To assess how changes in OPPS payment for reimbursement of drugs under the 340B program would affect hospital reimbursement and Medicare Part B beneficiary cost sharing, Avalere estimated the impact of increasing reimbursement for 340B drugs in Medicare Part B to ASP + 6%. The analysis finds that most hospitals would see overall payment decreases, while payments would be subject to higher cost sharing.
Tune into the second episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Center for Medicaid and Medicare (CMS) employees Sean Creighton and Tom Kornfield discuss their thoughts on the best ways for health plans to influence CMS decision making, including timing of engagement and critical messaging elements.
Tune into the first episode in our video series focused on Medicare Advantage. In this segment, Avalere experts and former Centers for Medicare & Medicaid Services (CMS) employees, Sean Creighton and Tom Kornfield, discuss the outlook for Medicare Advantage, factors that will influence growth of the program, and a behind-the-scenes look at CMS policymaking considerations.
As Democrats seek consensus on a "skinny BBBA," concerns over inflation and deficit reduction will place greater emphasis on "pay-for" targets to advance healthcare priorities.
Join Avalere’s panel of market access and policy experts for a discussion on the growing cell and gene therapy (CGT) pipeline, an in-depth look at the unique opportunities and challenges these novel therapies present, and an overview of the many hurdles stakeholders need to navigate for success.
Successful initiatives to address malnutrition and food insecurity through quality measurement and community partnerships are improving malnutrition care across the country and addressing health equity.
The proposed inclusion of the Global Malnutrition Composite Score in the Hospital Inpatient Quality Reporting Program will enable hospitals and their patients to benefit from identifying and addressing malnutrition. The measure’s use facilitates high-quality and comprehensive nutrition care that begins in the inpatient setting and continues across transitions of care.
Congressional Democrats have indicated interest in a slimmed-down BBBA alternative that could pass the Senate. Pending deadlines and the expiration of ARPA subsidies may create impetus for Democrats to act on legislative health care priorities in 2022.
An updated Avalere analysis examines Medicare Part D plan tier placement of generic prescription drugs, finding that over time their percentage on generic tiers has declined from 65% in 2016 to 43% in 2022.
A recent Avalere analysis of Medicare Fee-for-Service (FFS) data illustrates that treating major depressive disorder (MDD) in Medicare-eligible beneficiaries results in a 4% reduction in total cost compared to untreated patients, highlighting the importance of incentivizing adequate provider supply and payment in the geriatric psychiatry market.
An Avalere analysis found differences in the performance of low- and high-intensity prostate cancer episodes in the Oncology Care Model (OCM). High-intensity prostate cancer episode expenditures were consistently below the benchmark price while low-intensity episode expenditures were similar to the benchmark price. This finding is likely driven by the Centers for Medicare & Medicaid Services (CMS) methodology used to calculate benchmark prices but may also indicate participant success in controlling costs for these episodes.
The FY 2022 update of the ICD-10-CM includes 19 new Z codes that relate to social determinants of health (SDOH). Z codes present an opportunity to standardize and improve patient SDOH data collection to assist stakeholders in addressing non-clinical needs that impact health outcomes and healthcare costs.
Consumers ages 50–64 could see higher exchange premiums starting in 2023 without extension of ARPA subsidies.
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the final in our series on cell and gene therapies, experts from our Market Access practice discuss the need for patient support in cell and gene therapies, and the role that manufacturers and other stakeholders can play in providing it.
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the final in our series on cell and gene therapies, experts from our Market Access practice discuss the need for patient support in cell and gene therapies, and the role that manufacturers and other stakeholders can play in providing it.
The CDC recommends HBV vaccinations for persons with a history of current or recent injection drug use, but uptake remains low. Avalere research shows an opportunity to leverage alternative care settings to address the growing rates of HBV infection.
Tune into another episode of Avalere Health Essential Voice. In this segment, Avalere policy expert Matt Kazan discusses what he expects to see from a legislative perspective this fall on Capitol Hill.
As Congress considers the bipartisan infrastructure package and budget reconciliation agenda, the coming months are likely to include debate on what could be the most significant federal healthcare legislation in over a decade. Additionally, the Biden administration is expected to release several important healthcare rules this fall, including the details necessary to implement the new law banning surprise billing and regulations to protect and strengthen Medicaid and the Affordable Care Act (ACA).
A new claims-based analysis from Avalere examined vaccine uptake among low-income adolescents enrolled in Medicaid Managed Care and found a 26% decline in routine vaccinations when comparing March–October 2019 to the same period in 2020.
On July 19, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 OPPS/ASC Proposed Rule, which includes a number of proposals to modify the timing and design of the Center for Medicare & Medicaid Innovation’s forthcoming Radiation Oncology (RO) Model. The design proposals include changes to the set of included modalities and cancer types, reduction of the CMS discount factors applied to the prospective payments, and adoption of an extreme and uncontrollable circumstances policy. Looking ahead, stakeholders should continue to assess the model payment methodology and design in the context of evolving care delivery and practice patterns.
