News
Medicare Advantage Patients Less Likely to Use Post-Acute Care
New analysis from Avalere finds that Medicare Advantage (MA) patients use fewer post-acute care services after being discharged from the hospital compared to traditional Medicare fee-for-service (FFS) patients.
Proposed High-Risk Pool Funding Likely Insufficient to Cover Insurance Needs for Individuals with Pre-Existing Conditions
Funding earmarked for high risk pools in the American Health Care Act will cover five percent of the total number of enrollees with pre-existing chronic conditions in the individual market today.
Avalere Panel Highlights the Importance of Analytics in Value-Based Care
At the Asembia Specialty Pharmacy Summit 2017, an Avalere-led panel identified three focus areas for specialty pharmacies looking to achieve market leadership in an increasingly value-based care environment.
Avalere Deepens Expertise in Medicare Advantage Payment Systems with Hire of Sean Creighton
Sean Creighton has joined the Avalere team as a vice president in the policy practice, and will be responsible for leading advisory services work tied to Medicare Advantage, risk adjustment, and related issues.
Medicaid Per Capita Caps Could Cut Funding for Dual-Eligible Beneficiaries
Capping Medicaid funding could also shift costs to Medicare
Hidden Epidemic of Older Adult Malnutrition: New National Blueprint Advances Integrated Solutions
Citing alarming statistics that show that nearly 1 of every 2 older Americans is at risk of malnutrition and that disease-associated malnutrition in older adults is estimated to cost $51.3 billion annually, a broad group of advocates laid out a roadmap for a new national effort to help millions of Americans who suffer from malnutrition or could be at risk as they grow older.
AHCA State Stability Fund Would Give More Money to States with Limited Insurance Competition
New research from Avalere finds that under the American Health Care Act (AHCA), large states as well as those states with fewer insurers offering plans in the individual and small group markets could receive the most money from the federal government to help stabilize their markets.
House of Representatives ACA Repeal and Replace Legislation Could Increase Penalties for Failure to Buy Insurance
Low-income and older individuals would incur higher penalties for failing to purchase health insurance, compared to current individual mandate.
Capped Funding in Medicaid Could Significantly Reduce Federal Spending
Analysis shows Medicaid block grants and per capita caps could result in state budget gaps.
Impact of Medicare Advantage Data Submission System on Risk Scores
Avalere analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
Avalere to Support Boehringer Ingelheim in Outcomes-Based Contracting
Avalere will empower expanded insight and improvement in outcomes for value-based diabetes medications, using Inovalon’s data resources and advanced value-based care platforms.
Consumer Costs Continue to Increase in 2017 Exchanges
Plans sold in exchange markets in 2017 feature higher premiums, growing consumer out-of-pocket costs, and more restricted access to providers and hospitals than in previous years, according to a new analysis from Avalere.
Plan Participation and Premium Growth in 2017 Exchanges
As 2017 exchange open enrollment begins, Avalere examined marketplace changes in plan choice and premiums at the county level.
1.2 Million People Could Gain Access to Medicaid Coverage Based on State Election Results
New analysis from Avalere finds that 1.2 million individuals from non-expansion states could gain Medicaid coverage in 2017 should a newly elected governor decide to expand the program.
2017 Open Enrollment Preview
2017 exchanges struggle to address challenges with enrollment, risk management, and consumer choice.
CORRECTION: Premium Increases for Most Popular Medicare Drug Benefit Plans, Market for Medicare Advantage Plans Appears Stable in 2017
According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for stand-alone prescription drug plans (PDPs) will increase and the number of PDPs available in 2017 will decrease. Conversely, the Medicare Advantage market appears strong as 8 in 10 beneficiaries have access to MA plans that offer prescription drug benefits with a zero premium.
Health Insurance Is a Good Buy to Protect Against Significant Financial Risk for a Range of Common Health Conditions
A new analysis from Avalere finds that consumers with a range of common health conditions could reduce their spending between $8,800 and $90,020 by purchasing insurance through the Affordable Care Act (ACA).
Few Manufacturers Publicly Share Policies for Granting Patient Access to Investigational Products
Proposed Requirements in 21st Century Cures Act Would Increase Transparency Requirements
8 Million Adults Could Be Eligible to Purchase Medicare Coverage Under Proposed Clinton Plan
A new Avalere analysis finds that approximately 8 million Americans age 55 or over who are currently uninsured or have individual coverage purchased through the private market-inside and outside the exchange- could be eligible to buy-in to the Medicare program under a plan proposed by Democratic presidential candidate Hillary Clinton.
Consumers Enrolling in Exchanges through Special Enrollment Periods Have Higher Costs, Lower Risk Scores, than Open Enrollment Consumers
A new analysis from Avalere finds that individuals who enroll in exchange coverage during special enrollment periods (SEP) have higher costs and lower risk scores than open enrollment period (OEP) consumers.