapies, experts from our Market Access practice discuss the need for patient support in cell and gene therapies, and the role that manufacturers and other stakeholders can play in providing it.
Earlier Cancer Detection Improves Quality of Life and Patient Outcomes
Cancer has been the second-leading cause of death in the US for over a decade. Patient survival and quality of life depend to a large degree on stage at diagnosis, making early detection critical. However, most cancers have limited or no early screening technology available, reducing the opportunity to detect them early and leading to worse survival rates.
Video: Cell and Gene Therapy in Oncology, Part II
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the second in a series focused on cell and gene therapies, experts from our Policy and Market Access practices discuss value-based payment arrangements in cell and gene therapies, and the role they play in facilitating access to these therapies.
Podcast: Cell and Gene Therapy in Oncology, Part II
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the second in a series focused on cell and gene therapies, experts from our Policy and Market Access practices discuss value-based payment arrangements in cell and gene therapies, and the role they play in facilitating access to these therapies.
Podcast: Direct Contracting and Advancing Home-Based Care with Landmark Health
Tune into another episode of Start Your Day with Avalere. In this segment, Chris Johnson of Landmark Health joins Fred Bentley, Managing Director in Avalere’s Center for Healthcare Transformation, to discuss his organization’s experience as an early participant in CMMI’s Direct Contracting payment model and how value-based models can advance home-based care.
Removing Low-Risk Cancers Has Variable Impact on OCM Performance
An Avalere analysis found that the impact of removing low-risk/low-intensity episodes from the Oncology Care Model (OCM) reconciliation process would not have a notable impact for most practices. Among practices where performance would change, however, performance would improve for most practices if enrolled in 1-sided risk but worsen for most practices if enrolled in alternative 2-sided risk.
Neil Lund Joins Avalere Health as a Senior Advisor
He brings more than 30 years’ worth of actuarial and formulary management experience to the firm.
Video: Oncology Care and NCCN Key Takeaways
Tune into another episode of the Avalere Health Essential Voice series focused on disease education. In this segment, our Market Access experts discuss major takeaways from the 2021 NCCN annual conference in the areas of diagnostics, holistic approaches to cancer treatment, and how the pandemic has influenced cancer care.
Podcast: Oncology Care and NCCN Key Takeaways
Tune into another episode of the Avalere Health Essential Voice series focused on disease education. In this segment, our Market Access experts discuss major takeaways from the 2021 NCCN annual conference in the areas of diagnostics, holistic approaches to cancer treatment, and how the pandemic has influenced cancer care.
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.
Assessing the Reach of Oncology Clinical Pathways
Avalere analysis finds that approximately 1 in 5 Medicare beneficiaries with advanced urothelial carcinoma (UC) or renal cell carcinoma (RCC) see a physician that has access to McKesson Value Pathways or Elsevier ClinicalPath vendor clinical pathways programs
Avalere Broadens Market Access Capabilities with 3 New Hires
Each brings leadership and deep experience within the life sciences industry.
Video: Patient Support Programs and Rare Disease
Tune into the second segment of the Avalere Health Essential Voice series focused on disease education. In this segment, experts from our Market Access practice discuss rare disease patient support programs and the need for stakeholder partnerships to address many of the barriers patients and their caregivers face.
Podcast: Patient Support Programs and Rare Disease
Tune into the second segment of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, experts from our Market Access practice discuss rare disease patient support programs and the need for stakeholder partnerships to address many of the barriers patients and their caregivers face.
Incorporating Clinical Factors Could Improve OCM Cost Prediction
An Avalere analysis found that among high-risk breast cancer episodes, those in later stages of the disease had higher episode expenditures relative to their benchmarks compared to those in earlier stages.
Copay Accumulator and Maximizers: Evolving Policy Landscape
Implementation of copay accumulator and maximizer programs continues to increase; recent policy provisions finalized through federal rulemaking and state-level legislation have created new uncertainty for the future of these programs and the stakeholders they affect.
Kidney Care Policy, Market Shifts in Light of New and Old Challenges
The COVID-19 public health emergency, new policy changes, and existing unmet patient needs will pressure the evolving payer, provider, and reimbursement landscape for kidney care in 2021.
Lengthening Episode Duration Would Not Improve OCM Performance
An Avalere analysis found that lengthening episode duration from 6 months to a year would not have a large impact on the relationship between episode expenditures and benchmark costs, meaning that performance on longer episodes would not improve relative to shorter episodes.