Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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Differential Impact on OCM Performance by Cancer Type During COVID-19 PHE
An Avalere analysis found that OCM episode spending remained below the benchmark price for prostate cancer and low-risk breast cancer during the COVID-19 public health emergency (PHE). However, spending continued to exceed the benchmark for other cancers. These patterns suggest a differential impact of the PHE on OCM performance and episode service use by cancer type.
More than 100 Drugs May Be Eligible for Negotiation Under BBBA by 2030
Avalere analysis estimates more than 120 drugs may be eligible for negotiation under the BBBA by 2030. This count reflects the cumulative nature of the policy.
Medication Adherence in Medically Underserved Areas
An Avalere analysis explores disparities in medication adherence for Medicare Part D beneficiaries living in medically underserved areas (MUAs) and non-MUAs.
Ex-US Approaches to Drug Accelerated Approval
International methods of expedited approval offer approaches that policymakers may adopt to reform the US system, as signaled in recent legislative proposals.
CAR-T Reimbursement Continues to Evolve in FY 2023 IPPS Proposed Rule
Policy proposals for Medicare’s CAR-T inpatient reimbursement build on market developments as bundled payment incorporates additional treatments.
White-Bagging Legislation Gains Popularity in State Legislatures
In recent years, payers and pharmacy benefit managers (PBMs) have been interested in implementing strategies that may reduce overall costs, such as the use of white bagging. However, provider and patient groups have raised concerns that these tactics may create access to care, cost, and safety issues. Legislation seeking to regulate this practice is on the rise in many state legislatures.
MQii Roundtable Proceedings / Malnutrition and Health Equity
Successful initiatives to address malnutrition and food insecurity through quality measurement and community partnerships are improving malnutrition care across the country and addressing health equity.
Underrepresented Groups Would Save with Part D OOP Cap
As policymakers continue to consider reforms to the Part D benefit design, an Avalere analysis finds that a disproportionate share of disabled beneficiaries and racial/ethnic minority groups, including Black and Hispanic beneficiaries, would have out-of-pocket (OOP) costs above $2,000 in 2024, indicating that an OOP spending cap under Part D benefit redesign may particularly benefit these patient populations.
Addressing Climate Change Impacts on Health
As climate change continues to alter the patterns of everyday life, healthcare stakeholders should consider strategies to prevent and mitigate negative environmental contributions and proactively address the impacts of climate change on health outcomes, health equity, and healthcare costs.
Global Malnutrition Composite Score Included in IPPS Proposed Rule
The proposed inclusion of the Global Malnutrition Composite Score in the Hospital Inpatient Quality Reporting Program will enable hospitals and their patients to benefit from identifying and addressing malnutrition. The measure’s use facilitates high-quality and comprehensive nutrition care that begins in the inpatient setting and continues across transitions of care.
340B Hospital Child Sites and Contract Pharmacy Demographics
Avalere analysis finds that 340B child sites and contract pharmacies are often located in less diverse and higher income ZIP codes than their disproportionate share hospital parent entities.
Health Plan Roles in Addressing Health Equity with Quality Measures
Quality regulators are implementing new requirements and performance measures to expand health equity expectations for health plans. Avalere describes common approaches and identifies data-driven strategies to respond.
Final CMS Alzheimer’s Coverage Memo Will Impact Access Beyond Medicare
The final CMS NCD for amyloid beta-targeting monoclonal antibodies for Alzheimer’s Disease establishes a dual pathway to Medicare coverage based on FDA approval and likely creates access and operational challenges for stakeholders.
Socioeconomic Factors May Impact Patient Access to Cell Therapies
Analysis finds that patients face barriers to cell therapy treatments regardless of proximity to cell therapy treatment sites.
Medicare Draft NCD for Alzheimer’s Drugs Poses Equity Questions
Avalere analysis seeks to understand potential access to clinical trial sites by race, given the draft requirement to ensure diverse participation.
Enrollment in MA Plans with SSBCI Nearly Quadrupled Since 2020
In 2022, nearly 4.5 million beneficiaries are in Medicare Advantage (MA) plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI), compared to 1.2 million in 2020, the first year these benefits were available.
Microarray Patches Could Improve Pandemic Vaccination
The rollout of COVID-19 vaccines highlights the need for continued innovation in how vaccines are delivered.
Shaping Health Equity Policy in 2022
Multiple health equity focused policy proposals are expected in 2022. Healthcare organizations should be primed to engage in comment periods and evaluate readiness for changes to quality measures.
How Healthcare Staffing Shortages Are Changing the Labor Market
A nationwide shortage of clinical and non-clinical professionals is straining the healthcare industry. Every part of the health ecosystem is making contingency plans for this ongoing and worsening labor shortage. Solutions range from traditional market approaches of wages and benefits to innovative staffing activities and advocating for policy changes.
PREVENT Act Creates Opportunities for Life Sciences
The COVID-19 pandemic identified gaps in US public health infrastructure and resources, prompting policy proposals and opportunities for stakeholder engagement.