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 Analysis: Exchange Enrollment Outpaces Expectations in 22 States
Analysis assumes 85 percent of enrollees pay first month's premium.
Dialogue Proceedings: Measuring the Quality of Malnutrition Care
Malnutrition is a leading cause of morbidity and mortality, especially among the elderly.
CMS Releases FY 2015 IPPS Proposed Rule: Policies Continue to Focus on Modifying Payment Due to Quality Improvement
On April 30, CMS released the Fiscal Year (FY) 2015 Inpatient Prospective Payment Systems (IPPS) proposed rule.
CMS Creates a Special Enrollment Period for Individuals Losing Coverage Through the Pre-Existing Condition Insurance Program
On April 24, CMS announced a Special Enrollment Period (SEP) for individuals losing coverage through the Pre-Existing Condition Insurance Program (PCIP).
Avalere Analysis: Exchange Consumer Experience
Study finds lack of transparency on drug coverage in exchanges, but better data on provider networks.
Avalere Health Launches Center for Payment & Delivery Innovation™
New center will combine data, analytics, advisory services and research for all U.S. healthcare stakeholders to adapt to new payment and delivery models.
Study Finds that Two-Thirds of Beneficiaries in Medicare ACOs Received Outpatient Specialty Care from Providers Outside Their ACO
On April 21, the Journal of the American Medical Association (JAMA) published a study about beneficiary assignment and leakage in the two Medicare ACO programs, the Pioneer program and Medicare Shared Savings Program (MSSP).
Managing Access to Pseudoephedrine: Potential Impacts of a Prescription-Only Policy versus Real-Time Stop Sale Technology
This April, Avalere experts finalized a paper surrounding the policy issues of control, access and usage for products containing pseudophedrine (PSE).
CMS’ Final Notice Keeps Pressure on Medicare Advantage Payments
In this week's edition of McKnight's Long-Term Care News & Assisted Living, Avalere's Jennifer Rak wrote a guest blog piece on the effects of the recently released Final Medicare Advantage (MA) Rates.
OIG Finds Lowering HOPD Payment Rates to ASC Level for ASC-Approved Procedures Could Save Medicare and Beneficiaries Billions of Dollars
On April 17, the HHS Office of Inspector General (OIG) released a report evaluating the impact on total Medicare expenditures of the payment differential between hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs).
CMMI Releases Revised ESRD Seamless Care Organization RFA, In Attempt to Further Stimulate Provider Participation
On April 15, CMS released a revised version of the ESRD Seamless Care Organizations (ESCOs) Request for Application (RFA).
Bundled Payment and the Strategy Behind PAC Provider BPCI Participation
In this week's edition of McKnight's Long-Term Care News & Assisted Living, Avalere's Brian Fuller wrote a guest post discussing the merits behind PAC provider bundling.
CBO and JCT Revise Health Reform Enrollment and Cost Estimates, Scale Back Medicaid Enrollment for 2014 and Premium Increases for 2015
On April 14, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released updated estimates on health insurance coverage provided through the ACA.
United Healthcare (UHC) Retracts its Proposed Policy to Block the Use of Manufacturer-Provided Retail Copay Coupons
On April 11, UHC announced that they will no longer implement their policy to ban the use of manufacturer-provided retail copay coupons.
WHO Publishes Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection
On April 9, the World Health Organization (WHO) issued its first guidance for the treatment of hepatitis C infection (HCV).
In Continuous Effort to Make Medicare More Transparent, CMS Releases Dataset with Information on More than 880,000 Unique Providers
On April 9, CMS released cost and utilization data on services provided to Medicare fee-for-service (FFS) beneficiaries by physicians and other healthcare professionals in calendar year (CY) 2012.
Express Scripts Data Provides Early Look at Exchange Enrollee Drug Utilization
On April 9, pharmacy benefit manager (PBM) Express Scripts released a report highlighting prescription drug utilization by enrollees in new exchange plans.
Downward Pressure on Medicare Advantage Payment Continues in Final Rate Notice
On April 7, CMS finalized their Calendar Year (CY) 2015 capitation rates, methodological changes to rates and risk models, and other payment and program policies for Medicare Advantage (MA) and Part D plans.
ACC/AHA Publishes Methodology Statement on How to Incorporate Cost/Value Information in Clinical Guidelines
On March 27, the American College of Cardiology (ACC)/ American Heart Association (AHA) announced that they will begin to include cost and value information in their guidelines recommendations, while simultaneously publishing a methodology statement on how guideline writing committees should incorporate this information.
Limited Data Does Not Preclude Payer Coverage – Humanitarian Device Exemptions: A Case Study
An Avalere Health study commissioned by The Pew Charitable Trusts examined how payers cover medical devices that come to market and what role the extent of evidence generated to seek FDA approval impacts downstream coverage and payment for these devices.