Research /

Avalere Health performs incisive and objective analytic research, focused on the intersection of business and policy, on behalf of a diverse customer base that includes healthcare companies, non-profits, foundations, and government. Our research portfolio includes studies of the impact on diabetes patients of reimbursement policies for new diabetes technologies, Medicaid cost containment policies, and the Medicare prescription drug benefit. Below is a sample of diabetes-focused projects from our research portfolio. Take a moment and broaden your view.

University of Michigan Center for Value-Based Insurance Design (VBID)
Value-Based Insurance Design in the Medicare Prescription Drug Benefit/ An Analysis of Policy Options
This white paper presents options for advancing a VBID approach within the Medicare’s prescription drug benefit (Medicare Part D). Avalere and its research partners examined how VBID can be implemented in the current environment and whether legislative or regulatory changes are necessary. According to the analysis, Medicare Part D plans currently have three options for immediately implementing VBID, while two other options exist that require changes to existing legislation or regulation. The paper’s findings may help guide policymakers considering VBID as a potential approach to reforming Medicare or organizations focused on benefit design, such as health plans, pharmacy benefit managers, and employers.

Association for Community Affiliated Plans
Medicare Advantage Special Needs Plans / Six Plans' Experience with Targeted Care Models to Improve Dual Eligible Beneficiaries' Health and Outcomes
This report profiles six not-for-profit Medicaid managed care plans and how they are using Medicare's Special Needs Plans (SNP) authorization to develop targeted care models to better serve dual eligible beneficiaries.  Despite variation in their geography, plan size, and relationship to their Medicaid programs, all of the profiled plans invest across four key dimensions: coordination of the Medicare and Medicaid benefit, intensive case management for high-risk members, links to community social services, and benefit design to fund enhanced care coordination and fill coverage gaps.  These plans' "high-touch" care approach may be instructive for any future efforts to promote managed care offerings to dual eligible and other frail Medicare beneficiaries and make modifications to the SNP program.

National Business Coalition on Health (NBCH) University of Michigan Center for Value-Based Insurance Design (VBID)
Assessing Value in Pharmacy Benefits / Do Employers Have the Right Tools?
This white paper studies the existing measures available to employers to assess the value of pharmacy benefits they provide their employees. Conducting an in-depth examination of the metrics and tools currently available to employer decision-makers, Avalere and its research partners conclude that employers lack reliable ways to evaluate the value of the pharmacy benefits they purchase. Of the over 175 existing pharmacy benefit related measures identified in the analysis, only 4 percent focus on value. The paper's findings may help guide future development efforts and priority-setting activities by employers, measure developers, and other quality-focused organizations.

American Diabetes Association
The Impact of the Medicare Prescription Drug Benefit on People with Diabetes
This white paper examines out-of-pocket exposure for people with diabetes under the new Medicare drug benefit. The analysis shows wide variation in impacts by income; people with incomes at 150% of poverty spend an estimated 21% of their income on diabetes medications and blood glucose screenings. Monitoring all Medicare beneficiaries with diabetes as they transition into private drug plans is critical as many of them will be experiencing formularies for the first time, and non-compliance with their drug regiment can result in costly medical complications.

California HealthCare Foundation
The Medicare Drug Benefit: Implications for Chronic Disease Care
Part of a series of publications exploring the potential impact of the Medicare drug benefit in California, this issue brief examines the transition of chronically ill patients into private drug plans. The paper makes several recommendations to ensure that beneficiaries get the information they need to make decisions about their care, that utilization management tools do not create unintended barriers to drug access, and that necessary medication regimens are uninterrupted. Recommendations include encouraging CMS to carefully monitor adherence to chronic care guidelines, ensuring that patients with chronic illness have effective assistance in choosing a plan, and requiring plans to share selected utilization data with states.

California HealthCare Foundation
Medicaid Disease Management Overview
Disease management continues to garner the attention of health policymakers as more and more states look to disease management initiatives to improve quality outcomes for beneficiaries with chronic conditions and to reduce health costs. This slide presentation, completed on behalf of the California HealthCare Foundation, provides an overview of disease management in Medicaid and incorporates lessons learned from some of the first Medicaid disease management programs.

Center for Insulin-Dependent Diabetes Access
Special Paper: The Center for Insulin-Dependent Diabetes Access Reimbursement Advisory Panel Meeting Summary
This paper, published in Diabetes Technology & Therapeutics, summarizes the proceedings of a panel on patient access to existing and new treatments for Type I diabetes. Panelists noted that despite clinical evidence, many important therapies are unavailable to patients due to reimbursement barriers. Panelists also discussed new technologies for the treatment of Type I diabetes such as islet cell transplantation, and identified possible next steps to obtain widespread coverage and payment for these technologies.

Center for Insulin-Dependent Diabetes Access
Reimbursement of Diabetes Services and Supplies in Five State Medicaid Program
This brief analyzes Medicaid reimbursement for diabetes-related services and supplies to determine whether access is being unnecessarily restricted in the drive to cut costs. It provides an overview of benefit guidelines and reimbursement levels in five states — California, Colorado, New Jersey, Texas, and Washington. The brief also examines diabetes disease management programs in the five states. It concludes that Texas and California have potentially restrictive policies in place for the coverage of insulin pumps, and that access to these technologies needs to be monitored proactively going forward.

Duke University
Medicaid Cost Containment and Potential Effects on Diabetic Patients
Diabetes is the sixth leading cause of death among adults, and one of the major cost drivers in the Medicaid program. This study assesses whether states that implemented cost containment for diabetic patients are also tracking the quality of patient care. It finds that most states are not collecting or studying data on HbA1C levels, and are not monitoring the effects of restrictive preferred drug lists (PDLs) on Medicaid beneficiaries with diabetes. It concludes that states and the federal government need to ensure that resources are available to monitor and assess quality under PDLs.