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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Avalere & the SCAN Foundation Release Person-Centered Care Roadmap
On October 29, Avalere Health and The SCAN Foundation released a roadmap on person-centered care sustainability, offering organizations specific examples of person-centered care models leading towards short and long-term savings.
Avalere Analysis: 2014 Governors’ Races Could Lead to More Medicaid Expansion
In at least six states, Medicaid programs could be expanded as a result of the outcome of the 2014 governors' races.
Avalere Medicaid Expansion Map – October 2014
As of October 28, 2014, 28 states and D.C. have decided to expand Medicaid eligibility; more may expand next year.
JAMA Study Shows Drug Labels Rarely Demonstrate Clinical Utility
On October 13, JAMA Internal Medicine published a study on the available clinical validity and clinical utility of pharmacogenomic information included in drug labels.
Avalere Analysis: Medicaid Managed Care Enrollment Set to Grow by 13.5 Million
A new analysis from Avalere Health projects that enrollment of Medicaid and Children's Health Insurance Program (CHIP) beneficiaries in managed care - i.e., state payment of private companies to provide benefits - will increase by 13.5 million individuals from 2013 to 2016.
Part D Formulary Data Reveals Continued Shift to Coinsurance by Plans, With All PDPs Designating a Specialty Tier in 2015
On Oct. 8, the Centers for Medicare & Medicaid Services (CMS) posted detailed information regarding formulary structures, drug coverage, cost-sharing amounts, and utilization management (UM) trends across standalone Medicare prescription drug plans (PDPs) for the 2015 benefit year.
8.7 M Additional Medicaid Beneficiaries Enrolled as a Result of the Affordable Care Act
On Oct. 17, the Centers for Medicare & Medicaid Services (CMS) released their most recent report detailing Medicaid enrollment attributable to the Affordable Care Act (ACA).
Avalere Health Releases Enhanced Recovery White Paper
"On June 10, 2014, the Center for Medical Technology Policy (CMTP) in collaboration with Avalere Health hosted a multi-stakeholder forum in Baltimore, Maryland, to discuss potential challenges and opportunities to accelerate the adoption of enhanced recovery protocols (ERPs) in the U.S.
CMS Report Shows Medicare Advantage Plan Performance and Quality Continue to Improve
On Friday, the Centers for Medicare & Medicaid Services (CMS) released data on Medicare Advantage (MA) plan performance and quality.
EMA Posts Final Decision on Clinical Trial Data Transparency
After a year and a half of discussion, revisions and more than 1,000 various stakeholder comments, the European Medicines Agency (EMA) just announced its final decision on clinical trial data transparency.
Barriers to the Implementation of Patient-Reported Outcome Based Performance Measures for Assessing Quality
The pressure to constrain healthcare costs, maximize clinical quality and improve patient experience has stimulated new approaches to measuring value, and places greater focus on the use of patient-reported outcome (PRO) based performance measures.
Avalere Analysis finds In-Network Coverage of Select CSCs and Affiliated Specialty Physicians Highly Variable
A new analysis by Avalere Health, sponsored by the American Heart Association, examined the extent to which qualified health plans (QHPs) offered on the health insurance exchanges included selected comprehensive stroke centers (CSCs) and certain affiliated cardiologists, neurologists and diagnostic radiologists in their provider networks.
Avalere Issues White Paper on the Management of High-Risk Medicare Populations in Partnership with The SCAN Foundation
New Avalere research for The SCAN Foundation demonstrates the ROI potential of well-targeted care coordination programs supported by robust data.
HHS Report Finds Carrier Participation in Exchanges Will Grow 25 Percent
On September 23, HHS released a new report that finds the number of issuers participating in the 2015 exchange market will grow by 25 percent when compared to 2014.
Unique Device Identification (UDI) – 10 Things You Need to Know
Here is a list of ten things one must know about Unique Device Identification (UDI).
Avalere Analysis Finds Exchange Coverage of Drugs Used to Treat Patients with Rare Diseases Varies
A new analysis from Avalere Health, published today in the "Journal of Managed Care & Specialty Pharmacy," examined exchange coverage rates of 11 drugs used to treat rare diseases and found that plans in the exchange cover these drugs 65 percent of the time on average across plans, although coverage varies widely by product and metal level.
Avalere Analysis Reveals Significant Consolidation Among PDPs
According to a new Avalere Health analysis of the Centers for Medicare & Medicaid Services' (CMS) Landscape Files for 2015, the number of Part D standalone prescription drug plans (PDPs) will shrink by about 14 percent, from 1,169 in 2014 to 1,001 in 2015.
Exchange Enrollment Down to 7.3M
On Sept. 18, the Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner told Congress that there are currently 7.3 million people enrolled in health insurance plans on the exchanges.
ACO Performance Results Demonstrate Savings to Medicare, Minimal Savings to Individual ACOs
On Sept. 16, CMS released aggregate financial and quality results from Performance Year (PY) 2 of the Pioneer program and PY1 of the Medicare Shared Savings Program (MSSP).
CMS Medicare Landscape Files: Attention Focused on MA Plan Participation; Low-Cost PDPs Poised To Compete
The Centers for Medicare & Medicaid Services (CMS) is expected to release landscape files containing data on plan participation, premiums, and benefit designs for the 2015 Medicare Part D and Medicare Advantage (MA) markets.