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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Congress’ 2018 Budget Includes Updates for Providers
On February 9, the Senate voted to pass the Bipartisan Budget Act of 2018, which funds the government through March 23, lifts spending caps for 2 years, and suspends the debt ceiling until March 2019.
Three Ways the FDA Can Facilitate Claims of Interchangeability
In the US, an interchangeability designation by the Food & Drug Administration (FDA) is perceived as the holy grail in biosimilars development by some and yet regarded as irrelevant by others.
Our Take on the President’s FY2019 Budget Proposal
Today, the Trump Administration released its budget for fiscal year 2019 (FY 2019).
Impact of Coverage Gap Discount Changes in Budget Agreement
Avalere experts provide their insights on what the impact of coverage gap discount changes in budget agreement.
BPCI Advanced Provides a Glimpse into the Future of Bundled Payments
Last month, the Centers for Medicare & Medicaid Services (CMS) released a Request for Application (RFA) for the Bundled Payment for Care Improvement (BPCI) Advanced initiative.
Our Take on the 2019 Advance Notice and Draft Call Letter
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Advance Notice and Call Letter (ANCL), describing the Agency's proposed 2019 payment policies and other policy updates for the upcoming plan year for Medicare Advantage (MA) and Part D plans.
BPCI Advanced: What Hospitals and Physicians Need to Know
With applications for the new Bundled Payment for Care Improvement (BPCI) Advanced initiative due on March 12, providers have a short window to act.
Payer Trends in Oncology
The shift from volume to value has played a significant role in shaping current payer behavior in the oncology space.
What Are Association Health Plans?
On January 4, the Department of Labor (DOL) issued a proposed rule to allow certain self-employed individuals, small businesses, and large businesses, including as part of a professional/trade organization or chamber of commerce, to band together to provide health insurance for their employees and their dependents.
2018 Healthcare Industry Outlook
2018 will bring change from all parts of the healthcare system.
Our Take on the BPCI Request for Application Announcement
The Centers for Medicare & Medicaid Services (CMS) have released a Request for Application (RFA) for the Bundled Payments for Care Improvement (BPCI) Advanced Initiative.
Gillian Woollett’s Research Published in BioDrugs
Gillian Wollett, Senior Vice President of Avalere’s FDA & Regulatory Policy team, recently published “A ‘Global Reference’ Comparator for Biosimilar Development” in BioDrugs.
Final 2018 Exchange Enrollment Numbers
At 100% of the OEP, we are at 96% of total Healthcare.gov enrollment compared to 2017 (8.8M n 2018 compared to 9.2M in 2017).
FDA Prepares for the Next Generation of Regenerative Medicines
In its new regulatory framework for regenerative medicines released in November 2017, FDA takes a flexible approach, creating opportunity for manufacturers.
Issue Brief: The Promise of Shared Decision-Making in Improving Value in the US Healthcare System
Evidence suggests that shared decision-making can play a role in advancing a value-based care delivery system.
Emerging Trends for Market Access Planning in 2018
Market access teams should consider 3 growing trends in their 2018 strategic planning.
Our Take on the Final QPP Rule
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes changes to the second year of the Quality Payment Program (QPP) for 2018. The QPP was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Our Take on the NBPP Proposed Rule
This past Friday, the Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
Impact Evaluation: Medicare Advantage Transition from RAPS to EDS
In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
Vaccine Coverage Requirements Vary by Market
Avalere has released a new white paper explaining the current insurance coverage requirements for vaccines and the laws that govern those requirements for the Medicare (Parts B and D), Medicaid, and commercial (group and individual) markets.