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, nonprofits, foundations, and government. Our research portfolio includes studies of top healthcare reform issues, including policies for reimbursement for new treatments and technologies, value-based payment, long-term care, and expansions of entitlement programs. Below is a sample of projects from our research portfolio.

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 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.

SCAN Foundation
Long-Term Care --- an Essential Element of Healthcare Reform
This chart book examines the role of long-term care in broader healthcare reform efforts. Through original and secondary research, the authors focused on four key points: long-term care users constitute the majority of Medicaid spending; home health and hospice Medicare post-acute care services may fill-in for long-term care; Medicare and Medicaid spending for dual eligible beneficiaries is often uncoordinated; and a significant amount of long-term care has been financed privately. Researchers conclude that reform efforts should carefully consider the healthcare needs of the long-term care population as well as leveraging private financial resources in order to strengthen the long-term care system.

The Council for Quality Respiratory Care
Home Oxygen Therapy: An Analysis of Recent Medicare Payment Policy
Companies that provide home oxygen to Medicare beneficiaries face estimated total payment reductions of more than $800 million in 2009, says an analysis conducted by Avalere Health.  Avalere’s assessment finds that by 2009, the average Medicare payment for home oxygen therapy will be less than half of what it was back in 1997.

National Institute for Health Care Management
Getting to Value
This paper outlines four primary barriers to recognizing and rewarding value in the U.S. healthcare system. According to the authors, these four barriers – measuring value, capturing appropriate data, coordinating efforts, and rewarding system-wide improvements – will require extensive coordination among stakeholders and strong leadership from the federal government. The paper concludes with concrete recommendations for addressing these issues and promoting fair, objective, and patient-focused dialogue among stakeholders.

Medical Imaging & Technology Alliance
Diagnostic Imaging / Spending Trends and the Increasing Use of Appropriateness Criteria and Accreditation
This report examines recent efforts by physician leaders, health plans, and manufacturers to optimize the utilization of medical imaging services. Focusing on the development and use of clinical appropriateness criteria, accreditation programs, and physician education, the authors profile forward-leaning efforts to target the right services to the right patients. The report concludes that these non-traditional utilization management strategies may serve as valuable tools for policymakers and researchers contemplating Medicare reform.

The Health Information Summit
Summary
The United States should act quickly and decisively to reform healthcare by putting people first, creating a reliable and predictable system that delivers quality care, and instituting a system that pays for value, says a unique panel of some of the nation’s most respected healthcare leaders.  Avalere Health recently convened the group at its first-ever summit on health information – “The Power of Information/New Directions in Health System Reform” – as a way to further policy discussions centered on creating meaningful and more immediate systemic health reform.  

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.

Georgetown University
Linking Medicare and Private Health Insurance for Long-Term Care
This paper proposes that a restructured Medicare could offer catastrophic long-term care coverage if beneficiaries purchase a pre-approved private long-term care insurance policy. The core concept involves two steps:  redeploying certain entitlement funding to create catastrophic long-term care coverage and leveraging the purchasing clout of the Medicare population to create a more favorable environment for private long-term care insurance. The authors posit that this public-private approach to long-term care financing reform is a sustainable way to simultaneously protect consumers from catastrophic costs of chronic illness and better develop the private insurance marketplace.