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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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.
Patient Registries Can Pave the Way to Establishing a Learning Health System
As the shape and scope of America’s learning health system evolves, Avalere partners with industry leaders, engaging multiple stakeholders to formulate patient registry strategies that develop, evaluate, and utilize registry data – and help improve care in real time.
2020 Election: Healthcare Coverage Landscape Varies in Super Tuesday States
Ahead of the Super Tuesday primaries on March 3, healthcare remains a top issue among voters. According to January 2020 polling from Bipartisan Policy Center, 56% of individuals ranked healthcare as one of their top 3 issues when determining how to vote in the upcoming election, above the economy (44%), immigration (33%), taxes (31%), gun control (30%), and environmental policy (23%).
Recent Federal Rule Could Undermine Some Patient Support Programs
The Center for Medicare & Medicaid Services (CMS) recently issued its proposed Notice of Benefit and Payment Parameters (NBPP) for the 2021 plan year. The proposed rule would significantly expand commercial payer flexibility to not count manufacturer copay support toward deductibles or out-of-pocket (OOP) maximums.
OOP Costs for MS Drugs Are Substantially Higher for Non-Employer-Based Part D Plans
Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for multiple sclerosis (MS) drugs than beneficiaries enrolled in other types of Part D plans.
CMS Proposal May Increase Obstacles for State-Mandated Benefits
In the Notice of Benefit and Payment Parameters (NBPP) for the 2021 plan year, CMS questioned whether states were appropriately deciding if the state was required to defray the premium impacts of new benefit mandates added since 2011. CMS proposes requiring states to report on and justify defrayal decisions for all state benefit mandates.
With an Influx of Cell and Gene Therapies on the Horizon, New Access, Coverage, and Financing Models Are Needed
With new cell and gene therapies poised to revolutionize treatment for a growing number of disease states, stakeholders are working to reimagine existing value and reimbursement models to meet the special challenges these breakthrough services present.
Patient Costs Among Medicare Part D Users of Mental Health Drugs
According to a new analysis from Avalere, Medicare Part D beneficiaries who are taking mental health drugs and do not receive low-income cost-sharing support are responsible for a higher share of the cost of mental health drugs (46%) than for non-mental health drugs (23%).
Medicare Advantage and Medicaid Managed Care Growth Present Risks and Opportunities for Post-Acute Care Providers
The payer landscape continues to evolve for post-acute care (PAC) providers. Fueled by lower annual costs and expanded benefit options relative to the Medicare fee-for- service (FFS) program, Medicare Advantage (MA) is growing rapidly, now encompassing more than one-third of all Medicare beneficiaries. At the same time, nearly half the states have implemented managed care plans to provide Medicaid long-term care benefits.
Medication Adherence Rates Low Among Patients with Serious Mental Illness
Avalere research recently published in ClinicoEconomics and Outcomes Research compared patient characteristics and real-world outcomes in 2 distinct high-risk cohorts of patients with serious mental illness (SMI), including patients with a hospitalization related to SMI (recently discharged) and patients newly diagnosed with SMI (early episode). The research included 51,705 patients with bipolar disorder, major depressive disorder, and schizophrenia.
5 High Impact Areas in the MA Advance Notice & Proposed Rule
This month, the Centers for Medicare & Medicaid Services (CMS) proposed changes to Medicare Advantage (MA) through the annual Advance Rate Notice and Proposed Rule. These proposals impact MA in many ways, including changes to quality bonus payments, network adequacy requirements, coverage of End Stage Renal Disease (ESRD), plans targeting dual eligibles, and supplemental benefit offerings. Stakeholders should examine each of these areas closely as they respond to CMS.
Live Discharge Rates for Hospice Patients Vary by Diagnosis
Avalere’s analysis found that hospice patients diagnosed with cardiovascular and dementia conditions represent the largest proportion of “live discharges” compared to patients with other conditions.