Medicare Advantage Beneficiaries Will See a Jump in New Supplemental Benefit Offerings in 2019
MA plans expand coverage of supplemental benefits following administration’s policy change.
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.
Multidisciplinary Workgroup Publishes Appropriate Use Criteria for LP and CSF Testing for the Diagnosis of Alzheimer’s Disease
Today, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association published appropriate use criteria (AUC) to guide the use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis for use in the diagnosis of Alzheimer’s disease.
E3 – New Appropriate Use Criteria Increases Likelihood of Accurate Diagnosis for Alzheimer’s Disease
Explore the value of the newly released Alzheimer’s Association appropriate use criteria for lumbar puncture and cerebral spinal fluid testing in the diagnosis of Alzheimer’s disease with guest presenter Dr. Steven Salloway, Director of Neurology and the Memory and Aging Program at Butler Hospital.
E2 – CSF Clinical Diagnosis’ Used to Inform Guidance on Detecting Alzheimer’s Disease
Dr. Leslie Shaw, Professor of Pathology and Laboratory Medicine at the Pearlman School of Medicine at the University of Pennsylvania and Chair of the Workgroup that developed the Alzheimer’s Association’s appropriate use criteria for lumbar puncture and cerebral spinal fluid (CSF) testing in the diagnosis of Alzheimer’s disease, discusses how the Workgroup reviewed an extensive body of research on advances in CSF testing to develop the AUC.
E1 – New Appropriate Use Criteria in Diagnosing Alzheimer’s Disease
We explore the value of the newly released Alzheimer’s Association appropriate use criteria for lumbar puncture and cerebral spinal fluid (CSF) testing in the diagnosis of Alzheimer’s disease. We kick off this series with Dr. Maria Carillo, the Alzheimer Association’s Chief Science Officer and Dr. Jim Hendrix, Director of Global Science Initiatives.
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.
Provider Performance Under Oncology Care Model Varies by Cancer Type
Clinicians who treat certain types of cancer may be better positioned to earn performance-based payments under the Oncology Care Model.
Experienced Medicare Accountable Care Organizations Generate Savings
Assuming risk appears to be a less important factor than experience in predicting ACO success.
Mental Illness Research Wins Award
Findings from a new Avalere study, titled “Prevalence and Likelihood of Hospital Admission and Readmission in Patients with Serious Mental Illness,” were presented at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Asia Pacific conference on Sunday, September 9, 2018.
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.
CMS Proposal Encourages Advanced Alternative Payment Model Participation
Early adoption and participation in an AAPM can provide a higher incentive payment to Medicare clinicians than MIPS.
FDA Seeks Stakeholder Input on How to Enhance Biosimilars and Interchangeable Biologics Market
Earlier this week, the Food & Drug Administration (FDA) released a Part 15 public hearing announcement and request for comment on how the FDA can facilitate greater availability while balancing competition and innovation for all biologics.
Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions
Although malnutrition can lead to greater risk of chronic disease, frailty, and disability, and increases healthcare costs, patients’ nutrition status is rarely evaluated and managed as they transition across care settings.
Fewer Seniors Get Vaccinated as Their Out-of-Pocket Costs Increase
New research shows higher cost sharing for vaccines under Part D leads to fewer seniors getting vaccines. Immunization rates are higher for vaccines covered by Part D plans with lower cost sharing.
Health Plan Interest in Outcomes-Based Contracts Increasing
Outcomes-based contracts most common in cardiovascular disease, infectious disease, and oncology.
Strategic Imperatives for Skilled Nursing Facilities Preparing for New Payment System
In August 2018, CMS is expected to finalize a proposed new payment methodology for skilled nursing facilities (SNFs) that would shift the focus from resource use to patients’ clinical needs.
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.
Reforming Medicare Vaccine Coverage to Reduce Barriers to Access
On June 14, Avalere experts came together with Cynthia Tudor, former Deputy Center Director of the Center for Medicare and Senior Advisor to Avalere, to discuss vaccine coverage and access challenges under Medicare.
Shifting Drugs from Medicare Part B to Part D: Learnings from Medicare Coverage of Vaccines
A proposed shift of Part B drugs into Part D could affect patient access and increase the burden on providers.