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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How a New Technology Add-On Payment (NTAP) Works
Additional Medicare payment in the inpatient setting may be available to certain qualifying new technologies, but requires successful navigation of application processes.
Revisiting Medicaid Work Requirements
Federal policymakers are considering Medicaid work requirements as a mechanism to reduce spending; recent state experiences offer important considerations.
Trump EO Lays Out a Roadmap for Drug Pricing Action
New Executive Order on drug pricing revives earlier Trump proposals and also suggests new approaches for Medicare and states.
PBM Delinking: Policy Considerations
Legislation aimed at changing how PBMs operate, including “delinking” bills, could have unforeseen consequences for drug prices, contracting and competition.
Recent Part D Final Policies Leave Open Areas for Future Action
After the release of the CY 2026 MA and Part D final rules, CMS may take further action on several key policy areas, including anti-obesity medications and premium stabilization.
Five Forces Reshaping the Future of Community Oncology Networks
Community oncology networks are growing in size and influence. Five trends are poised to reshape how these networks deliver care, make decisions, and engage stakeholders.
Analysis of Hospital Mergers and Acquisitions and 340B Status
From 2016 to 2024, buyer hospitals undergoing mergers or acquisitions were more likely to be large (500+ beds) and 340B covered entities.
Analysis of CMMI Model Costs, Quality Performance, and Transparency
Avalere Health assessed 18 CMMI models for their performance on financial and quality measures as well as the transparency of their development and implementation.
New Analysis Finds Top-Performing ACOs Across Models Focus on Patients with Complex Needs
With ACO REACH sunsetting in 2026 amid ongoing stakeholder interest in identifying successful value-based care models, findings highlight the critical future role of High Needs ACOs.
Expiration of Enhanced Tax Credits Would Impact 18M Americans
If the ACA marketplace enhanced premium tax credits are made permanent, nearly 5 million people ages 50–64 will be eligible to receive premium subsidies in 2026.
Update: Health Plans’ Perceptions of PDABs and UPLs
In interviews and a survey, health plans communicate concerns with UPLs’ potential impact on patient access, pharmacists, providers, and their own financial positions.
Navigating the Evolving World of Drug Compounding
Drug compounding regulation has evolved due to recent industry trends, emphasizing the need to understand its optimal role in healthcare delivery.
National Kidney Month: Setting the Stage for 2025 Changes
Political changes, transplant system reforms, research advancements, and expanded CKD indications create opportunities and challenges in the kidney care space.
Disease Registries Offer Solutions in Rare Disease
Disease registries can provide high-quality data and may serve as an additional resource when developing medical interventions for rare and ultra-rare diseases.
Impact of MFP Effectuation on Pharmacies and Beneficiaries
A large share (30%) of beneficiaries access IPAYs 2026 or 2027 negotiated drugs through independent or franchise pharmacies.
Telehealth in Medicare: Shifts Before and After COVID-19
Pandemic-era telehealth flexibilities in Medicare will expire in April 2025, potentially limiting primary care access for beneficiaries.
MA and Part D Enrollment Growth Slows in 2025
Year-over-year enrollment growth in MA and Part D slowed in 2025. Although, enrollment in chronic condition special needs plans experienced significant growth.
Stakeholders Can Influence Patient-Centered Value Research During Public Comment Period
Life sciences companies, payers, and advocates can weigh in on patient-centered value assessments in a new public comment opportunity.
Part D Prior Authorization Policies May Include Step Therapy
Analysis of Part D plans including step therapy in prior authorization and the frequency of step therapy criteria that include steps beyond the drugs’ FDA labels.
Updated: Key Considerations for MFP Effectuation and the 340B Rebate Model
With less than a year until the first MFPs take effect, stakeholder concerns remain, especially as it relates to 340B duplicate discount risk.