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.
Featured Content
Premium Content
Premium Content
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.
New Opioid Law Takes Broad Aim at Opioid Crisis
The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law on October 24, 2018, takes aim at the opioid crisis from multiple angles.
Avalere Partners with Leading Providers and Advocacy Groups to Chart Course for SDM in Cancer Care
Despite recognition that providers should implement shared decision making (SDM) as standard practice, integration of SDM into regular care delivery remains elusive.
Hospital Willingness to Assume Risk Growing
The majority of hospitals in BPCI Advanced, the second iteration of CMS’ largest bunded payment initiative, have no prior experience with risk in the original BPCI program.
Access to Abuse-Deterrent Opioid Formulations Tied to Reduced Risk of Opioid Abuse and Overdose
New Avalere research finds that health plan members enrolled in plans that cover abuse-deterrent formulations (ADFs) of opioids have a lower risk of opioid abuse (OA) and overdose (OD) and lower opioid abuse-related hospitalizations than people in plans that do not offer coverage of ADF opioids.
Trends in Opioid Use: History, Background, and Origins of the Epidemic
Shift in clinical practice as far back as 30 years ago planted the seeds for the current opioid epidemic. New research by Avalere Health finds that between the mid-1980s and 1990s, individual pharmaceutical manufacturers, national scientific bodies, and professional societies began a push to treat pain more aggressively.
Summary: What’s on the Horizon for US Drug Pricing Policy in 2019 and Beyond?
On October 25, Avalere experts came together to discuss the latest policy developments related to drugs.
Alternative Financing Models for Durable Cures
Transformative medicines, like gene and cell therapies, are beginning to be approved in the US, and more are expected to come.
The Data Behind Social Determinants of Health Research
New Avalere study entitled “Using Aggregate Data to Proxy Individual-Level Socioeconomic Characteristics in Research on Medication Adherence: 9-Digit ZIP Code vs. Census Block Group” selected for the AMCP Foundation Best Poster Award at AMCP Nexus 2018.
CMS HCC Risk Adjustment Model 2019: Winners & Losers
Our analysis finds there will be winners and losers at the plan level under the new models.
Avalere Observations: 2018 Election Cycle and the Outlook for Health Policy
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
CMS 2019 Star Ratings Remain Stable for MA-PD Plans, Shift for PDPs
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
Multidisciplinary Workgroup Publishes Appropriate Use Criteria for LP and CSF Testing for the Diagnosis of Alzheimer’s Disease
Today, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association published appropriate use criteria (AUC) to guide the use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis for use in the diagnosis of Alzheimer’s disease.
California Becomes the 6th State to Restrict Short-Term Plans in 2018
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.