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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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.
RWE Strategy Leads to Support for Avalere-Developed Composite Measure
Avalere was pleased to partner with the nutrition community to develop and test the Global Malnutrition Composite Score, which has now received conditional support from the Measure Applications Partnership (MAP)—pending endorsement by the National Quality Forum (NQF)—for inclusion in the Hospital Inpatient Quality Reporting (IQR) Program.
Measuring Scope of COVID-19 Relief Coverage Expansion Provisions
Avalere analysis finds that Congress's healthcare reforms under the COVID-19 relief bill could expand exchange coverage subsidies for up to 18.3 million individuals.
Generic Drug Placement on Part D Generic Tiers Declines Again in 2021
A new analysis from Avalere finds that in 2021, Medicare Part D plans place generic prescription drugs on generic tiers 45% of the time, a decrease from 64% in 2016.
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.
Copay Accumulator and Maximizers: Evolving Policy Landscape
Implementation of copay accumulator and maximizer programs continues to increase; recent policy provisions finalized through federal rulemaking and state-level legislation have created new uncertainty for the future of these programs and the stakeholders they affect.
Strengthening Our Public Health Infrastructure: COVID-19 Lessons
Amid the continuing pandemic and calls for healthcare reform, the new administration seeks to confront the myriad public health issues facing our country today.
Kidney Care Policy, Market Shifts in Light of New and Old Challenges
The COVID-19 public health emergency, new policy changes, and existing unmet patient needs will pressure the evolving payer, provider, and reimbursement landscape for kidney care in 2021.
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.
mAb Utilization for COVID-19 Remains Low, Despite Availability
Since the beginning of the Public Health Emergency (PHE), manufacturers have been developing monoclonal antibodies (mAbs) and other treatment modalities to prevent and treat COVID-19.
Medicare FFS Utilization Decreased During the COVID-19 Pandemic
Avalere analysis finds healthcare utilization among Medicare Fee-for-Service (FFS) beneficiaries decreased in the spring of 2020 compared to the spring of 2019.
Senior Preferences for COVID-19 Vaccination Released with Tivity Health
The COVID-19 pandemic has disproportionately impacted seniors nationwide, with this population at an increased risk of hospitalization or death following a COVID-19 diagnosis.
Impacts of Part D Redesign Vary by Therapeutic Area
New Avalere analysis finds that 3 proposals to redesign the Part D benefit—H.R.19/S.3129, Prescription Drug Price Reduction Act (PDPRA), and Elijah Cummings Lower Drug Costs Now Act (H.R.3)—would increase 2023 mandatory manufacturer discounts by 80%, 81%, and 283%, respectively, with significant variation across therapeutic areas.
MA Enrollment in Plans with Extra Benefits for Chronically Ill Tripled in 2021
Over 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
Considerations in Ensuring Equitable COVID-19 Vaccine Administration
On January 21, the Biden administration released its National Strategy for the COVID-19 Response and Pandemic Preparedness. The plan highlights numerous actions that the administration intends to implement as it assumes responsibility in the fight against COVID-19.
What to Watch for in MA and Part D Contracting for the 2022 Plan Year
Recent regulatory action released in the final days of the Trump administration related to Medicare Advantage (MA) and Part D could significantly impact plan and manufacturer calendar year (CY) 2022 contracting strategies and stakeholder advocacy priorities.
How COVID-19 Has Impacted US Adolescent and Adult Vaccine Utilization
Globally and in the US, widespread vaccination has demonstrated medical, economic, and social value to both individuals and public health and has contributed to reductions in morbidity and mortality of certain diseases.
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.
Considerations for Employers in the Era of the COVID-19 Vaccine
On December 14, 2020, an intensive care unit nurse in New York was the first American to receive an injection of the COVID-19 vaccine.