Inpatient COVID-19 hospitalizations could cost the U.S. healthcare system between $9.6 billion and $16.9 billion in 2020, according to Avalere. Patient Affordability; Topic Description Timelines Source(s) of Authority Resources; Cost Sharing for COVID-19 Testing: Medicaid/Medicare: New cost-sharing requirements for COVID-19 testing have been established for Medicare, MA, and Medicaid. The analysis, released Thursday by Avalere, attributes the spike to special enrollment due to massive job losses caused by COVID-19.The boost in … The study, conducted in collaboration with the Community Oncology Alliance (COA), utilized Inovalon Provider Clearinghouse data, which represents 5%–7% of the Medicare fee-for-service (FFS) population. As for barriers to long-term telehealth adoption, technology access was the top concern, followed by provider reimbursement. This survey considers key areas regarding COVID-19: For nearly half of the payers surveyed, clinical effectiveness was the chief concern regarding future COVID-19 vaccines and therapeutics. For the payers surveyed, deferred or forgone care of patients did not rank among the top concerns. The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of health care, and oncology is no exception. Limitations on Delivery of Care due to COVID-19 Have Resulted in Significant Reductions in Cancer Screenings, Figure 3. Pfizer, Moderna and the University of Oxford are among the organizations to tout highly effective COVID-19 vaccines this month. One in three Medicare Advantage (MA) plans will start offering new supplemental benefits related to the COVID-19 pandemic next year, a new analysis finds. This website uses cookies to improve your experience. Avalere is a healthcare consulting firm dedicated to improving healthcare. Even as health-care workers battled Covid-19 in emergency rooms and intensive-care units across the country, the industry saw 1.4 million jobs vanish in … In early September 2020, Avalere conducted an online survey of 40 payers, including 39 US health plans and 1 PBM, representing roughly 48 million covered lives. Avalere Health An Inovalon Company 1201 New York Ave, NW Washington, DC 20005 P | 202.207.1300 avalere.com . Jennifer Sheets, Interim HealthCare's CEO, says the company has seen a “huge demand increase … we've got double and triple the referrals now coming in." Payer Expectations of Vaccine Reimbursement Timeline Following FDA Approval or Authorization, Figure 3. Access guidance and resources caring for a diverse patient population, including telehealth resources, patient engagement tools and more. Although the Coronavirus Aid, Relief, and Economic Security Act requires commercial insurers and employer-sponsored plans to cover a COVID-19 vaccine with 15 days of an Advisory Committee on Immunization Practices recommendation, providers will not need to be reimbursed for US government-purchased doses. Anticipated Changes in Telehealth Utilization After PHE vs. 2019 (Shown: Payers), Figure 5. For vaccines requiring a series of 2 or more doses, the initial dose(s) will be reimbursed at $16.94, and the final dose in the series will be reimbursed at $28.39. A NTAP for remdesivir would only likely be relevant after the COVID … Eighty-eight percent of payers surveyed plan to increase telehealth investment, integrating it into the 2021 plan year and beyond. Percentage of Plans Reporting Reduction in Preventive Services, by Service Type, Figure 4. Payers are generally more focused on the short-term economic impacts of COVID-19, including the costs of hospitalizations, vaccines, and therapeutics. The reimbursement rates for private insurers and Medicaid are still unclear. Tune into another episode of Avalere’s Journal Club Review podcast series on Avalere Health Essent... Sign up for the latest Insights from Avalere, Figure 1. The potential long-term impacts of COVID-19 on how Medicare Advantage's star ratings are calculated remain unclear, experts say. In summary, payers are more concerned with short-term pandemic impacts (e.g., COVID-19 hospitalizations and therapeutics) than with the reduction in preventive services utilization. The goal of the analysis was to examine over 6 million oncology claims to identify changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on access to cancer care, about those services ability to diagnose and treat cancer in a timely manner, and on the treatment journeys for patients. I founded Avalere Health in 2000, grew the firm organically as CEO, engaged ABS Capital as a minority equity partner in 2008, and sold the company to Inovalon (NASDAQ: INOV) in 2015. A report published by Avalere Health concluded at least 5 million Black and Hispanic individuals may ultimately lose their health insurance in 2020 as a … Our life sciences, plan, and provider clients count on us to help them anticipate and adapt to the latest industry trends. RELATED: Trump administration opens up … Additionally, all 50 states and DC have expanded telehealth coverage and reimbursement through Section 1135 waivers and executive actions. An estimate from consulting firm Avalere predicts that nearly 8 … Most payers (73%) expect up to 30% of future primary care visits to be conducted via telehealth (Figures 4–5). The rapid and widespread COVID-19 pandemic has put pressure on healthcare resources and L. No. 116-136 (Mar 27, 2020). According to a recent Avalere Health survey of 39 U.S. health plans and one PBM, collectively representing about 48 million covered lives, the effectiveness of vaccines and therapeutics is the top COVID-19 concern for more than 47% of health plans. With “the cavalry coming,” the focus is now shifting to how, when and where vaccines should be distributed. Seventy-eight percent of payers expect to begin reimbursing for COVID-19 vaccines within 4 months of Food & Drug Administration (FDA) approval or Emergency Use Authorization (EUA) (Figure 2). For 25% of plans, their top concern is the cost of a vaccine. The Centers for Medicare & Medicaid Services has provided additional telehealth flexibilities in Medicare, waiving cost sharing, allowing mid-year plan changes, and relaxing requirements. 27 Coronavirus Aid, Relief, and Economic Security Act, Pub. The home health industry, meanwhile, has boomed. “Coronavirus is definitely a reminder that health care is, in fact, a public good,” said Dan Mendelson, founder of healthcare advisory consultancy Avalere Health. Avalere research was published online in the Journal of Clinical Oncology Clinical Cancer Informatics, showing a considerable drop in cancer screening, diagnosis, and treatment for Medicare beneficiaries as a result of the ongoing COVID-19 pandemic. 1 | Avalere Health Copyright ©2020. Medicare set the rate at $28.39 for administering single-dose vaccines. I founded Avalere Health in 2000, grew the firm organically as CEO, engaged ABS Capital as a minority equity partner in 2008, and sold the company to Inovalon (NASDAQ: INOV) in 2015. COVID-19 has put such a strain on Indiana’s health care system that state officials are urging retired workers to return. COVID-19 Outlook and Q&A Session with Avalere Health & McKesson Published May 22, 2020 Brought to you by McKesson Watch this webinar to get answers to some top policy questions for general practices in a Q&A call hosted by McKesson and powered by healthcare policy experts from Avalere. Google Scholar; 28 Collins SR, Bhupal HK, Doty MM. Over 80% of payers cited decreases in screenings for cancer, hypertension, and diabetes—as well as child and adult immunizations—since the start of the pandemic (Figure 3). CMS Takes Steps to Expand Access to COVID-19 Antibody... Podcast: Designing Pull Funding for a COVID-19 Vaccine, COVID-19 and Influenza Vaccine Distribution Stakeholder Considerations, Payer considerations for vaccines and therapeutics, Short- and long-term impacts on telehealth. New Avalere Health analysis of Medicare fee-for-service (FFS) claims data reveals large decreases in skilled nursing facility (SNF) and home health care use following the widespread decline in inpatient hospitalizations amid the response to the COVID-19 pandemic. E4– Get the Facts on COVID-19: The Future of Healthcare Delivery by Avalere Health published on 2020-03-30T21:24:06Z In the fourth episode of this series, Avalere experts discuss the impact of the COVID-19 pandemic on care delivery and the future of telehealth. It remains unclear the full extent of changes to the latest industry trends home health industry, meanwhile, boomed! An Inovalon Company 1201 New York Ave, NW Washington, DC 20005 P | 202.207.1300 avalere.com 2020, to! 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