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
Medicare Advantage and Medicaid Managed Care Growth Present Risks and Opportunities for Post-Acute Care Providers
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.
Live Discharge Rates for Hospice Patients Vary by Diagnosis
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.
Skilled Nursing Facilities Adjust to the PDPM Era
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.
Healthcare Organizations See Reduction in ED Visits and Inpatient Admissions when Focusing on Value
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.
4 Things Hospital Executives Need to Know About Post-Acute Care
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.
4 Key Takeaways from USPSTF Recommendations for BRCA-Related Cancers & Risk-Reducing Medications
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.
Understanding ICER’s Evolving Influence on Drug Pricing and Negotiation
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.
Physician-Led Accountable Care Organizations Outperform Hospital-Led Counterparts
Medicare ACOs continue to realize experience-level results.
Avalere’s Home Health Expertise Featured in AHHQI Chartbook
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.
4 Compelling Use Cases for Blockchain in Healthcare
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.
More than Half of Health Plans Use Outcomes-Based Contracts
Cost savings and improved clinical outcomes cited as top advantages for payers according to survey conducted by Avalere Health.
Maximizing Access in an Evolving Policy and Payer Landscape
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.
How a New Technology Add-On Payment (NTAP) Works
Additional Medicare payment options available for new, high-cost technologies used in the inpatient setting.
Avalere and the Robert Wood Johnson Foundation Launch Initiative to Transform Health Systems
Avalere will serve as the RWJF Health Systems Transformation Research Coordinating Center to meet patients’ interrelated clinical and social needs.
Getting Ready for Primary Care First: Ambitious CMMI Initiative Aims to Redefine Primary Care
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.
Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy
Avalere experts published a supplement in the June 2019 American Journal of Managed Care entitled “Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy.”
Avalere Adds New Experts in Payer, Pharmacy Benefit Management, Provider and Specialty Markets
Dr. Roy Beveridge and Mike Schneider Join the Firm
Avalere Participates in Initiative to Advance the Identification and Management of Heart Valve Disease
In January 2018, Avalere Health partnered with the Society of Cardiovascular and Angiography Interventions to launch the development of the Heart Valve Initiative.
Avalere and Other Scientific Leaders Publish Paper on Advances in Value Frameworks
Paper details recent developments in leading value frameworks, including Avalere’s Focus on Patient Orientation in Value Assessment.
Cancer Treatment Costs Are Higher Among Oncology Care Model Participants than Benchmarks Predict
A new Avalere analysis finds that oncology practices participating in the Oncology Care Model (OCM) treated patients with 2–3% higher Medicare costs per episode, on average, than OCM prediction model estimates during the first two performance periods.
