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.

Kelly Brantley

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.

Madison Davidson

OCM Lung Cancer Episode Costs Have Increased Dramatically Over Time

An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.

Mark Gooding

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.

Madison Davidson

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.

Brook Getachew

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.

Amy Schroeder

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.

Saran Traore

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.

Saran Traore

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.

Brook Getachew

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.

Melissa Morley

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.

Morenike AyoVaughan

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.

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