Issue Brief: The Promise of Shared Decision-Making in Improving Value in the US Healthcare System
Evidence suggests that shared decision-making can play a role in advancing a value-based care delivery system.
Funding Reinsurance and Cost-Sharing Reductions Would Lower Individual Market Premiums and Increase Enrollment
New analysis by Avalere examines the impact of two market stabilization proposals-funding the cost-sharing reductions (CSRs) and implementing a federal reinsurance program-on individual market premiums and enrollment.
Emerging Trends for Market Access Planning in 2018
Market access teams should consider 3 growing trends in their 2018 strategic planning.
Plans with More Restrictive Networks Comprise 73% of Exchange Market
Deductibles remain high, nearing $4,000 on average for silver plans.
Avalere Welcomes Matt Brow as Executive Vice President and General Manager
Brow was most recently regional SVP of The US Oncology Network for McKesson.
Broader Federal Flexibility for Medicaid Expansion Rules Could Increase Coverage in Both Medicaid and Exchanges
If federal government permits states to expand Medicaid to only 100% of poverty, nearly 4M people could shift from Medicaid to exchanges, and 7M could be newly eligible for coverage.
The Data-Driven Enterprise: Drive Growth and Deliver Value
Learn more how analytics derived from proprietary commercial datasets empower provider executives to successfully partner across the healthcare industry.
Our Take on the Final QPP Rule
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes changes to the second year of the Quality Payment Program (QPP) for 2018. The QPP was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Most Counties Will Have Free 2018 Exchange Plans for Low-Income Enrollees
New analysis from Avalere finds that nearly 98% of counties with exchanges operated by HealthCare.gov will have free bronze plan options for low-income consumers aged 50 earning 150% of poverty or less ($18,090 for an individual or $36,900 for a family of four).
Our Take on the NBPP Proposed Rule
This past Friday, the Centers for Medicare & Medicaid Services released the proposed Notice of Benefit and Payment Parameters (NBPP) for the 2019 plan year.
Impact Evaluation: Medicare Advantage Transition from RAPS to EDS
In February 2017, Avalere, an Inovalon company, analyzed data from eight Medicare Advantage Organizations (MAOs) representing 1.1 million beneficiaries in more than 30 unique plans operating across the country to understand the impact of shifting the determination of plan risk scores from the traditional Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS).
Silver Exchange Premiums Rise 34% on Average in 2018
New analysis from Avalere finds that the 2018 exchange market will see silver premiums rise by an average of 34%. According to Avalere's analysis of filings from Healthcare.gov states, exchange premiums for the most popular type of exchange plan (silver) will be 34% higher, on average, compared to last year.
Uncertainty Reigns as Consumers Begin to Make Health Insurance Decisions for 2018
Avalere experts preview the 2018 ACA open enrollment season
E4 – Digital Health the Missing Partner in Pain Management?
We interview Martha Lawrence, Chief Executive Officer of AccendoWave, discussing how technology has the promise to reduce pain for patients as an alternative to opioids. AccendoWave's system assesses patient discomfort levels using EEG technology.
Vaccine Coverage Requirements Vary by Market
Avalere has released a new white paper explaining the current insurance coverage requirements for vaccines and the laws that govern those requirements for the Medicare (Parts B and D), Medicaid, and commercial (group and individual) markets.
Administration’s Decision to End Cost-Sharing Reduction Payments Will Lead to Substantial 2017 Losses for Health Plans
New analysis from Avalere finds that the administration's decision last week to end federal funding for the cost-sharing reduction (CSR) payments could lead to substantial losses for health plans-ranging from -$1.2M in North Dakota to -$200M in Florida through the end of 2017 (Figure 1).
Christie Teigland Contributes to NQF’s Disparities Report
Avalere’s Teigland was selected by the National Quality Forum to participate in the Disparities Standing Committee.
Evolving Value-Based Care Strategies in 2017 and Beyond
Avalere's Fred Bentley explores how a leading health system adapts to evolving value-based payment models in an interview with Dr. Robert Nesse, senior director for Payment Reform at Mayo Clinic.
CMS Proposal for New Medicare Payment System Could Lead to Large Payment Variability for Specialists
New analysis from Avalere finds that payments to certain physician specialists could increase or decrease by as much as 16% for their 2018 performance under the Merit-based Incentive Payment System (MIPS).
Beneficiaries in Specialized Diabetes-Focused Medicare Plans Have Fewer Hospitalizations
Compared to beneficiaries with diabetes who are enrolled in other Medicare Advantage plans, enrollees in special needs plans experience better outcomes, after adjusting for demographic and clinical factors.