The payer landscape continues to evolve for post-acute care (PAC) providers. Fueled by lower annual costs and expanded benefit options relative to the Medicare fee-for- service (FFS) program, Medicare Advantage (MA) is growing rapidly, now encompassing more than one-third of all Medicare beneficiaries. At the same time, nearly half the states have implemented managed care plans to provide Medicaid long-term care benefits.

• Fred Bentley
• Heather Flynn

Avalere’s analysis found that hospice patients diagnosed with cardiovascular and dementia conditions represent the largest proportion of “live discharges” compared to patients with other conditions.

• Gabriel Sullivan
• Michael Kearney
• Fred Bentley

Skilled nursing facilities (SNF) nationwide continue to adapt to the Patient-Driven Payment Model (PDPM), a transformational new approach to SNF Medicare reimbursement that took effect October 1, 2019.

• Fred Bentley
• Heather Flynn

Avalere worked with a healthcare organization to assess the impact of their quality improvement program over a 4-year period. The organization prepared primary and specialty care providers/practices to transition from fee-for-service (FFS) to value-based payment arrangements. Avalere’s analysis found participation in the program led to a reduction in both emergency department (ED) visits as well as inpatient (IP) admissions over the period reviewed.

• Michael Kearney
• Natascha Dixon Edelin
• Joanna Young

Despite the oft-repeated mantra that provider collaboration and care coordination are the bedrock of a more rational and cost-effective healthcare system, relationships between hospitals and post-acute care providers remain largely fragmented and uncoordinated.

• Fred Bentley

Announced this past August, the US Preventive Services Task Force (USPSTF) expanded risk assessment and genetic testing recommendations for BRCA-related cancers and recommendations for risk-reducing therapies. This expansion marks the growing importance of genetic literacy in the healthcare system.

• Hillary Stires
• Alaya Martin

ICER is eager to position itself as the primary comparative and cost-effectiveness research body in the US. While their activity has been traditionally more limited to product-specific reviews, the Institute is increasingly looking to shape the broader debate around value and drug pricing.

• Samantha Ferguson
• Haile Dagne
• Kayla Amodeo
• Michael Schneider

For the last several years, Avalere has worked with the Alliance for Home Health Quality and Innovation (AHHQI) to analyze the ever-changing home health landscape.

• Heather Flynn

While emerging blockchain technology is expected to impact a range of businesses in the years ahead, its strengths seem particularly well suited for the complex data-sharing demands of the pharmaceutical and healthcare industries.

• Oladeji Faborode

Manufacturers currently face an almost-unprecedented level of uncertainty in developing contracting strategies for the coming plan years. Avalere’s combination of policy and commercialization expertise, paired with its data capabilities, allow us to support life sciences companies understand this challenging landscape to ensure access to innovative therapies for their patients.

• Michael Schneider
• Mark Gooding

Additional Medicare payment options available for new, high-cost technologies used in the inpatient setting.

• Abby Moorman
• Mark Gooding
• James Coffelt

Announced in late April, the Center for Medicare & Medicaid Services’ (CMS) Primary Care First initiative marks a critical step forward in the long and complex journey toward a fundamentally transformed healthcare system.

• Fred Bentley
• John Feore

Avalere experts published a supplement in the June 2019 American Journal of Managed Care entitled “Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy.”

• Brigit Kyei-Baffour
• Samantha Ferguson

Paper details recent developments in leading value frameworks, including Avalere’s Focus on Patient Orientation in Value Assessment.

• Josh Seidman