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.
Exchange Enrollment Is on Track to Meet Administration’s Goal
Today, the Department of Health and Human Services (HHS) announced that 9.6 million individuals selected a health insurance plan on HealthCare.gov during the recent open enrollment season. Avalere estimates that 2016 year-end enrollment will slightly exceed the Obama administration's goal of enrolling 10 million people.
Spotlight On: Patient Access to Oncology Care in Exchange Plans
In an article published in The American Journal of Managed Care, Avalere's Caroline Pearson and Deirdre Parsons examine provider networks and benefit design for oncology care in health insurance exchanges.
Prescription-Only Pseudoephedrine-Containing Products Contribute to Growing Primary Care Physician Shortage
According to a new analysis by Avalere, a prescription requirement for pseudoephedrine-containing products also fuels the growing shortage of primary care physicians, thereby increasing the cost, time, and difficultly of obtaining the treatment for legitimate users.
Nearly 60 Percent of New Medicare Advantage Plans Are Sponsored by Healthcare Providers
A new analysis from Avalere Health finds that hospitals and health systems are increasingly taking risk for the cost of Medicare patients and the quality of the care they receive.
Federal Government Underpays Medicare Advantage Plans for Enrollees with Multiple Diseases
A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions.
Proposed Exchange Standardized Benefit Designs Expand First-Dollar Coverage for Services and Drugs
As the government considers rules for 2017 insurance plans offered through exchanges, a new analysis by Avalere finds that proposed 2017 benefit designs could increase coverage of certain services and drugs, while lowering out-of-pocket costs for many consumers.
MACRA and the Promise of Better Patient/Family Engagement in Post-SGR World
The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a "patch" that they regularly deployed through a "doc fix" for nearly two decades.
Where Are the States Going on Payment and Delivery Reform? Tracking SIM Grant Developments
Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.
Business Education for Healthcare Innovation
The healthcare delivery system is one of the most complex businesses in the country.
Medicare Drug Plans Favor Generic Opioids that Lack Abuse Deterrent Properties
New research from Avalere finds that despite the innovation of abuse-deterrent properties and labeling for branded opioids, Medicare Part D plan coverage for these products is declining rapidly.
An Analysis of the Impact of Breakthrough Therapies on Government Spending
To evaluate public program spending on new medications in the drug development pipeline, Avalere projected the fiscal impact of 10 FDA breakthrough therapies to Medicare, Medicaid, and the health insurance exchanges created by the Affordable Care Act (ACA).
Upcoming Managed Care Regulation Will Impact Plans Serving 46M Medicaid Beneficiaries
Over the past four years, enrollment in Medicaid managed care has increased by 48 percent, with 46 million beneficiaries now receiving coverage through these plans. The government will soon update regulations that direct the plans providing this coverage.
Leading Cancer Centers May Be More Widely Included in Exchange Networks than Expected
A new survey conducted by Avalere and the National Comprehensive Cancer Network® (NCCN®) shows that exchange plan participation by the nation's leading cancer centers is highly varied, but may be better than initial 2014 reports suggested.
State-Based Exchanges Saw Higher Attrition from 2014 to 2015 Than Federally-Facilitated Exchanges
Exchanges run by the federal government both retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than states that run their own exchanges, according to a new Avalere analysis.
Two Seasoned Healthcare Professionals Join Avalere
Lisa Latts, MD, and Rick Smith join Avalere's team.
Avalere Medicaid Expansion Map – February 2015
28 States & DC Are Expanding Medicaid Eligibility; Others May Decide to Expand
Avalere Medicaid Expansion Map – November 2014
28 States & DC Are Expanding Medicaid Eligibility; Others May Make Decisions to Expand.
Avalere Analysis: 2014 Governors’ Races Could Lead to More Medicaid Expansion
In at least six states, Medicaid programs could be expanded as a result of the outcome of the 2014 governors' races.
Avalere Health Names Lindy Hinman its New Senior Vice President of Health Plans and Managed Care
Avalere Health announced today that Lindy Hinman will be re-joining the company as senior vice president, leading its Health Plans and Managed Care Practice.
HHS Report Finds Carrier Participation in Exchanges Will Grow 25 Percent
On September 23, HHS released a new report that finds the number of issuers participating in the 2015 exchange market will grow by 25 percent when compared to 2014.