CMS has until September 1 to announce the #MFP for negotiated drugs in IPAY 2026, but manufacturers of competitor products should be thinking through their response strategy now. The #IRA requires coverage on all #PartD plan formularies, which will impact contracting dynamics for 2026. Connect with Milena Sullivan, Megan West (Olsen), or another #AvalereExpert today to learn more: https://lnkd.in/eZiys9me #InflationReductionAct #DrugPricing #Medicare #healthpolicy
Avalere
Business Consulting and Services
Washington, DC 15,495 followers
Part of Avalere Health
About us
Avalere, part of Avalere Health , is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, D.C., the firm delivers actionable insights, business intelligence tools, and custom analytics for leaders in healthcare business and policy. Avalere's experts span 200+ staff drawn from Fortune 500 healthcare companies, the federal government, and top consultancies and nonprofits. The firm offers advisory services on a wide range of healthcare business issues affecting healthcare companies. Avalere’s focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. Avalere sits within the Policy, Access, Value, and Evidence discipline of Avalere Health and collaborates with colleagues across the firm to offer actionable, thoughtful guidance to clients. Visit AvalereHealth.com to learn about our full Policy, Access, Value, and Evidence offering.
- Website
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http://www.avalere.com
External link for Avalere
- Industry
- Business Consulting and Services
- Company size
- 201-500 employees
- Headquarters
- Washington, DC
- Type
- Public Company
- Specialties
- Health insurance and reform, Evidence-based medicine, Reimbursement and product commercialization, Health economics and outcome research, Healthcare networks, Post-acute and long-term care, Data analytics and modeling, and Financial Services
Locations
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Primary
1201 New York Ave NW
Suite 1000
Washington, DC 20005, US
Employees at Avalere
Updates
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The Wall Street Journal released an analysis estimating that #Medicare paid #MedicareAdvantage plans $50 billion for diagnoses that were either not made by a member’s physician or not associated with subsequent care. The article brings a complex topic into the public sphere, and we are already expecting CMS to resume #RADV audits. #Healthplans should not only review their internal programs to ensure program integrity but should also conduct primary research to provide evidence to counter some of the points made. We've helped health plan clients enhance risk adjustment program integrity and audit preparedness while also identifying significant additional revenue from data leakage in the plan’s claims adjudication and submission process. Let’s connect about how we can help: https://lnkd.in/eWHHXKNx
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📅 MARK YOUR CALENDARS! 📅 Tomorrow at 2pm ET, #AvalereExpert Maddi Davidson will be speaking with colleagues at the Community Oncology Alliance about CMMI's recently reopened Enhancing Oncology Model. Click here to register and learn more: https://lnkd.in/e2hkaESP
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After years of delays, new drug price transparency requirements may be on the horizon. In a new Insight, #AvalereExpert Kolton Gustafson, MPH details the history of recent transparency initiatives and what stakeholders need to know about the increased availability of information related to negotiated prices on drugs and other services: https://lnkd.in/egNM8_rS #drugpricing #pricingtransparency #lifesciences #lifesciencesindustry #healthpolicy #healthcare #IRA #InflationReductionAct
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Join #AvalereExpert Maddi Davidson on Wed, July 10 at 2pm ET for a webinar hosted by Community Oncology Alliance on the recently reopened Enhancing Oncology Model. Maddi and COA colleagues will be discussing changes to the model and considerations for stakeholders going forward. Register here: https://lnkd.in/e5t79u2H #oncology #oncologycaremodel #AvalereInAction
In response to feedback from participants and advocacy organizations, CMMI will reopen the Enhancing Oncology Model (EOM) for interested practices. Join COA for a webinar on July 10 at 2 p.m. ET to hear from policy experts on the impact of changes to the #EOM, and from practices who are currently in the EOM or deferred participation in the first round. Speakers will review the changes to the EOM, share feedback COA has heard from practices, and discuss important considerations for practices as they think about joining the second cohort.
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Extending from payer to point-of-care, our Payer Marketing approach drives agile strategies and impactful engagements that meet the full spectrum of access needs across the patient journey. Learn more and connect with us: https://bit.ly/3XEt5pn #AvalereHealth #MarketAccess #HealthcareMarketing #PayerMarketingAgency
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Read our #AvalereExperts' key takeaways from the proposed changes to CMS's CY 2025 #ESRD Prospective Payment System that will impact #kidneycare stakeholders. To learn more about the CMS proposal to revise the ESRD bundled market basket, subscribe to #AvalereHealth's Federal Policy 360: https://lnkd.in/eKAHn_C4 To hear more about this issue directly from our experts, reach out to Emily Belowich and check our 2024 outlook for the kidney care environment: https://lnkd.in/eQz38uwe
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Margia Argüello MSc, MBA and other #AvalereExperts understand that high-quality, inclusive healthcare efforts need to involve women from all racial and ethnic backgrounds. Read our latest analysis and research findings on how coverage, care, and outcomes related to women’s health and health services are shaped by policymakers, industry, plans, and advocates: https://lnkd.in/eFrc2RBN
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Over 1 in 5 US adults experiences a #mentalillness, yet many face significant barriers in accessing adequate care, with downstream implications for overall health outcomes, comorbidities, and system expenditures. To understand this complex issue, #AvalereExperts analyzed the relationship between mental health conditions, comorbidities, and overall spending, as well as geographic variations in reimbursement in mental health treatments. Read our findings: https://lnkd.in/eJqSKX48
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CASE STUDY: A large #healthplan recently sought to expand its access to #Medicaid coverage regions in a state with a large, diverse beneficiary population. We used our extensive understanding of the Medicaid program and specific state markets to showcase our client’s past successes and ability to expand in new regions with different demographics. The client not only successfully retained but also expanded its Medicaid footprint in the state, gaining access to 100% of the regions for which it submitted bids. Read about how we approached this project: https://lnkd.in/eZH3JeTR To learn more about our work with health plans, connect with #AvalereExperts Eric Levine and Michael Lutz: https://lnkd.in/ePasqdyP
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