MACRA and the Promise of Better Patient/Family Engagement in Post-SGR World

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.

  • Josh Seidman
  • Nelly Ganesan

New Study Finds that Clinical Pathways Are Being Used to Improve Quality and Control Cost but Concerns Remain

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.

  • Kristi Mitchell
  • Nelly Ganesan
  • Archive

CMS Releases Comprehensive Care for Joint Replacement (CCJR) Model

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.

  • Archive

Exchange Plans Include 34 Percent Fewer Providers than the Average for Commercial Plans

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.

Focus on Innovation: FDA’s Rare Pediatric Disease Priority Review Voucher Program

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.

  • Kelly L. George
  • Gillian Woollett
  • Archive

Do CMS Measures Measure Up?

Recently, Avalere presented on the issue of quality measures and clinical practice guidelines at Academy Health. We sat down with one of the researchers, Avalere's Minnie Song, to discuss this research.

FDA and Sponsors Discuss Quality Challenges in the Breakthrough Therapy Pathway

Need to Know: On June 10, Friends of Cancer Research held a public meeting to discuss how sponsors and FDA may be able to expedite rate-limiting steps in Chemistry, Manufacturing, and Controls (CMC) and current Good Manufacturing Practices (cGMPs) for breakthrough therapy designated products, while ensuring an adequate supply of safe and efficacious product at the time of approval.

  • Kelly L. George
  • Gillian Woollett
  • Kristi Mitchell

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