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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Note on Avalere’s Recent Biosimilars Policy Modeling
Avalere was recently commissioned to project how policy proposals related to biosimilars would impact government spending and patient costs, including modeling and scoring analyses created for 3 proposals publicly released by the Biosimilars Forum in May 2019.
Identifying Payer and Provider Opportunities for Quality Measures Alignment
This past spring, Avalere and MITRE experts presented “Implementation of the Core Quality Measures Collaborative (CQMC) Core Measure Sets by Public Payers: Successes and Opportunities” at the Pharmacy Quality Alliance (PQA) annual meeting.
Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy
Avalere experts published a supplement in the June 2019 American Journal of Managed Care entitled “Ensuring Appropriate Access to Pulmonary Arterial Hypertension Therapy.”
Strategic Opportunities for Health Plans: 2020 and Beyond
Health plans today have a range of strategic opportunities that align well with emerging policy themes for 2020.
Avalere Publishes Viewpoint on Personalizing Value in Cancer Care
To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision-making by embedding shared decision-making (SDM) as a routine part of clinical practice.
Avalere Oversees Development of Care Referral Pathway for Inflammatory Bowel Disease
Avalere supports development of the Inflammatory Bowel Disease (IBD) Care Referral Pathway, which aims to coordinate care and optimize referral practices among different clinicians that treat patients with IBD.
More Medicare Beneficiaries Are Initiated on Direct Oral Anticoagulants According to a Recent Avalere Analysis
New Avalere analysis evaluates the trends in baseline patient characteristics among Medicare fee-for-service beneficiaries with stand-alone Part D coverage who initiated a direct oral anticoagulant during the period 2013–2017.
Over Half of Medicare Advantage Beneficiaries Enrolled in Plans that Require Step Therapy for New Starts of Part B RA Biologics in 2019
Avalere analysis of 1,375 Medicare Advantage plans’ 2019 medical benefit drug coverage policies finds that 672—covering approximately 14.3 million lives—apply step therapy to at least 1 of the rheumatoid arthritis biologic drugs covered under Medicare Part B in 2019.
Avalere Participates in Initiative to Advance the Identification and Management of Heart Valve Disease
In January 2018, Avalere Health partnered with the Society of Cardiovascular and Angiography Interventions to launch the development of the Heart Valve Initiative.
How to Account for the Full Impact of Social Determinants of Health in Medicare Advantage Plans
Avalere experts recently presented “Risk Adjusting Medicare Advantage Plan Performance Measures for Social Determinants of Health: Are Dual Eligibility and Disability Status Enough?” at the Academy Health 2019 Annual Research Meeting.
Transitioning RA Drugs from Part B to Part D Would Increase Catastrophic Benefit Fills
New Avalere analysis finds that shifting Part B-covered rheumatoid arthritis (RA) drugs to Part D benefit would increase the share of prescriptions occurring in the catastrophic phase for impacted beneficiaries by more than 5 times.
Avalere Analysis Examines Drug Spending in Medicare Part D
As policymakers increasingly consider policy options to reform Medicare Part D and reduce program expenditures, an Avalere analysis examines spending across classes with various availability of brand and generic drugs.
Get the Most Out of In-Home Assessments to Retain Members and Improve Health Outcomes
As health plans evaluate more efficient ways to engage and retain members, they should focus on existing high-touch points to improve healthcare access and the overall experience. Augmenting these efforts can generate more evidence-based patient management thus improving overall health outcomes.
Avalere and Other Scientific Leaders Publish Paper on Advances in Value Frameworks
Paper details recent developments in leading value frameworks, including Avalere’s Focus on Patient Orientation in Value Assessment.
Is Tiered Provider Reimbursement on the Horizon for Medicare Part B?
As policymakers explore opportunities to reform Medicare Part B, a tiered average sales price (ASP) add-on payment may be under consideration to align system incentives and curb spending.
Proposed Rebate Rule May Impact Commercial Coverage in Some States
While the Department of Health & Human Services (HHS) did not intend for proposed changes to Anti-Kickback Statute (AKS) regulations to impact commercial market drug negotiations, some state laws may indirectly lead to commercial market implications.
Avalere Releases Recommendations to Drive More Patient Orientation in Value Assessment Methodology
Avalere published a white paper outlining global recommendations to increase the patient centricity of value assessment framework methodology and application.
Avalere’s Vaccines Experts Featured in Health Affairs Blog
On May 24, Avalere policy experts published a piece on the Health Affairs blog highlighting opportunities to leverage quality measurement tied to payment to drive adult immunization uptake and achieve national population health targets.
Testing Proves Usefulness of Avalere Shared Decision-Making Tool to Women with Advanced Breast Cancer
In 2018, Avalere partnered with CancerCare and Gabrielle Rocque, an oncologist at the University of Alabama Birmingham School of Medicine, to develop the Preparation for Shared Decision Making (PFSDM) tool.
Medicare Advantage Plans Outperform Fee-For-Service Medicare in Caring for Dual-Eligible Beneficiaries with Chronic Conditions
Avalere experts will present “Comparing Utilization, Cost and Quality in Dual Eligible Medicare Advantage and Fee-For-Service Medicare Beneficiaries” at the International Society for Pharmacoeconomics and Outcomes Research meeting on May 21.