A new Avalere analysis of CMS' proposed Comprehensive Care for Joint Replacement (CCJR) bundled payment initiative finds that 65% of selected hospitals will be subject to target prices based on regional episode spending averages that are lower than hospital-specific spending averages.
A new Avalere analysis finds that 28 organizations who entered the Medicare Advantage market between 2012 and 2015 currently offer plans to beneficiaries. Together, these new players offer 104 plan options, which are available to 13.6 million beneficiaries in 24 states.
We are excited to share with you the next phase in Avalere’s journey.
In The American Journal of Managed Care, Avalere's Kathy Hughes shares commentary on the potential impact of mobile health on evidence-based practice in diabetes care.
Orthopedic, Pulmonary, and Cardiovascular Conditions Most Likely To Be Treated under CMS Bundled Payment Program
A new Avalere analysis finds that more than 2 million exchange enrollees eligible for cost-sharing reductions (CSRs) are not receiving the subsidies because they have selected a non-qualifying plan. In addition to the more publicized tax credits that lower consumers' monthly premiums, exchange enrollees with incomes between 100 and 250 percent ($11,770 - $29,425) of the federal poverty level are eligible for CSRs. Exchange consumers must enroll in a plan on the silver metal level to access CSRs.
The American Journal of Managed Care featured perspectives from Avalere experts on reimbursement policies for clinical laboratory diagnostic tests.
The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a "patch" that they regularly deployed through a "doc fix" for nearly two decades.
A new white paper from Avalere finds wide variation in how organizations develop and use clinical pathways (CPs)-multidisciplinary plans that provide specific guidance on the sequencing of care steps and the timeline of interventions. While CPs have the potential to improve quality and reduce cost, their growing use prompts a range of questions and concerns from patient advocates and healthcare providers. Specifically, Avalere's new work examines the lifecycle of a CP and explores the potential implications of growing use of these tools for payers, providers, and patients.
This fact sheet examines the current state of choice and competition in the Medicare Advantage program.
Avalere won second place in the 2nd Annual LINK Innovation Competition for its Vantage Care Positioning System (CPS).
Recently, CMS took a significant step in its campaign to shift Medicare fee-for-service payments to alternative payment models by proposing the first mandatory bundled payment model-the Comprehensive Care for Joint Replacement (CCJR) model-which will pay hospitals in 75 markets a bundled payment for hip and knee replacements beginning in 2016. We sat down with Avalere's Brian Fuller to discuss the proposed rule.
Avalere's latest research, funded by The Pew Charitable Trusts, finds innovative approaches to accessing, extracting, and aggregating electronic health records (EHR) data associated with operating registries. Researchers interviewed various medical device registries and analyzed findings to identify common themes and innovative practices.
New analysis from Avalere finds that the average provider networks for plans offered on the health insurance exchanges created by the Affordable Care Act (ACA) include 34 percent fewer providers than the average commercial plan offered outside the exchange. The new data quantifies anecdotal reports that exchange networks contain fewer providers than traditional commercial plans.
Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.
Avalere senior vice president, Gillian Woollett, has been appointed to the U.S. Pharmacopeial Convention’s Nomenclature and Labeling Expert Committee (NLEC).
On June 30, 2015, Gayatri R. Rao, MD, JD, of the FDA's Office of Orphan Products Development (OOPD) presented an overview on the Rare Pediatric Disease Priority Review Voucher Program. Dr. Rao discussed the background and purpose of the program, application and review process, sunset provision, and what's next for the program followed by a short question and answer session.
The health insurance company Aetna announced Friday it will buy rival Humana for $37 billion. The merger comes as other health insurers consider consolidating to cut costs. Read NPR's interview with our founder, Dan Mendelson.
Avalere recently partnered with Third Way to estimate the cost savings of increasing medication adherence among Medicare beneficiaries by improving and expanding the current Part D Medication Therapy Management (MTM) program to target and address adherence issues for specific conditions.
A new Avalere assessment of the quality measures landscape shows that many important medical conditions are not fully represented in Medicare pay-for-quality programs, which limits Medicare's ability to pay for value.
