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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Five Key Principles for Maximizing Value in the Healthcare System
A new report examines the scientific evidence regarding how new payment models and interventions are helping to shift the healthcare system from one that rewards volume to one that rewards value.
UHC Announces Coverage of Video Provider Consultations
Recently, United Healthcare (UHC) announced that it will now cover video consultations from three platforms: Doctor on Demand™, American Well's Amwell™, and Optum's NowClinic®.
What You Need to Know about the Pioneer ACO Announcement
This past Monday, CMS announced the findings of a recent analysis which found that $384 million was saved over the first two years in the Pioneer ACO program. Most of the savings was accrued in the first performance year, totaling $279.7 million.
Individual Mandate Penalty May Be Too Low to Attract Middle-Income Individuals to Enroll in Exchanges
A new analysis from Avalere finds that the penalties associated with the individual mandate, which grow in 2015, might be too low to attract enrollment, particularly among middle-income, healthy individuals.
Leading Cancer Centers May Be More Widely Included in Exchange Networks than Expected
A new survey conducted by Avalere and the National Comprehensive Cancer Network® (NCCN®) shows that exchange plan participation by the nation's leading cancer centers is highly varied, but may be better than initial 2014 reports suggested.
Stakeholder Input in the Harmonization of U.S. and Canadian Drug Development Regulations
On April 13, the Federal Register announced a public meeting entitled "Preparations for International Conference on Harmonization Steering Committee and Expert Working Group Meetings in Fukuoka, Japan."
State-Based Exchanges Saw Higher Attrition from 2014 to 2015 Than Federally-Facilitated Exchanges
Exchanges run by the federal government both retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than states that run their own exchanges, according to a new Avalere analysis.
New Trends and Analysis for ACO Participants
The recent addition of 89 Accountable Care Organizations (ACOs) to the Medicare Shared Savings Program (MSSP) coupled with HHS' January announcement on transitions to value-based care highlight payment and delivery innovation's gathering momentum in federal health reform.
Access Avalere’s Latest Research on Brand-Name Prescription Drug Spending
Avalere released its latest report today, which highlights current brand-name prescription drug spending and projections for federal healthcare programs (Medicare, Medicaid, TRICARE and VA).
Insider’s Take on This Week’s MEDCAC Panel
We recently sat down for a Q&A with Avalere Director and MEDCAC panelist, Dr. Lakshman Ramamurthy, to get his take on the MEDCAC panel that happened earlier this week. Here's what he had to share.
Exchanges Struggle to Enroll Consumers as Income Increases
New analysis from Avalere finds that while exchanges have succeeded in enrolling very low-income individuals, they continue to struggle to attract middle and higher income enrollees.
New Avalere Analysis Examines the Unintended Consequences of “Hold Harmless” Rules in New Jersey
A new Avalere analysis finds that New Jersey's "hold harmless" regulations that apply when health plan members involuntarily use out-of network (OON) providers may not protect consumers as intended and, instead, have the unintended consequence of driving up healthcare spending in the state.
Sixty Percent of Medicare Advantage Enrollees Now in Plans with Four or More Stars
New analysis from Avalere finds that the proportion of Medicare Advantage (MA) beneficiaries enrolled in plans with 4 or more stars climbed from 38 percent in 2014 to 60 percent in 2015.
Listen In: QMN Webinar Archive
Missed our webinar on Tuesday?
Discussion Aids Reduce Spending and Improve Patient Outcomes for Medicare Beneficiaries
Avalere recently partnered with Third Way to estimate the cost savings of advancing the use of medical decision aids for Medicare beneficiaries, which would allow for shared decision-making between physicians and patients in preference-sensitive care.
Recap: Pharmacy Quality Alliance’s February 2015 Quality Forum
Avalere Health led the Pharmacy Quality Alliance's February 2015 Quality Forum Lecture entitled: A Look Ahead at 2015.
Avalere Observations: Impact of King v. Burwell & Potential Fixes
Today, the U.S. Supreme Court will consider whether it is legal for consumers in states with a federal exchange to receive tax credits to subsidize monthly premiums for plans purchased through the exchange.
Lessons Learned from Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract as HHS Explores Different Payment Models
As healthcare leaders and policymakers look to curb spending and improve quality, they should examine models like the Alternative Quality Contract (AQC), according to a new paper by Avalere.
Nearly 7.5 Million Consumers Could Face Premium Increases as a Result of Supreme Court King v. Burwell Ruling
Majority of affected enrollees would be exempt from individual mandate
California Exchange Formularies Offer Broad Coverage for Commonly Used Drugs
In a new analysis published by the California HealthCare Foundation, Avalere researchers found that Covered California plans provided comprehensive access to the most commonly used drugs.