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
Avalere Medicaid Expansion Map – March 2014
27 states and Washington, D.C. are currently expanding their Medicaid eligibility.
Employers Value Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) As Coverage Option for Retirees
More than 2.7 million retirees receive health insurance coverage from their employer through a Medicare Advantage Employer Group Waiver Plan (MA-EGWP).
SGR Bills Aplenty, But Doc Fix Extension Seems Imminent
The bipartisan, bicameral legislative framework for a repeal of the Sustainable Growth Rate (SGR) formula and shifts toward quality/value-based payment and adoption of alternative payment models for physicians has been primed since early February.
Avalere Analysis: Consumers Face More Hurdles to Accessing Drugs in Exchange Plans Compared to Employer Coverage
A new analysis from Avalere Health finds that consumers purchasing insurance through exchanges are twice as likely to face utilization management controls on prescription medications compared to people enrolled in employer-sponsored insurance plans.
Enrollment Tops 4.2 Million as Exchanges Begin 2015 Preparations
With only two weeks left of 2014 exchange open enrollment, issuers and states are deeply engaged in maximizing enrollment before the end of the month.
FDA Releases Draft Guidance for Conducting Bioavailability and Bioequivalence Studies
On March 18, FDA released draft guidance containing recommendations for sponsors and new applicants preparing bioavailability (BA) and bioequivalence (BE) data for products in investigational new drug applications (INDs), new drug applications (NDAs) and NDA supplements.
HHS Publishes Interim Final Rule on Third Party Payments
On March 14, HHS published an interim final rule on third party payments requiring qualified health plans (QHPs) and standalone dental plans (SADPs) to accept third party payments on behalf of enrollees from the Ryan White program, Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs.
CMS Releases Proposed Rule on Exchange and Insurance Market Standards for 2015 and Beyond
On March 14, CMS released the Exchange and Insurance Market Standards for 2015 and Beyond proposed rule.
CMS Offers End-to-End Testing of ICD-10 Claims and Beta Software to Support Providers through the ICD-10 Implementation
From July 21 to 25, CMS will conduct end-to-end testing on the International Classification of Disease, Tenth Revision (ICD-10) coding system.
CMS Offers End-to-End Testing of ICD-10 Claims and Beta Software to Support Providers through the ICD-10 Implementation
From July 21 to 25, CMS will conduct end-to-end testing on the International Classification of Disease, Tenth Revision (ICD-10) coding system.
Strategies to Improve Medication Management Communications in SNFs
In this week's edition of McKnight's Long-Term Care News & Assisted Living, Avalere's Anne Tumlinson wrote a guest post discussing ways to improve medication management communications at skilled nursing facilities (SNFs).
Congress Proposes Bill to Expand New Technology Add-On Payments for Antibiotics under Medicare
In the July/August 2013 RPM Report, I co-wrote an article with Avalere's Scott Gottlieb and Lauren Barnes discussing the potential to use the new technology add-on payments (NTAPs), a novel pathway created by Congress in 2001, as a foundation for new policies that support innovation and address public health goals.
March MedPAC Meeting Discussion Highlights CMS’ Interest in Part B Payment Reform
At March's MedPAC meeting, staff discussed improving Medicare spending value by linking Fee-for-Service (FFS) payment to the comparative clinical effectiveness of healthcare therapies.
Nationwide Exchange Enrollment Tracking Toward 5.4M by the End of March
New Avalere analysis finds that exchange enrollment is on track to reach 5.4 million by the end of March when open enrollment is set to end. That number falls short of current Congressional Budget Office (CBO) estimates that six million people will enroll in exchanges in 2014.
MedPAC’s March 2014 Meeting in Brief
MedPAC's latest public meeting was March 6 and 7 and covered topics such as equalizing payments across post-acute settings of care, improving quality measurement, exploring alternative methods to pay for Part B drugs, enhancing delivery of primary care services through payment incentives, and ways to improve payments and care delivery across Medicare fee-for-service (FFS), Medicare Advantage (MA) and Accountable Care Organization (ACOs).
New CPT Codes for Next Generation Sequencing Procedures on the Horizon for 2015
The American Medical Association's (AMA) Current Procedural Terminology (CPT®) Editorial Panel (Panel) announced on March 5 its acceptance of a set of codes that will be used to report testing for large-scale, multianalyte genomic sequencing procedures typically performed using Next Generation Sequencing (NGS) technology.
HHS Notice of Benefit and Payment Parameters for 2015 Final Rule Released
On March 5, CMS released the HHS Notice of Benefit and Payment Parameters for 2015 final rule.
CMS Seeks Stakeholder Input on Possible DMEPOS Payment Methodology Changes
On Feb. 24, CMS released an advance notice of proposed rulemaking and request for comments on two potential methodology changes to adjust Medicare fee schedule payment amounts or other Medicare payment amounts for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
FDA to Hold Public Hearing on Issues and Challenges Associated with Demographic Subgroup Data
FDA will hold a public hearing on April 1 to receive feedback from key stakeholders on 1) demographic subgroup representation in clinical trials, 2) analysis of demographic subgroup data, and 3) communication of demographic subgroup information to the public.
Duals Demonstrations Pick Up Speed: 4 States Have Launched, 13 to Follow in 2014
The financial alignment demonstrations (FAD), designed to coordinate care for dual eligible beneficiaries, are gaining momentum as states begin implementation and final planning.