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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CMS Opens NCA on Lung Cancer Screening with LDCT and Schedules MEDCAC for April 30
On Feb. 10, CMS opened a national coverage analysis (NCA) on the use of lung cancer screening with Low-Dose Computed Tomography (LDCT) devices.
7.4M Medicare Beneficiaries Could Be Affected By Proposed Meaningful Differences Policy
A Medicare proposed rule change limiting the number of prescription drug plans (PDPs) that insurers may offer in the Part D market could require 39 percent of all enhanced plans to be eliminated in 2016.
AHRQ White Paper Offers Payer Perspectives on How to Improve the Usability of AHRQ’s Comparative Effectiveness Reviews for Decision Making
On Feb. 3, the Agency for Healthcare Research and Quality (AHRQ) released a white paper that provides payer perspectives on how to improve the usability of reports produced by AHRQ's Effective Health Care (EHC) program.
OIG Report Finds Contract Pharmacy Arrangements “Create Complications” in the Administration of the 340B Program
On Feb. 4, the Office of the Inspector General (OIG) released a report describing select covered entities' contract pharmacy arrangements and their oversight to prevent diversion of 340B purchased drugs to ineligible patients, and to prevent duplicate discounts through Medicaid.
26 States & D.C. Are Expanding Medicaid Eligibility in 2014; A Few Others May Decide to Expand Later This Year or in 2015
Avalere analysis from the February "State Reform Insights" shows that in addition to the 26 states and D.C. committed to expending Medicaid in 2014, Utah, Tennessee and Indiana could follow suit.
MAP Releases Final 2014 Pre-Rulemaking Report, Providing Recommendations on Measures for 20 Federal Programs
On Feb. 3, the Measures Application Partnership (MAP) released its final pre-rulemaking report, providing recommendations on the adoption of new measures in more than 20 federal public reporting and payment programs, including clinician programs (e.g., Physician Quality Reporting System, Physician Compare) and facility programs (e.g., Inpatient Quality Reporting System (IQR), Hospital Acquired Conditions Payment Reduction Programs).
Draft 2015 Letter to Issuers in the Federally-facilitated Marketplace (FFM) Institutes New Requirements and Standards
On Feb. 4, CMS published a draft letter to issuers seeking to offer qualified health plans (QHPs) and standalone dental plans (SADPs) in the FFM or federally-facilitated small business health options program (FF-SHOP).
Recent Industry Efforts to Increase Data Transparency Will Enhance Trust in Research
Previously, I have written about the role that increased data transparency can play in improving trust in biopharmaceutical and medical products industry-funded research and the credibility of industry-sponsored study results.
1.1M to 1.8M New Medicaid Enrollees as a Result of ACA
Avalere estimates that from October through December 2013, between 1.1M and 1.8M people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).
ACOs are a “Long-Term” Measure to Achieve Medicare Savings
CMS released financial results on Jan. 30 indicating that nearly half of the Medicare ACOs (54 of 114) had lower expenditures than projected in their first year of participation.
IRS Proposes Rule on Minimum Essential Coverage and Individual Shared Responsibility Payments
On Jan. 27, the IRS published a proposed rule to clarify and modify the requirement that individuals have minimum essential coverage (MEC) starting in 2014.
USPSTF Issues Recommendation Statement on Screening for Abdominal Aortic Aneurysm
On Jan. 28, the United States Prevention Services Task Force (USPSTF) released the draft recommendation for public comment, "Screening for Abdominal Aortic Aneurysm."
Anne Tumlinson to Join Senior Living 100 Panel
Avalere's Anne Tumlinson, Senior VP, Provider Client Solutions, will be participating on a panel at the Senior Living 100 conference in Laguna Nigel, CA on Feb. 24 at 11am, titled: "Using Historical and Predictive Analysis to Drive Organizational Strategy."
PCORI Finalizes Topics, Timing, and Funding Amount for Upcoming Announcements on Pragmatic Clinical Trials
PCORI will fund more head-to-head trials that compare two or more efficacious treatment alternatives for the therapeutic area being examined.
GAO Finds Aggregate ACA-Based FUL Amount Similar to Drug Acquisition Costs, but Recommends Continued CMS Monitoring
The Government Accountability Office (GAO) released a report comparing ACA-based federal upper limit (FUL) amounts to National Average Drug Acquisition Cost (NADAC) amounts for 1,035 Medicaid-reimbursed outpatient drugs.
ACR Leads Effort to Encourage CMS to Open NCD on Lung Cancer Screening
The American College of Radiology (ACR) is leading a coalition to encourage CMS to open a national coverage determination (NCD) on lung cancer screening.
New Web Tool Shows Out-Of-Pocket Costs Are Highly Variable Under Marketplace Plans
NEWS RELEASE: PuttingPatientsFirst.net uses Avalere Health analytics to educate consumers about marketplace choices.
More Than 2 Million Individuals Enroll for Exchange Coverage
Despite the challenging exchange rollout, more than 1.8 million individuals signed up for exchange coverage in December alone, bringing total enrollment to 2.2 million during the first three months of open enrollment.
FDA Releases Draft Guidance on Fulfilling Regulatory Requirements for Postmarketing Submissions of Interactive Promotional Media for Prescription Drugs and Biologics
On Jan. 14, FDA issued draft guidance for industry called "Fulfilling Regulatory Requirements for Postmarketing Submissions of Interactive Promotional Media for Prescription Human and Animal Drugs and Biologics."
CMS to Disclose Physician Payment Data
On Jan. 14, HHS announced that it will begin responding to Freedom of Information Act requests for physician-payment information.