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
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.
In Developing Strategic Framework for HIT Regulation, HHS Continues to Focus on HIT Functionality
On April 3, HHS released a draft report with proposed strategies and recommendations for health information technology (HIT) regulation.
Avalere Analysis: Ten States Driving New Medicaid Enrollment
700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.
New Medicaid Eligibles in Seven States Will Have a Unique Benefit Package
In 2014, most states are choosing to cover new Medicaid eligibles with the same benefit package that current eligibles receive.
Temporary SGR Bill Passed With One-Year Doc Pay Patch, ICD-10 Delay
On March 31, the Senate passed the "Protecting Access to Medicare Act of 2014," which was passed in the House last week, to provide a temporary fix to the Sustainable Growth Rate (SGR) formula.
USPSTF to Update Its Recommendation on Screening for Depression in Adults; Posts Draft Research Plan for Comment
On March 27, the United States Prevention Services Task Force (USPSTF) released for public comment a draft research plan, "Primary Care Screening for Depression in Adults," taking the first step in the process to update its recommendation released in 2009.
FDA Advisory Panel Unanimously Recommends Exact Sciences’ Cologuard®, the First Product to Undergo FDA-CMS Parallel Review
On March 26 and 27, FDA's Advisory Panel reviewed two DNA-based colorectal cancer (CRC) screening tests, Epigenomics-Epi proColon® Septin 9 test and Exact Sciences-Cologuard®.
OIG Finds Increase in Dialysis Facility Acquisition Costs for ESAs Over Three-year Period, Decrease in Costs for Most Other Drugs; Could Signal Lower Market Basket for 2015 and Beyond
On March 25, OIG released an updated report on Medicare payments for End Stage Renal Disease (ESRD) drugs.
Observations As ACA Open Enrollment Closes
As 2014 open enrollment comes to a close, core issues (listed below) associated with exchange implementation remain unsettled.
United Healthcare Network Retail Pharmacies to no Longer Accept Manufacturer-Provided Retail Copay Coupons
Beginning July 1, retail pharmacies in United Healthcare's (UHC) network will no longer accept manufacturer-provided retail copay coupons.
House Releases SGR Bill With 1-Year Doc Fix; Extenders, ICD-10 Delay and Major Lab Payment and ESRD Changes Included
On March 25, the House released the bill text for the "Protecting Access to Medicare Act of 2014," which provides a temporary fix to the Sustainable Growth Rate (SGR).
CMS Implements Part B Drug Payment Policy with No Public Warning
On March 18, the HHS OIG released a report providing an overview of specific Medicare Part B drugs where the Average Sales Price (ASP) exceeded the Average Manufacturer Price (AMP) by at least five percent in 2012.