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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Pioneer ACOs First Year Results: Better Success in Improving Quality than Lowering Costs
The Centers for Medicare and Medicaid Services (CMS) released long-awaited data about the first-year of the Pioneer ACO program.
New Issue of State Reform Insights Released
States, HHS Focus on Final Details as Exchanges Ready for Launch
The Joint Commission and AMA Identify Five Medical Treatments that May Be Overused
The Joint Commission and the American Medical Association (AMA) Convened Physician Consortium for Performance Improvement® released a report on July 8, which was previously under an embargo, focusing on the overuse of tests, treatments, or procedures that provide zero to negligible benefit and expose patients to risk of harm.
Exchange Operational Models for 2014
In 2014, most states are relying on the federal government for some or all exchange operational functions.
Labs May See Payment Cuts if CMS Revalues Medicare CLFS Codes
CMS plans to revalue the oldest laboratory service codes first. An Avalere analysis found pre-1997 codes accounted for nearly 37% of Medicare Clinical Laboratory Fee Schedule (CLFS) spending in 2011.
Six States Expected to Start Duals Demos In 2013
Overall, implementation of the duals demonstrations is slower than expected and states continue to delay.
New Research Tracks Impact of CER
New Avalere research found that public and private payers reversed non-coverage policies following a recommendation from a regional CER initiative.
New Research: Real World Evidence
New Avalere research shows market demand for real world evidence (RWE), but a lack of stakeholder consensus on how to define it.
Do You Know Where Your Patients Are Going?
Emerging payment models will demand that hospitals establish tight and narrow networks of high performing post-acute care (PAC) providers.
Innovative Strategies to Boost Medication Adherence
A new literature review concludes that prescription drugs, when used appropriately, are often the most cost-effective component of the health care delivery system.
Analysis: Access to Anticonvulsant Therapy
An Avalere analysis found that Medicare prescription drug plans (PDPs) had lower levels of coverage and fewer medicines on less expensive formulary tiers than commercial health insurance plans, potentially impacting patients' access to anticonvulsants.
SGR Patch in 2014 Likely
Congress is likely to pass another short term doc-fix for CY2014.
FDA Sets Precedents on Abuse-Deterrent Product Regulation
Recent FDA decisions should act as a blueprint for generic and brand manufacturers of innovator products.
Three Critical Factors for Exchange Success
Avalere estimates that exchanges will enroll 8 million individuals and families in 2014, growing to 26 million in the next decade.
What You Need to Know About DSH Cuts
With DSH cuts looming, hospitals should enroll patients in coverage programs to minimize the burden of uncompensated care.
Providers Look to Telemedicine to Manage Risk
The growing pressure to manage patient care post-discharge in an efficient manner will drive significant growth in telemedicine over the next few years.
Three Strategies to Reduce PAC Spending
Nowhere are there more opportunities for savings than in post-acute care (PAC) settings.
Three Strategies to Manage High-Cost Populations
To drive down costs, focusing exclusively on managing chronic illness misses the boat.
Reinventing the American Hospital
In this new era of payment reform, understanding patient populations and capabilities of providers outside of the hospital will be critical to success.
Rx Coverage in Exchanges to Vary by State
The number of drugs health plans are required to cover in the individual and small group markets will vary dramatically by state in 2014.