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Earler this month, the Obama Administration released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2018 plan year. Meanwhile, the exchange market faces instability. Recent Avalere analysis finds that more than one-third of rating regions may have only one insurance carrier participating on the exchange in 2017.
CMS released another mandatory bundled payment proposed rule which will significantly expand the scope of hospitals bearing risk for episodes of care nationally.
Recently we examined the various models of specialty pharmacy integration/ownership and how they result in different care coordination dynamics and access to drugs. Our findings demonstrate real value and opportunities in linking medical and pharmacy data to better support the patient journey with services and tools.
Shifting to a value-based purchasing (VBP) system provides opportunities to engage payer and provider customers in unique contracting and reimbursement relationships that may optimize market access.
One year after Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in a landslide, the Department of Health and Human Services is implementing this legislation to transform physician payment.
With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.
The Centers for Medicare & Medicaid Services (CMS) will release the Advance Notice and Call Letter describing CMS' proposed 2017 payment policies for Medicare Advantage (MA) plan sponsors on February 19. Based on previously released information in the fall of 2015, CMS is likely to propose modifications to the risk adjustment model and the current MA Star Ratings methodology.
Our experts and McKnight's Long-Term Care News explore the current value-based purchasing landscape for post-acute care.
As the U.S. healthcare system continues to make the shift from volume to value, stakeholders are taking on new approaches to adapt and thrive in this changing environment. Quality measurement is playing a more prominent role to ensure effective and efficient care for patients.
In 2016, two key themes underlie much of the shift in the healthcare landscape: cost and value. Each of these elements is critical to all sectors of the healthcare system as we attempt to reduce costs and deliver value.
FDA oversees access to investigational treatments by eligible patients (compassionate use) through its expanded access program. But how do you decide whether to give these patients the unapproved treatments they seek?
Recently, stakeholders have raised concerns around whether the current star rating methodology appropriately adjusts for the socioeconomic impacts on quality ratings.
The FDA has shown growing interest in regulating laboratory developed tests (LDTs) to ensure their safety and effectiveness.
Our final webinar in a three-part series: Navigating the New Dynamics of Outcomes Contracting and Risk Sharing Arrangements covers: Key considerations for designing effective Performance Contracts; current therapeutic areas of focus between Payers and Pharma; ways to better align data collection and outcomes measurement; considerations to address key regulatory and compliance challenges; and various financial incentive models that can govern these arrangements.
Last week, CMS took a significant step in its’ campaign to shift Medicare fee-for-service payments to alternative payment models. CMS proposed the first mandatory bundled payment model – the Comprehensive Care for Joint Replacement Model (CCJR) – which will pay hospitals in 75 markets a bundled payment for hip and knee replacements beginning in 2016. The CCJR bundle includes both the hospitalization and care 90-day post-discharge.
In the second of our three-part series of webinars on Navigating the New Dynamics of Outcomes Contracting and Risk Sharing Arrangements, we cover: Examples of performance contracting from both the US and EU5; important lessons learned from first generation arrangements; key considerations for aligning payers and manufacturers on incentives, measures, and data collection; and characteristics of good payer and manufacturer partners.
Avalere hosts a series of webinars on “Navigating the New Dynamics of Outcomes Contracting and Risk Sharing Arrangements”. While traditional rebating and discounting terms have been a staple of industry contract negotiations, a new strategic focus is emerging on additional modes through which overall value can be measured for the wave of high-cost drugs now coming to shore.
Achieving a vision of patient-centered healthcare requires multi-stakeholder collaboration each step of the way. As national attention on the use of patient-reported outcomes (PROs) grows, significant progress needs to be made to ensure that they are fairly used for accountability purposes in the context of performance-based payment models.
By the end of 2016, HHS plans to make 30% of fee-for-service payments through alternative payment models, such as accountable care organizations and bundled payments, and tie 85% of all fee-for-service payments to quality or value. This places increasing urgency on healthcare organizations to make a fundamental shift in their approach to care delivery.
To help you organize the chaos of the ever-evolving quality measures landscape, we are pleased to introduce the Avalere Quality Measures Navigator (QMN).