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).
In light of proposed changes to the ESRD Treatment Choices Model to address health disparities, an Avalere analysis of Medicare claims found gaps in access to and utilization of specific dialysis-related services by patient race, ethnicity, and socioeconomic status.
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.
In the recently released Centers for Medicare & Medicaid Services (CMS) proposed rule for the CY 2022 Medicare Physician Fee Schedule, CMS proposed to include an Avalere-submitted malnutrition-focused improvement activity (IA) in the Merit-based Incentive Payment System (MIPS).
Stakeholders in the COVID-19 pandemic response face regulatory and commercial uncertainties as emergency operations transition and market access of products face both emergency use and full licensure.
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the second in a series focused on cell and gene therapies, experts from our Policy and Market Access practices discuss value-based payment arrangements in cell and gene therapies, and the role they play in facilitating access to these therapies.
Tune into another episode of the Avalere Health Essential Voice podcast series focused on disease education. In this segment, the second in a series focused on cell and gene therapies, experts from our Policy and Market Access practices discuss value-based payment arrangements in cell and gene therapies, and the role they play in facilitating access to these therapies.
Avalere’s analysis shows differences in payments between employer and non-employer Part D plans.
Avalere’s data analytics and market access experts will be joined by Jeff Patton, MD and CEO of OneOncology, to explore critical issues and considerations for life sciences stakeholders following the pandemic.
An Avalere analysis found that Oncology Care Model (OCM) lung cancer episode expenditures increased over 20% from performance periods 2 to 6 while the benchmark price increased about 10% during this period. During this same period, The Center for Medicare & Medicaid Innovation (CMMI) included 20 lung-cancer-specific changes to the OCM Novel Therapy Adjustment (NTA) list. This dynamic supports the inclusion of tumor-specific adjustments in the future Oncology Care First (OCF) model to further account for advancements in cancer management.
The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.
