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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Where We Stand on COVID-19 Treatments
Globally, the need to flatten the epidemic curve of COVID-19 cases has become the top public health priority to save lives and minimize the burden on the health care system. In the absence of treatments and prophylactics for the novel coronavirus, social distancing and quarantine strategies continue to be implemented in the US.
New Federal Rule Could Affect Infusion Site of Care Amid COVID-19 Pandemic
The Centers for Medicare & Medicaid Services (CMS) issued a new Interim Final Rule (IFR) that is intended to allow additional beneficiaries, especially those who are at high-risk, to receive home infusions amid COVID-19 transmission concerns. Specifically, the CMS clarified the definition of “homebound” under the Medicare Home Health Benefit and temporarily suspended enforcement of the National and Local Coverage Determinations (NCD and LCD) related to home infusion services. Uncertainties remain as to how these new flexibilities will be utilized, as well as how these flexibilities could impact treatment outcomes.
Select Part D Plans Have Higher PMPM Spending for LIS in Most Protected Classes
As plans continue to assess the proposed changes to their liability in the Medicare Part D benefit, understanding variations in spending by enrollee can help elucidate how policy changes might affect their spending. This Avalere analysis examines a subset of MA-PD and PDP plans with at least 75% of their enrollment comprising those with LIS. This analysis aims to quantify spending on drugs within the 6 protected classes for low-income subsidy (LIS) and non-LIS beneficiaries in this subset of PDP and MA-PD plans.
Ensuring COVID-19 Vaccine Affordability
On March 30, Avalere policy experts published a piece in the Health Affairs blog about the existing programs in place to ensure patient access to affordable COVID-19 vaccines.
Data from MQii Featured in British Medical Journal Open Quality
On March 25, the British Medical Journal Open Quality published an article, “Impact of an Interdisciplinary Malnutrition Quality Improvement Project at a Large Metropolitan Hospital,” co-authored by Kelsey Jones and Kristi Mitchell.
Payer Issues, Part 2: Health Plans’ Interventions to Address Food Insecurity
The growing prevalence and disparities in chronic diseases necessitate that health plans address food insecurity to improve patient outcomes. The combination of increasing need for access to healthy food and changes in the health policy and insurance landscape create opportunities to address food insecurity through a variety of payers.
Identifying and Treating Malnutrition Associated with Lower Readmission Rates
Avalere Health partnered with the Academy of Nutrition and Dietetics and other stakeholders for the Malnutrition Quality Improvement Initiative (MQii) designed to advance evidence-based, high-quality, and patient-driven care for hospitalized older adults who are malnourished or at risk for malnutrition.
What the Rollover from Drugs to Biologics Means
On Monday, March 23, over 90 products that had historically been regulated as drugs were deemed to be licensed as a biologic. This includes insulin products. During the past several years, the Food & Drug Administration (FDA) has released guidance about their interpretation of the provision to guide sponsors and provide information about what to expect for the transition.
States Act to Ensure Coverage Protections in Advance of ACA Decision
The majority of 2020 state legislative sessions are either approaching crossover deadlines or adjournment. In 2019 and 2020, at least 15 states (CT, DE, FL, HI, IN, LA, MD, ME, NH, NJ, NM, NV, OR, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions or coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).
An Update on the Preparation for Shared Decision-Making Tool for Stage III Non-Small Cell Lung Cancer Patients
Avalere published an abstract in the online Journal of National Comprehensive Cancer Network (JNCCN).
Diagnostic Considerations for COVID-19
As the Coronavirus Disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, rapidly spreads through the US, media and public scrutiny over the current diagnostic testing landscape has increased, given that the US lags behind other countries in the number of tests performed and turnaround time for results reported.
Medicare Telehealth Expansion Amid Coronavirus May Have Long-Term Access Implications
New flexibilities for telehealth services in fee-for-service (FFS) Medicare are designed to support ongoing COVID-19 response efforts.
SCOTUS Decision to Review ACA Case Could Undermine Coverage and Access
On March 2, the Supreme Court (SCOTUS) announced that it will review an appeal of the 5th Circuit Court of Appeal’s decision in Texas v. Azar regarding the legality of the Affordable Care Act’s (ACA’s) individual mandate and other provisions.
COVID-19 Supply Chain Considerations
As the novel coronavirus disease (COVID-19) continues to change daily life, concerns about the impact on global supply chains and possible drug shortages have increased. Additionally, changes to FDA processes may limit its ability to perform essential drug related activities.
Over 1 Million MA Enrollees Are in Plans Offering New Benefits for the Chronically Ill in 2020
Medicare Advantage (MA) plans are using new flexibilities to provide additional supplemental benefits to beneficiaries with chronic illnesses.
Variations in Part D OOP Costs for Insulin Across the Year
Avalere analysis finds that average beneficiary out-of-pocket (OOP) spending for 3 commonly used insulin products remains similar throughout the year, ranging from $95 in December to $136 in June and July.
ESRD Patients Set to Enroll in MA in 2021 Differ in Key Demographics
Avalere analysis finds differences in the demographics of patients with End Stage Renal Disease (ESRD) enrolled in Medicare Advantage (MA) compared to ESRD patients in Fee-for-Service (FFS) Medicare
MS Patients Face High OOP Costs for Prescription Medicines
Avalere analysis finds that out-of-pocket (OOP) spending on prescription drugs for beneficiaries with multiple sclerosis (MS) could be as high as one third of their income.
CMS Proposed Changes to MA D-SNP Look-Alikes May Especially Impact Duals in CA MA Plans
Avalere analysis finds that many CA beneficiaries enrolled in D-SNP look-alike plans may not be able to a transition to a D-SNP.
Chronic Disease Mobile Health Apps Need Better Value Propositions and Evidence
Rising healthcare costs and the increased prevalence of chronic disease in the US are incentivizing stakeholders to develop new solutions to tackle these issues. Many have turned to digital health innovations like mobile health applications to facilitate care prevention and management for chronic disease, but significant gaps remain in their ability to be used in real-world practice.