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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Series of Changes to Drug Pricing Metrics Will Interact in Coming Years
The intersection of upcoming changes to drug pricing metrics will require new methods of calculating and reporting government pricing with implications for net pricing and contracting strategies.
Self-Administered Vaccines Present Broad Opportunities
The COVID-19 pandemic response has increased investment in vaccine innovations, but also exposed gaps in US and global vaccine access and delivery.
Addressing the Diagnostic Journey for Rare Disease Patients
Avalere’s white paper draws on recommendations from a multi-stakeholder workshop to look at roadblocks and solutions for scaling sustainable solutions to address the diagnosis of rare disease.
Higher Gap Discount Payments for Employer Part D Plans
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
4 Reasons to Watch PCORI’s Evolving Role in Healthcare Decision-Making
The Patient Centered Outcomes Research Institute (PCORI) recently announced an open comment period for a new set of proposed national priorities to inform its research agenda. Avalere analysis finds that from March 2019 to September 2020, PCORI directed roughly $259 million to comparative effectiveness research (CER) awards with an increasing share of new projects focused on drugs.
Payer Survey Finds Opportunities for Renewed Focus on Mental Health
An Avalere survey of 37 decision-makers at risk-bearing payer entities identified shifting trends and focus for coverage of and access to behavioral health treatments and services.
How Lessons from COVID-19 Can Improve Access to Future Medicines
Crises often drive change at a pace not thought feasible in normal times. The COVID-19 pandemic has been no exception, bringing the accelerated development and emergency approval of vaccines, the wide implementation of telehealth, and potentially permanent changes to the way that global business is conducted.
6 Ways for Manufacturers to Engage in Health Equity
Reducing health disparities is critical to advancing health equity, and each stakeholder has a role to play.
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.
What to Watch for in Medicare Advantage Policy in the Coming Months
As the Centers for Medicare & Medicaid Services (CMS) consider what, if any, changes to propose to Medicare Advantage (MA) through fall rulemaking, stakeholders should consider where the Biden administration’s priorities may differ from the previous administration’s. Topics that may be addressed—either in regulation or via legislation—include health equity, supplemental benefit flexibility, star ratings, payment and risk adjustment, and end-stage renal disease (ESRD).
COVID-19 Pandemic’s Considerable Impact on Skilled Nursing Facilities
The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.
Digital Health Advances Create Opportunities for Access and Engagement
Digital health solutions continue to advance the way healthcare is delivered. Through research and development as well as stakeholder partnerships, life science companies can leverage digital health technologies to optimize access along the patient care journey.
Updated Analysis Finds Sustained Drop in Routine Vaccines Through 2020
In 2020, the COVID-19 pandemic resulted in nationwide lockdowns and restrictions with a well-documented impact on utilization of routine healthcare services.
Unprecedented Mid-Year Plan Changes Could Impact Patient Access
While access to insurance has increased for millions, mid-year plan switching can have unforeseen consequences for patients.
Avalere Analysis Examines Part D Program Spending Trends
As Congress renews focus on drug pricing reforms, an Avalere analysis examines recent trends in the Part D program’s subsidy payments and implications on stakeholder liabilities in the program.
Coverage of COVID-19 mAbs Presents Opportunities for Stakeholders
In November 2020, the Food and Drug Administration (FDA) granted Emergency Use Authorization (EUA) to COVID-19 monoclonal antibodies for treatment of mild-to-moderate COVID-19 infection.
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).
CMS Introduces Changes to CAR-T Reimbursement in IPPS Proposed Rule
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on policies finalized in last year’s rulemaking. Looking ahead, stakeholders will continue to weigh the appropriateness of payment.
Healthcare Among High-Need, High-Cost Beneficiaries in FFS vs. MA
Avalere experts participated in a pre-release panel session, "Healthcare Utilization, Cost, and Quality Among High-Need, High-Cost Beneficiaries in Medicare Fee-for-Service versus Medicare Advantage," that was presented at the International Society for Pharmacoeconomics and Outcomes Research annual conference May 17–20, 2021.
US Government Continues Investing in Solutions to Combat AMR
As the COVID-19 pandemic draws to a close in the US, another public health concern is once again coming to the fore: antimicrobial resistance (AMR).