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.
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.
CMS Appoints Lakshman Ramamurthy as Industry Representative to MEDCAC
Lakshman Ramamurthy, PhD, director of FDA & Regulatory Policy at Avalere Health, has been appointed by the Centers for Medicare and Medicaid (CMS) to serve as an industry representative to the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC).
MolDX May Be the Norm, but Is It the Future?
With over 16,000 genetic tests already on the market and thousands more in development, stakeholders cannot ignore the rapidly evolving field of personalized medicine.
Supreme Court Hobby Lobby Decision Limits Contraception Coverage Mandate
In a 5-4 ruling on June 30, the U.S. Supreme Court issued a majority opinion on Burwell v. Hobby Lobby Stores, Inc., holding that the contraceptive mandate violates the Religious Freedom Restoration Act (RFRA) as applied to closely held, for-profit corporations.
Washington State Rate Analysis: Carriers with Low 2014 Market Share Hold Down Premiums in 2015
A new analysis from Avalere Health finds that proposed rate increases for 2015 exchange plans in Washington state were lowest among carriers with the smallest share of the 2014 market.
CMS Proposes to Cover TMVR under CED
On May 14, CMS released a proposed national coverage determination (NCD) for Transcatheter Mitral Valve Repair (TMVR), and proposed to cover TMVR under its Coverage with Evidence Development (CED) program.
States Propose “Right to Try” Bills Allowing Physician Prescribing of Investigational Drugs for Terminally Ill Patients
At least four states -- Arizona, Colorado, Louisiana and Missouri -- have recently proposed bills that would allow physicians to prescribe investigational drugs, biologics or devices to eligible terminally ill patients.
Avalere Analysis: Medicaid Non-Expansion States Experience Up to 10% Enrollment Growth Due to Woodwork Effect
Over 550K New Medicaid Enrollees Gained Coverage in Non-Expansion States in First Quarter.
Managing Access to Pseudoephedrine: Potential Impacts of a Prescription-Only Policy versus Real-Time Stop Sale Technology
This April, Avalere experts finalized a paper surrounding the policy issues of control, access and usage for products containing pseudophedrine (PSE).
CBO and JCT Revise Health Reform Enrollment and Cost Estimates, Scale Back Medicaid Enrollment for 2014 and Premium Increases for 2015
On April 14, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released updated estimates on health insurance coverage provided through the ACA.
Downward Pressure on Medicare Advantage Payment Continues in Final Rate Notice
On April 7, CMS finalized their Calendar Year (CY) 2015 capitation rates, methodological changes to rates and risk models, and other payment and program policies for Medicare Advantage (MA) and Part D plans.
Avalere Analysis: Ten States Driving New Medicaid Enrollment
700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.
Congress Proposes Bill to Expand New Technology Add-On Payments for Antibiotics under Medicare
In the July/August 2013 RPM Report, I co-wrote an article with Avalere's Scott Gottlieb and Lauren Barnes discussing the potential to use the new technology add-on payments (NTAPs), a novel pathway created by Congress in 2001, as a foundation for new policies that support innovation and address public health goals.