Federal and State Policy
As the largest US healthcare payer, the federal government plays a dominant role in shaping the healthcare marketplace, while states take center stage when it comes to developing novel policy approaches. Our experts track, interpret, and model policies that affect insurance coverage, access, and consumer choice so you can see around the bend.
Avalere Observations: 2018 Election Cycle and the Outlook for Health Policy
With the 2018 mid-term elections weeks away, polls show healthcare is a top issue on the minds of voters.
CMS 2019 Star Ratings Remain Stable for MA-PD Plans, Shift for PDPs
Join Avalere experts for our analysis of CMS’ 2019 Star Ratings and a look at what’s to come for 2020 on our webinar on November 1, 2018.
Rheumatoid Arthritis Patients Could Face Access Barriers Under Proposal to Address Drug Prices
New research from Avalere finds that Medicare patients with rheumatoid arthritis (RA) may face higher out-of-pocket costs under a proposal to move Medicare Part B drugs into Part D, absent additional policy change to lower cost sharing in the Part D program.
California Becomes the 6th State to Restrict Short-Term Plans in 2018
On September 22, California became the sixth state to limit or ban short-term limited-duration insurance (STLDI) plans.
2019 Premium Increases Lowest on Average Since 2015
Average premiums projected to grow 3.1% heading into next year.
CMS Proposal Would Alter Office Visit Payments
In its proposed changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2019 (CY2019), the Centers for Medicare & Medicaid Services (CMS) proposes a potentially sweeping change to the way it values physician office and outpatient visits, also known as Evaluation & Management (E/M) codes.
Medicare Advantage Achieves Better Health Outcomes and Lower Utilization of High-Cost Services Compared to Fee-for-Service Medicare
New research from Avalere finds that Medicare Advantage (MA) beneficiaries with hypertension, hyperlipidemia, and diabetes experienced significantly fewer inpatient stays and emergency room visits relative to those in traditional fee-for-service (FFS) Medicare.
CMS Rejects Massachusetts’ Medicaid Closed Formulary Proposal
On June 27, CMS notified Massachusetts of a partial approval of the MassHealth program’s proposed 1115 waiver request.
Final Rule Lowers Barriers to Forming and Joining Association Health Plans
On June 19, the Department of Labor (DOL) released its final rule on Association Health Plans (AHP).
Double-Digit Premium Increases Expected in the Exchange Market in 2019
2019 rate filings suggest increased competition and plan choice
Opioid Supply Levels Decline in Most States
Maine had the greatest decline at 25% compared with the national average of 11%.
Medicare Trustees Report Triggers Program Funding Warning
In its 2018 Report, the Medicare Trustees issued a Medicare funding warning, citing concerns over the program's near-term financial health and spending impact on the federal budget.
Seniors Pay More for Medicare Part D Generics Despite Stable Prices
Avalere analysis finds that price of generic drugs has remained flat but the cost to seniors is increasing.
More Medicare Part D Enrollees Are Reaching Catastrophic Coverage
Patient out-of-pocket costs continue to grow despite policies to increase affordability for beneficiaries.
The Medicare Advantage Factor in Assisted and Senior Living Facilities
Avalere's founder and president, Dan Mendelson, recently sat down with Senior Housing News editors to discuss opportunities for senior living providers to leverage data to facilitate synergistic partnerships with payers.
The Opioid Crisis: An Ongoing Legislative Priority
The House and Senate are advancing legislative packages aimed at mitigating the crisis.
Patient Out-of-Pocket Assistance in Medicare Part D: Direct and Indirect Healthcare Savings
Avalere examines the effect of foundation-sponsored financial assistance on out-of-pocket costs and federal spending.
Policymakers Seek to Balance Patient Information Sharing with Privacy Protections
Coordinated information sharing can facilitate the delivery of integrated care to patients using both physical and behavioral health services.
Limits on Opioid Prescriptions Are Becoming More Widespread
In response to the concern that overprescribing is a driver of the opioid crisis, payers are limiting opioid fills as one solution.
CMS Gives More Flexibility to States When Regulating Health Insurance
The Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.