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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CMS Finalizes Modified Medicare Advantage and Part D Changes
On May 16, the Centers for Medicare & Medicaid Services (CMS) released its final rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.
Avalere Commentary on Vague Vaccine Recommendations Featured in Health Affairs Blog
On May 7, Avalere policy experts published a piece in the Health Affairs blog about the Advisory Committee on Immunization Practices (ACIP) recommendations, and how they may be leading to provider practice confusion and potential access barriers for patients.
Care Pathways Offer an Opportunity to Improve Care Through Evidence-Based Practices
Care pathways can help providers make evidence-based decisions about where to focus care improvement efforts.
Administration Seeks Input on Federal STD Prevention and Treatment Initiative
On May 3, the Office of HIV/AIDS and Infectious Disease Policy, in partnership with other Department of Health and Human Services agencies, released a request for information (RFI) from stakeholders on strategies for the development of a Sexually Transmitted Diseases (STDs) Federal Action Plan, an initiative designed to address the domestic STD public health epidemic.
Avalere Partners with Leading Health Care Foundation, Provider Associations, and Advocacy Groups to Improve Conversations About Costs Between Patients and Clinicians
A supplement to Annals was just published that includes research on how to help physicians talk with their patients about costs of care, including a commentary co-authored with Avalere.
What Will Drive SNF Profitability Under the New Patient-Driven Payment Model?
Liz Moore recently sat down with Fred Bentley, managing director, to talk about the Patient-Driven Payment Model (PDPM) and how it may impact skilled nursing facility (SNF) profitability. Check out the interview below.
The Growing Presence of Pharmaceutical-Backed Corporate Venture Capital in Digital Health
As technology comes to the forefront in healthcare innovation, the venture capital arms of many pharmaceutical companies are solidifying their presence as key investors.
Enhancing Manufacturer Partnerships in an Evolving Specialty Landscape
Recent developments in the specialty pharmaceutical marketplace merit distinct attention from manufacturers.
2020 Implementation of Rebate Rule Could Create Uncertainties for Part D Plans
On April 5, CMS issued guidance announcing a voluntary, 2-year demonstration that would modify the Part D risk corridors if the proposed rule to revise the Anti-Kickback Statute safe harbors is effective for 2020.
Issue of Part D Cost Sharing for Preventive Services Arises at Senate Drug Pricing Hearing
An April 9 hearing before the Senate Finance Committee entitled “Drug Pricing in America: A Prescription for Change” included discussion related to cost-sharing for preventive services in the Medicare Part D.
CMS Announces 5 New Advanced Primary Care Payment Models
The CMS announced the new CMS Primary Cares Initiative, comprising 5 new payment models under 2 programs, which will test the impact of providing considerable financial incentives and flexibility to primary care practices and organizations in exchange for significant provider risk.
Bringing Real Innovation to Medicare
The Centers for Medicare & Medicaid Services (CMS) is currently reviewing a new payment rule, which could impact coverage of innovative procedures like transcatheter aortic valve replacement for the treatment of severe aortic stenosis.
CMS Grants Flexibility to Counter Drug Manufacturers’ Coupons
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2020 plan year. This annual rule, released today, updates guidance and regulations related to exchanges as well as the broader individual, small group, and large group insurance markets.
A Review of the New Medicare App: The Role of Patient Engagement and Digital Health
The Centers for Medicare & Medicaid Services (CMS) is embracing digital health and virtual care in many ways.
Avalere Commentary on HIV Prevention Policy Featured in Health Affairs Blog
On April 9, Avalere policy experts published a piece in the Health Affairs blog about the administration’s recently launched “Ending the HIV Epidemic: A Plan for America” initiative.
Comparing the Effectiveness of New Versus Established Multiple Sclerosis Therapies in the Managed Medicaid Population
Avalere experts recently presented their research, “Comparison of Healthcare Utilization Among Managed Medicaid Individuals Diagnosed with Multiple Sclerosis Treated with Emergent vs. Established Disease-Modifying Therapy in the US.”
US Healthcare Spending Projected to Grow 5.5% Annually Through 2027
Healthcare spending is expected to represent 19.4% of US GDP in 2027.
Avalere Research and Expertise to be Featured at AMCP and ISPOR Conferences
In the coming months, Avalere experts will be presenting new data and research at major conferences, featuring insights derived from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®).
Understanding the Combined Effects of Drug-Pricing Reforms
The interaction of recently announced drug pricing reforms will have differential implications for stakeholders.
Vaccine Exemptions and the Federal Government’s Role
With the number of measles cases rising across the country, FDA Commissioner Scott Gottlieb raised the prospect of federal intervention over exemptions to state-level immunization school-entry requirements. While not specifying what role the federal government would play, Gottlieb stated, “You could mandate certain rules about what is and isn’t permissible when it comes to allowing people to have exemptions.”