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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Avalere Commentary on the 2020 National Vaccine Plan Featured in Health Affairs Blog
On December 16, Avalere policy experts, including Senior Adviser Dr. Angela Shen, published a piece in Health Affairs blog entitled “Shaping the 2020 National Vaccine Plan.” It explores the progress to date against the 2010 National Vaccine Plan (NVP), recurring challenges, and the 2020 NVP.
FDA Launches Global Platform of CURE ID Application
A new FDA resource is available to identify drug candidates for additional study and serve as a resource to shape medical decisions.
Adapting and Validating a Tool to Guide People with Stage III Non-Small Cell Lung Cancer
Avalere used a human-centered design approach to adapt a patient-centered tool to help patients prepare to make treatment decisions with their clinicians.
AI in Healthcare: 5 Areas in Which Artificial Intelligence Is Disrupting the Status Quo
The rapid expansion of artificial intelligence (AI) across healthcare holds the promise of dramatically altering not only diagnosis and treatment but also research, risk assessment, drug development, care management, and even insurance and payment systems.
USMCA Compromise Drops Key Biologics Exclusivity Provisions
The replacement to North American Free Trade Agreement (NAFTA), the United States-Mexico-Canada Agreement, was originally proposed to increase biologics exclusivity in Mexico and Canada to 10 years. As part of the Administration’s compromise with the House of Representatives, these provisions have been removed from the amended version that was recently agreed to by the US, Mexico, and Canada. While exclusivity in the US remains unchanged at 12 years, that it is not increased for Canada and Mexico may impact market entry for biologics ex-US.
The Evolving EHR: Information Systems Drive Improvements in Care Quality and Decision Making, But Work Remains
Electronic health record (EHR) platforms continue to accelerate the transformation of healthcare by streamlining access to patient records, improving clinical outcomes, and fostering better decision-making at the point of care.
Assessment of Regulatory Proposal to Eliminate the FFS Adjuster from Medicare Advantage Plan Audits
In a recent post on the RISE website, Sean Creighton examines the methodology and evidence behind CMS’s proposal to eliminate the Fee-for-Service (FFS) Adjuster from Risk Adjustment Data Validation (RADV) audit methodology.
An Opportunity for Remote Patient Monitoring as Part of Healthcare Delivery for Neurological Care
Remote patient monitoring (RPM) provides an opportunity to diagnose and treat patients facing neurological diseases. Given that multiple sclerosis (MS), Parkinson’s disease, and epilepsy require intervention from specialized care teams, effective management of these chronic neurological conditions can be supported through RPM to improve patient outcomes. Although RPM has been shown to be a complement and in some cases an alternative to office-based care, reimbursement and coverage barriers remain.
Medicare Advantage Plans May Be Paid Below Actual ESRD Patients’ Costs in Large Metropolitan Areas in 2021
Avalere analysis finds that payment to Medicare Advantage (MA) plans for end-stage renal disease (ESRD) patients in highly populated regions may be significantly below actual patient costs.
Avalere Presents First Real-World Evidence on Medicare Patients’ CAR-T Experiences at ASH Press Briefing
On Saturday, December 7, Karl Kilgore discussed “Medicare Patients Receiving Chimeric Antigen Receptor T-Cell Therapy for Non-Hodgkin Lymphoma: A First Real-World Look at Patient Characteristics, Healthcare Utilization and Costs” during a press briefing at the American Society of Hematology’s Annual Meeting.
Policy Issues, Part 1: Promoting Health by Addressing Food Insecurity
Various national and local health policies aim to address food insecurity through both healthcare and community-based programs.
Digital Health is Here to Stay—Get Engaged
With increasing legislative and regulatory activity promoting adoption of digital health, interest has continued to expand in 2019.
Immunization Implications in CY 2020 MPFS Final Rule
Two decisions finalized in the CY 2020 Medicare Physician Fee Schedule (MPFS) rule have important implications for vaccine policy and access.
Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020
Medicare Advantage (MA) plans continue expanding coverage of supplemental benefits following administration’s policy changes from a year ago.
More Practices Would Receive a Novel Therapy Adjustment in Medicare’s New Oncology Care First Model
New Avalere analysis finds that practices currently participating in the Oncology Care Model (OCM) would be more likely to receive a Novel Therapy Adjustment (NTA) in the newly proposed Oncology Care First (OCF) Model.
Affordable Patient Access to PCSK9 Inhibitors Remains Challenging Across Part D Plans in 2020
Avalere analysis finds that, despite substantial list price decreases across the PCSK9 inhibitor class, out-of-pocket costs for the majority of 2020 Part D beneficiaries remain significant
Where We Stand with Generic Drug Approvals and Authorized Generics
Patient access to high-quality, low-cost generic drugs continues to increase, due to a record number of generic approvals by the FDA in fiscal year 2019.
Policy and Market Access Trends in Kidney Care
A shifting policy landscape and emerging market forces could introduce significant disruption in the kidney care space in the coming years. Understanding the risks and opportunities that these changes may present will be critical for patients, providers, payers, and manufacturers alike.
2019 State Elections: What to Watch in Healthcare Policy
Healthcare policy remains a top priority for both voters and policymakers in 2019 and has been a key part of campaign platforms.
4 Things Hospital Executives Need to Know About Post-Acute Care
Despite the oft-repeated mantra that provider collaboration and care coordination are the bedrock of a more rational and cost-effective healthcare system, relationships between hospitals and post-acute care providers remain largely fragmented and uncoordinated.