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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Uses and Limitations of Medicare Advantage Encounter Data
In a recent post on the Health Affairs Blog, we examine the potential uses and limitations of Medicare Advantage (MA) encounter data.
CMS’s Annual Quality Conference Underscores Key Quality Improvement Priorities
In early February, Avalere attended the annual Centers for Medicare & Medicaid Services (CMS) Quality Conference, an annual gathering that brings stakeholders together to address challenges in healthcare quality improvement and discuss ways to spread these solutions locally and nationally.
Drug Rebate Proposal Fundamentally Changes Current System, Raises Critical Questions
The swift proposed implementation timeline will require stakeholders to evaluate quickly operational requirements, behavioral responses, cross-program implications, and impact on contractual arrangements.
ACIP Recommendations Shift Pneumococcal Vaccination Patterns
New research from Avalere finds that the provision of pneumococcal conjugate vaccines increased immediately after ACIP’s 2014 recommendation to add the vaccine to the routine immunization schedule for older adults.
Opportunities for Real-World Data Will Grow as Big Tech Embraces Healthcare Partnerships
Partnerships between traditional healthcare players and big technology companies seek to improve care delivery and patient outcomes in innovative ways.
Next Generation ACOs Outperform 2-Sided MSSP ACO Counterparts
ACO Experience Again Proves to Be an Indicator of Success
Avalere Launches Podcast Series for Clinicians on How to Talk to Patients About Costs of Care
In February, Avalere is releasing a 4-part podcast series that focuses on how clinicians and other care team members can improve the quality and frequency of cost-of-care conversations with patients.
Are Health Plans the Future of Public Health?
The transition from old-guard payer to wellness company is underway–and moving rapidly.
Drug Importation Proposals Gain Traction but Raise Cost and Operational Questions
The costs of ensuring the safety and efficacy of imported drugs and preventing the entry of counterfeit products are among the many factors that must be weighed against any potential savings from a drug importation program.
Landscape for Diagnostics Will Continue to Change in 2019
While precision medicine is expected to revolutionize patient therapy, the increasing complexity of diagnostics is leading policymakers to revamp the way these tests are regulated and paid for.
Emerging Influenza Vaccine Technologies Stand to Improve Vaccination Rates
Nearly 80,000 people died during the 2017–2018 influenza season. Only 37% of adults were vaccinated. Several novel emerging products could make vaccination more accessible and effective, potentially reshaping the market and lowering influenza disease burden.
International Price Index Model’s Impact on Patients and Providers
New Avalere analysis finds that most seniors in Medicare would not see a reduction in their out-of-pocket costs as a result of the International Price Index Model.
Lack of Clarity on Preventive Services Recommendations May Create Access Barriers
Ambiguous recommendations for preventive services are causing confusion among plans and providers on the clinically recommended preventive services that should be covered without cost sharing. A recent USPSTF recommendation on HIV prevention offers an opportunity to urge a recommending body to provide further clarity in its recommendation. Comments are due December 26.
New HRA Rule Could Reshape Enrollment and Access in Individual and Employer Markets
A proposed rule released by the Treasury Department, Department of Labor, and Department of Health and Human Services would expand the allowed uses of employer-sponsored Health Reimbursement Arrangements (HRA). Comments on the rule can be submitted until December 28, 2018.
Avalere Joins Core Quality Measures Collaborative
Avalere is excited to join the CQMC as quality measurement experts in an effort to further inform a discussion focused on core measure sets to assess the quality of American healthcare.
Adopting Patient-Reported Outcomes in Clinical Care
To better understand key motivations and barriers to using PROs in clinical care, Avalere conducted a literature review, identified existing PRO-PMs in use by payers through our proprietary quality measures database, and conducted interviews with early adopters of PROs. In this paper, we provide our findings and recommendations for next steps.
Out-of-Pocket Costs for Oncology Drugs Vary Substantially Between Employer and Non-Employer Based Part D Plans
New Avalere analysis finds that beneficiaries enrolled in Employer Group Waiver Plans (EGWPs) have lower out-of-pocket (OOP) costs for select drugs than beneficiaries enrolled in other types of Part D plans.
Post-Election, Part B Drug Reform Is Likely to Advance
Avalere analysis finds that most of the payment reductions from the proposed International Pricing Index Model for Part B drugs would affect oncologists, rheumatologists, and ophthalmologists.
Actionable Resources to Facilitate Cost Conversations Between Patients and Clinicians
As part of the Robert Wood Johnson Foundation Cost Conversation projects, Avalere led the development of a set of practice briefs that provide actionable resources to healthcare providers about how to improve the value and frequency of cost conversations with patients.
Patients Use Generics More Frequently than Brands in Medicare’s Protected Drug Classes
New Avalere research finds high utilization of generic medications in the 6 protected drug classes under Part D.