Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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Proposed MA Plan Payment Changes May Impact Premiums and Benefits
Due to changes proposed in the CY 2024 Advance Notice, enrollees in Medicare Advantage could have higher premiums and fewer benefits in 2024 than 2023.
Standards of Care Begin to Reflect Advances in Diabetes Technology
Changes to standards related to diabetes technology indicate a corresponding opportunity to evolve quality measurements.
Characteristics of Hospitals Undergoing Mergers and Acquisitions
Avalere found that from 2016 to 2022, hospitals undergoing mergers and acquisitions were more likely to have 500+ beds and to be a 340B covered entity.
Improving Health Equity in Medicaid-Eligible Populations
The Health Systems Transformation Research Coordinating Center aims to change how research is generated, funded, and used to transform health systems in promotion of broader health equity for Medicaid-eligible individuals.
Medication Adherence Among Medicare Patients with Kidney Cancer
Among LIS Medicare patients using oral/IV therapy for kidney cancer, social risk factors may impact adherence, even when the OOP burden is reduced.
What is the CMS Innovation Center?
The CMS Innovation Center offers policymakers a nimble, non-legislative pathway to experiment with new methods of care delivery, payment, and reimbursement in Medicare and Medicaid.
505(b)(2) Changes That Generic Manufacturers Should Know
Regulatory changes to the 505 (b)(2) pathway will impact the go-to-market strategy for follow-on products that are not currently deemed therapeutically equivalent to the reference product.
MA RADV Policy Changes Raise Questions for Plans
Policy changes included in the final MA RADV rule will substantially affect the MA program, plan benefit design, and operations.
2024 Advance Notice Would Substantially Alter Risk Adjustment Model
Proposed technical changes to the MA risk adjustment model would have major implications if finalized.
How Health Plans Use Value-Based Drug Pricing
Health plans and other payers can manage drug expenditures through value-based approaches that tie drug pricing to patient outcomes.
5 Ways the IRA Will Impact Healthcare Investors in 2023 and Beyond
The IRA’s drug price negotiation policies, extended marketplace subsidies, and Part D redesign will impact investors’ current portfolios and investment strategy in the future.
Some Enrollees May Face Affordability Challenges Under Part D Redesign
An Avalere analysis finds that about 800,000 beneficiaries in 2024 and 200,000 in 2025 will have OOP costs that exceed 10% of their annual income.
What to Expect in the Final Medicare Advantage RADV Rule
CMS is expected to publish a final MA RADV rule by February 1. Policy changes could have a substantial impact on 2024 bids, plan benefit design, and operations.
Treatment and Outcomes for MA and FFS Patients with Diabetes
Avalere released a white paper comparing detection, treatment, outcomes, and spending between MA and FFS Medicare for patients with type 2 diabetes.
After Roe, Growing Fertility Industry Faces Risks at State Level
Despite market growth, fertility services may be affected by the overturning of Roe v. Wade. The extent and nature of impact will vary by state.
340B Drug Payment Increase Would Reduce Most Hospitals’ Part B Pay
Avalere analysis shows that a CMS policy to increase payment for 340B drugs, compared to alternative approaches, will result in lower payment to most hospitals.
Limited Internet Access May Drive Disparities in Telehealth Use
Telehealth has the potential to expand access to healthcare by allowing people to interact with providers remotely, but disparities affect access to the technology that makes telehealth possible.
States Set 2023 Legislative Priorities Amid New Federal Landscape
Most states will begin new legislative sessions in 2023. Drug pricing, patient affordability, and coverage protection will be priorities in many states.
Precision in EOM Methodology Has Implications for EOM Decision Making
The EOM prediction model and benchmarking methodology are more precise than that of the OCM, which will heighten the ability of participants to directly manage costs, including oncolytic spend.
IRA Policy Will Fill Gaps in Medicaid Vaccine Coverage for Adults
Avalere identified 19 states that must change their Medicaid vaccine policies to comply with the IRA’s requirement that states cover all recommended vaccines without cost sharing.