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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Dan Mendelson Talks to NPR About Aetna’s $37 Billion Deal to Buy Rival Humana
The health insurance company Aetna announced Friday it will buy rival Humana for $37 billion. The merger comes as other health insurers consider consolidating to cut costs. Read NPR's interview with our founder, Dan Mendelson.
Improving Obstacles to Quality Patient Care Increases Medication Adherence and Reduces Avoidable Healthcare Spending
Avalere recently partnered with Third Way to estimate the cost savings of increasing medication adherence among Medicare beneficiaries by improving and expanding the current Part D Medication Therapy Management (MTM) program to target and address adherence issues for specific conditions.
VA National Formulary Covers 16 Percent Fewer Top Prescription Drugs than Medicare Part D Plans
New Avalere analysis finds that the VA National Formulary covers 163 of the top 200 most prescribed Medicare Part D drugs, compared to an average of 191 drugs for Medicare prescription drug plans (PDPs) and 194 drugs for Medicare Advantage prescription drug plans (MA-PDs).
Do CMS Measures Measure Up?
Recently, Avalere presented on the issue of quality measures and clinical practice guidelines at Academy Health. We sat down with one of the researchers, Avalere's Minnie Song, to discuss this research.
Consumer Premium Contributions to Increase $3,300 on Average in 2015 if Supreme Court Rules for King; 6.4 Million Current Enrollees Could Be Impacted by Loss of Subsidies
Consumers could face average annual premium contribution increases of $3,300 in 2015, if the Supreme Court rules tax credits are illegal in states with a federal exchange, according to new analysis from Avalere.1
The Spectrum of Accountability and Alternative Definitions of Alternative Payment Models
Secretary Burwell set the healthcare community abuzz January 26 when she announced the Department of Health and Human Services' (HHS) plan to set 30 percent of fee-for-service payments to alternative payment models (APMs) by 2016 and 50 percent by 2018.
Business Education for Healthcare Innovation
The healthcare delivery system is one of the most complex businesses in the country.
FDA and Sponsors Discuss Quality Challenges in the Breakthrough Therapy Pathway
Need to Know: On June 10, Friends of Cancer Research held a public meeting to discuss how sponsors and FDA may be able to expedite rate-limiting steps in Chemistry, Manufacturing, and Controls (CMC) and current Good Manufacturing Practices (cGMPs) for breakthrough therapy designated products, while ensuring an adequate supply of safe and efficacious product at the time of approval.
Lowest-Cost Exchange Premiums Remain Competitive in 2016; Consumers may be able to keep increases small by selecting a low-cost silver option
A new analysis from Avalere finds wide geographic variation in 2016 premium increases for individual market exchange plans, based on proposed rate filings in eight states where complete data is available.
Avalere White Paper: Hospital Acquisitions of Physician Practices and the 340B Program
Avalere recently researched the relationship between hospital participation in the 340B program and the recent trend of hospitals acquiring physician practices.
An Analysis of the Impact of Breakthrough Therapies on Government Spending
To evaluate public program spending on new medications in the drug development pipeline, Avalere projected the fiscal impact of 10 FDA breakthrough therapies to Medicare, Medicaid, and the health insurance exchanges created by the Affordable Care Act (ACA).
Quality Measures and Cancer Care: What You Should Know
Cancer is a burden to patients and the healthcare system. Last year, an estimated 1.6 million new cancer cases were diagnosed in the U.S and the latest figures estimate that 13.4 million people, about 4 percent of the U.S. population, live with cancer in the U.S.1
Patient Engagement: The Do-or-Die of Growing Alternative Payment Models
Avalere analyses show that more than 700 ACOs already operate in the U.S.
Upcoming Managed Care Regulation Will Impact Plans Serving 46M Medicaid Beneficiaries
Over the past four years, enrollment in Medicaid managed care has increased by 48 percent, with 46 million beneficiaries now receiving coverage through these plans. The government will soon update regulations that direct the plans providing this coverage.
Clarity on How Pharmaceutical Companies Can Communicate Data Could Spur Investment in Evidence Generation
New research from Avalere Health finds that 86% of pharmaceutical companies would invest more in studies to support the development of healthcare economic information if provided additional guidance on their ability to use this evidence with external audiences.
What’s on the Horizon for Bundled Payments?
We recently sat down Brian Fuller to discuss the latest developments that are occurring with risk models and bundled payments.
Spotlight On: Patient Engagement
Earlier this week, BioCentury featured guest commentary from Tanisha Carino and Reginald Williams about patient engagement.
Updated Breast Cancer Screening Recommendation Could Eliminate Guaranteed Coverage of Mammography for 17M Women
A new analysis from Avalere finds that 17 million women ages 40 to 49 could lose their guarantee of mammogram coverage, if new breast cancer screening guidelines from the United States Preventive Services Task Force (USPSTF) are finalized.
Better Shop Around: Out-of-Pocket Prescription Drug Costs in Covered California Plans
A new report by Avalere Health published by the California HealthCare Foundation
Focus on Value: Performance Contracting
Given the rapid evolution of the healthcare marketplace and increasing focus on delivery of value-based care, healthcare stakeholders across the spectrum are focused on appropriately managing risk.