The third annual open enrollment period for exchanges will kick off on November 1. As patients and the healthcare industry prepare for the 2016 plan year, below are critical questions for the future of exchanges:
How can you position your organization for new payment models that emphasize quality of care over quantity of services performed or therapies sold? Engage patients. In this short video, Josh Seidman, Avalere Payment & Delivery Innovation, defines the key imperatives to creating a successful patient engagement strategy that will bring your organization to the forefront of the industry's transition from fee-for-service to value-based care.
In recognition of National Healthcare Quality Week, we sat down with Avalere expert Nelly Ganesan to discuss upcoming trends and developments for physician quality measurement.
There is increasing consensus that comprehensive transformation of the healthcare system cannot be achieved without the engagement of patients, their families, and healthcare consumers. One stream of thought is that arming consumers with actionable cost and quality data could activate them as partners in controlling healthcare costs, which are expected to grow from 17.4 percent of the U.S. economy in 2013 to 19.6 percent in 2024.1 Although evidence remains mixed, some studies have shown that when patients are given easily digestible cost- and quality-of-care data, they choose high-value options.2,3
Recently, CMS released a Request for Information (RFI) inviting public comment on three provisions related to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)-the Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and Physician-focused Payment Models (PFPMs). Comments are due to CMS by November 17, 2015. We sat down with Avalere's Josh Seidman to discuss what to expect from the RFI.
Despite evidence demonstrating the benefits of optimal nutrition for healing and recovery, practice variation continues in hospitals for nutrition screening, assessment, diagnosis, and overall treatment and management of malnourished adults ages 65 and older. In response, Avalere launched the Malnutrition Quality Improvement Initiative (MQII) to support the delivery of high-quality care for older adults. The MQII not only aims to support the use of timely best practices for malnutrition care in the hospital setting but may also reduce costs associated with poor patient outcomes.
As the FDA and the clinical laboratory industry continue to battle over the agency's draft guidance regulating laboratory developed tests (LDTs), and as election year looms, the FDA may advance its issuance of a final guidance.
Avalere Health partnered with the Advanced Medical Technology Association (AdvaMed) to evaluate the impact of innovative technology adoption on Medicare spending. The analysis found that, on average, Medicare spending for the most technology-intense hospitals matched the national rate for all other hospitals. However, top technology hospitals have a higher percentage of hospitals with spending rates that are lower than the national average.
Network design is playing a central role in health benefit design and health policy debates. The goals of enhancing clinical quality and improving the patient experience, while lowering the total cost of care, are increasingly at the forefront of these discussions. Our latest research finds that tiered and narrow network insurance designs are becoming more prevalent, particularly, in the exchange market.
The Affordable Care Act (ACA) created health insurance exchanges to enhance competition and make health insurance more affordable and accessible for individuals and families. Specifically, exchanges are online portals where individuals and small businesses can shop among qualified health plans (QHPs) that meet certain benefit and coverage standards. As of June 30, 2015, 9.9 million individuals nationwide were enrolled in exchanges.
According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for standalone prescription drug plans (PDPs) will increase and the number of PDPs available in 2016 will decrease. Conversely, Medicare Advantage (MA) premiums will decrease in 2016, and the number of MA plans on the market will increase, despite years of Affordable Care Act payment reductions.
A new analysis from the National Health Council (NHC) and Genetic Alliance, with research and analytic support from Avalere Health, identifies critical barriers hindering the advancement of meaningful patient engagement and outlines tactical next steps for actionable solutions.
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.
