Value-Based Care
Alternative payment models are becoming more advanced as the healthcare system transitions to value-based care and payers drive to accelerate generated savings. Track and stay ahead of this evolution to identify strategic partnerships and measure results.
TPNIES Adjustment Promotes Access for Innovative ESRD Technologies
Medicare offers an add-on payment to facilities furnishing qualified new and innovative renal dialysis equipment and supplies via the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES).
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.
OCM, OCF, and the Future of Cancer Care: 5 Things to Look Out For
As the Oncology Care Model (OCM) approaches its conclusion, stakeholders are anxiously awaiting the details of the Center for Medicare & Medicaid Innovation's (CMMI’s) next oncology episodic payment model, Oncology Care First (OCF).
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
Differences in Spending and Demographic Profiles in Medicare KCC Model
The Kidney Care Choices (KCC) model, a new alternative payment model launched by the Center for Medicare and Medicaid Innovation (CMMI), is scheduled to begin on January 1, 2022. This model will provide population-based payments for beneficiaries with both advanced-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD) to improve patient health outcomes and lower Medicare fee-for-service (FFS) spending.
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.
A Roadmap for Advancing Care for Sickle Cell Disease
Avalere Health and Sick Cells have published a strategic roadmap, intended to advance care for individuals with sickle cell disease (SCD). The roadmap includes consensus-based solutions that various healthcare stakeholders can implement in the near future.
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.