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
CMS Announces Successful ICD-10 Testing Week
On May 30, CMS released results from the March week of ICD-10 acknowledgement testing.
Avalere Analysis: Cost-Sharing Reductions Unevenly Applied Across Services in Exchange Plans
A new analysis from Avalere Health finds that consumers in exchanges receiving federal assistance to reduce their out-of-pocket costs may experience inconsistent reductions in spending depending on the plan they choose.
Poster Presentations for Avalere at AcademyHealth
Avalere’s experts will be presenting several posters at AcademyHealth’s Annual Research Meeting in San Diego.
District Court Strikes Down 340B Orphan Drug Rule Concluding that HRSA Does Not Have Necessary Rulemaking Authority
On May 23, the U.S. District Court for the District of Columbia issued a decision striking down the 340B orphan drug rule that was finalized by the Health Services and Resources Administration (HRSA) in July 2013 and took effect Oct. 1, 2013.
Successful Value-Based Purchasing Strategies for Today’s PAC Providers
In this month's edition of McKnight's Long Term Care News & Assisted Living, Avalere's Sally Rodriguez wrote a guest blog discussing value-based payment strategies for post-acute care (PAC) providers, given the Affordable Care Act's (ACA) current focus on value over volume.
Final Medicare Advantage and Part D Rule Significantly Scales Back Proposed Policies
On May 19, CMS released the Final Rule on policy changes to the Medicare Advantage (MA) and Medicare Part D programs for Contract Year (CY) 2015.
Avalere Analysis: Low Premium Carriers Expected to Gain 2014 Market Share in Exchanges
A new analysis from Avalere Health finds that individuals choosing an exchange plan based on premiums are most likely to consider plans from Coventry (acquired by Aetna in 2013), Humana, and WellPoint in regions where they participate.
HHS Releases Exchange and Insurance Market Standards for 2015 and Beyond Final Rule, Finalizing Most Provisions as Proposed
On May 16, HHS released the final Exchange and Insurance Market Standards for 2015 and Beyond rule.
Exploring Pharmacists’ Role in a Changing Healthcare Environment
More and more, pharmacists are forging expanded roles in healthcare delivery to ensure optimal drug therapy and improve patient outcomes.
CMS Proposes to Cover TMVR under CED
On May 14, CMS released a proposed national coverage determination (NCD) for Transcatheter Mitral Valve Repair (TMVR), and proposed to cover TMVR under its Coverage with Evidence Development (CED) program.
FDA Releases Draft Guidance for Clinical Pharmacology Data to Support a Demonstration of Biosimilarity to a Reference Product
On May 13, FDA released a draft guidance describing the clinical pharmacology data needed to support a demonstration of biosimilarity to a reference product.
Data and Social Media Working Together
On April 9, HHS made public CMS reimbursement data for 880,000 Medicare providers for the first time in the Agency's history; but the bigger story was the social media response that followed.
Three of the Largest Payers Will Give Consumers Free Access to Healthcare Prices Beginning in 2015
On May 14, the Health Care Cost Institute (HCCI) announced that it will work with Aetna, Humana and, UnitedHealthcare to provide consumers free access to an online tool that displays information about the price and quality of healthcare services beginning in 2015.
Avalere Medicaid Expansion Map – May 2014
As of May 15, 2014, 28 states and D.C. are expanding Medicaid eligibility.
States Propose “Right to Try” Bills Allowing Physician Prescribing of Investigational Drugs for Terminally Ill Patients
At least four states -- Arizona, Colorado, Louisiana and Missouri -- have recently proposed bills that would allow physicians to prescribe investigational drugs, biologics or devices to eligible terminally ill patients.
Striking a Balance Between Affordability and Generosity
2014 has accomplished a great deal in terms of patient access, with the establishment of the exchange plans and the exchange market.
Avalere Analysis: Medicaid Non-Expansion States Experience Up to 10% Enrollment Growth Due to Woodwork Effect
Over 550K New Medicaid Enrollees Gained Coverage in Non-Expansion States in First Quarter.
ASCO Releases New Oncology Payment Methodology Framework
On May 5, the American Society of Clinical Oncology (ASCO) released a novel methodology for physician payment for cancer care services under Medicare.
Continued Innovation in the Era of Industry Consolidation
Pharmaceutical companies are facing multiple challenges in the constantly evolving healthcare landscape.
Avalere Analysis on Exchange Enrollment Data
Last week, the Department of Health and Human Services (HHS) announced that 8 million people enrolled in exchanges nationwide.