As we near the July conventions and the November election, the dialogue continues to ramp up on the latest policy proposals from the presumptive presidential nominees - Hillary Clinton and Donald Trump.
One year after Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in a landslide, the Department of Health and Human Services is implementing this legislation to transform physician payment.
Avalere's Biruk Bekele talks about a new model Avalere has developed to help life sciences companies more effectively target ACOs and customize their value propositions in the diabetes space based on ACO performance. The number of ACOs has grown rapidly in the past few years, reflecting the Department of Health and Human Services’ push to move 50% of Medicare spending to value-based payment models by 2018.
Our experts share the lessons that we’ve learned from our extensive experience with the Bundled Payments for Care Improvement Initiative. The Bundled Payments for Care Improvement demonstration is a voluntary program sponsored by CMMI in which hospitals, physician group practices, and post-acute care providers accept clinical and financial risk for patients over specified episode time frames post-hospital discharge.
In order to better coordinate care across the care continuum, CMS is allowing hospitals to establish “CJR Collaborators” or other providers that share risk with the participating hospital. Fred Bentley and Erica Breese discuss the details.
The passage of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI) to help advance new payment and delivery models.
Avalere and Inovalon recently entered into an agreement with Bristol-Meyers Squibb (BMS) to support the manufacturer's innovative initiatives using real-world outcomes data to design and test value-based contracting models. The agreement brings together Avalere's deep expertise on manufacturer and payer contract negotiation and Inovalon's significant data assets to meet the complex challenges around ensuring value and access while addressing growing healthcare costs concerns.
In 2016, more than 18 of 56 million Medicare beneficiaries receive their benefits from Medicare Advantage (MA) plans. MA plans are private managed care organizations that contract with the federal government to coordinate care for Medicare beneficiaries.
A new Avalere analysis finds that nearly 13 million Americans age 50 or over who are currently uninsured or have individual coverage purchased through the private market-inside and outside the exchange- could be eligible to buy-in to the Medicare program under a plan proposed by Democratic presidential candidate Hillary Clinton.
As the discussion intensifies, one of Avalere's experts provides keen observations on what you need to know about this topic.
The Medicare Access and CHIP Reauthorization Act (MACRA) passed last spring is transforming physician payment and standardizing requirements for APMs. Adam Borden and Jared Alves cover Advanced APMs, incentives CMS offers for providers to participate in APM, and the exclusion of specific tracks.
Christie Teigland, PhD, vice president, Advanced Analytics, recently received the Academy of Managed Care Pharmacy’s (AMCP) prestigious Platinum Award for her research entitled “Association of Socioeconomic and Clinical Factors with Rates of High-Risk Medication Use in Medicare Advantage Plans.”
Avalere Health has developed a set of malnutrition quality measures in collaboration with the Academy of Malnutrition and Dietetics. Embarking on a journey to improve care to malnourished patients, the collaboration spurred formal multi-stakeholder dialogues to be conducted.
With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.
An analysis from Avalere shows that more health insurance plans offered through the Affordable Care Act exchanges are making some drugs used to treat complex diseases—such as HIV, cancer, and MS—more accessible to patients in 2016 than in the previous years. Specifically, plans were less likely to place all drugs in a class on the highest cost-sharing tier.
HHS confirms continued movement away from traditional FFS payments, yet significant work remains to move more providers away from upside-risk models and into downside-risk models.
Two Potential Policy Changes Would Reduce Out-of-Pocket Costs for Consumers
On behalf of The Pew Charitable Trusts, Avalere conducted research to identify current barriers to interoperability and some of the best potential solutions in the current political and business environments.
Rule Would Decrease Medicare Reimbursement for Drugs That Cost More than $480 per Day; Seven of the 10 Most Affected Drugs Treat Cancer
FasterCures and Avalere partner to develop a patient-perspective value framework.
