In an article published in The American Journal of Managed Care, Avalere's Caroline Pearson and Deirdre Parsons examine provider networks and benefit design for oncology care in health insurance exchanges.
According to a new analysis by Avalere, a prescription requirement for pseudoephedrine-containing products also fuels the growing shortage of primary care physicians, thereby increasing the cost, time, and difficultly of obtaining the treatment for legitimate users.
A new analysis from Avalere Health finds that hospitals and health systems are increasingly taking risk for the cost of Medicare patients and the quality of the care they receive.
A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions.
Fred Bentley, an experienced leader in payment and delivery system reform, has joined Avalere’s Center for Payment & Delivery Innovation. Fred will supplement our existing deep expertise in provider strategy and provide analytic and strategic support on issues related to care delivery.
Get a sense of what to anticipate in the 2016 healthcare landscape in our annual 2016 Industry Outlook: Reducing Cost and Demonstrating Value.
As the government considers rules for 2017 insurance plans offered through exchanges, a new analysis by Avalere finds that proposed 2017 benefit designs could increase coverage of certain services and drugs, while lowering out-of-pocket costs for many consumers.
A new Avalere analysis finds that participation in the Centers for Medicare & Medicaid Services' (CMS) voluntary Bundled Payment for Care Improvement (BPCI) program remains strong even after the introduction of downside risk.
In 2016, 2 key themes underlie much of the shift in the healthcare landscape: cost and value. Each of these elements is critical as we attempt to reduce costs by improving value across the healthcare system. Caroline Pearson, Senior Vice President, Strategy and Policy, gives a preview of what to expect.
A new analysis by Avalere Health finds that proposed modifications to Medicare Advantage (MA) by the Centers for Medicare and Medicaid Services (CMS) could result in large changes in payments in certain geographic areas.
As part of an interprofessional panel of eldercare experts, Avalere's Miryam Frieder contributes to commentary published in the Journal of the American Geriatrics Society that better defines "person-centered care" and its key elements.
The US Food and Drug Administration's (FDA) Advisory Committee (AdComm) process remains a source of significant uncertainty for medical product manufacturers, despite FDA's guidelines in the Code of Federal Regulations (CFR)1 and in guidance.2 While the AdComm process is generally the same across Centers,3 each AdComm is unique and subject to the expertise and opinions of individual panel members, opinions voiced during the public comment period, and challenges exclusive to each new product or indication.
Sheila Fifer, PhD, and Randel Richner, BSN, MPH, have joined Avalere as senior advisors.
A new analysis by Avalere finds that causes of health insurance premium increases in 2016 generally mirror the distribution of healthcare spending in the individual and small group market. Specifically, inpatient and outpatient hospital services are modestly driving premium increases, while physician and other professionals make up less than their expected portion of premium growth. Prescription drugs' contribution to 2016 premium increases is roughly in line with their costs in 2014. Overall, premiums for 2016 will rise an average of $25.26 per month, with $5.44 of that increase caused by outpatient hospital services.
In recent years, several new U.S. Food and Drug Administration-approved, direct-acting antiviral medications to treat the chronic hepatitis C virus (HCV) have entered the market. Because of the potential impact on health plan and pharmacy budgets, researchers have conducted economic analyses, including cost-effectiveness analyses, to understand the value of the new medications.
New analysis from Avalere finds that only 16 percent of silver exchange plans in 2015 cover all top HIV drug regimens with cost sharing less than $100 per month per regimen. While almost half of plans include all 10 of the most commonly used HIV regimens on their formularies, many plans charge higher out-of-pocket costs for these drugs.
Pharmacists are increasingly providing direct patient care based on each state's scope of practice regulations in a variety of settings spanning inpatient, outpatient, and community pharmacies. Examples of these direct patient care services include immunizations, wellness and prevention screening, medication management, chronic condition management, and patient education and counseling. While opportunities for pharmacists to provide direct patient care services emerge, options for obtaining reimbursement for these services continue to be limited. Avalere Health assessed the current healthcare delivery and payment landscape to identify factors that can facilitate broader reimbursement of pharmacist services.
A new Avalere analysis finds fewer insurers are offering preferred provider organization (PPO) networks on exchanges in 2016. Specifically, from 2014 to 2016, the percentage of plans offering PPO networks dropped from 39 percent to 27 percent. This represents a 31 percent decline over the three year period. Meanwhile, use of health maintenance organization (HMO) and exclusive provider organization (EPO) networks has increased. In general, PPOs include a wider network of providers and cover more out-of-network care than HMOs and EPOs.1
In October, the American Cancer Society (ACS) released its recommendations for breast cancer screening. The guidelines, which apply to women with average breast cancer risk, recommend annual screening from age 45 to 54, with biennial screening recommended for women over age 55. This represents a notable departure from its 2003 guideline, which advocated annual mammography for women at age 40 and older. The dramatic change in screening recommendation is in line with the growing evidence of benefits and harms of breast cancer screening. However, varying guidelines from organizations, such as the U.S. Preventive Services Task Force (USPSTF) and National Comprehensive Cancer Network (NCCN) reveal that experts have not come to a complete agreement on this issue.
David Brancaccio of American Public Media's Marketplace Morning Report interviewed Dan Mendelson after Valeant Pharmaceuticals International ended its relationship with Philidor Rx Services.
