Avalere Health

More programs drop out of Pioneer ACO pilot

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The Pioneer Accountable Care Organization program is now down to 19 programs, out of an original 32, worrying those who have pushed for skilled nursing facilities to embrace the concept.

Episode-based payment the focus of Sept. 23 McKnight's webinar

Episode-based payment the focus of Sept. 23 McKnight's webinar

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As value-based payment and delivery models take hold in Medicare, providers must shift their focus from managing stays to managing episodes of care. Experts from Avalere Health leading a McKnight's Sept. 23 free webinar will delve into how key episode-level data can help long-term care managers form strategies for participating in new models and networks.

Hospitals cast a wide net for SNF patients

Hospitals cast a wide net for SNF patients

For skilled nursing facilities it's a struggle to stay ahead of the Medicare initiatives and market forces that are causing hospitals and health systems to narrow their post-acute care networks. With so many competing priorities — the alphabet soup of BPCI, ACOs, VBP, etc. — it can be hard to stay ahead of all the changes.

Positioning for narrowing PAC networks

Positioning for narrowing PAC networks

Variation and growth in post-acute care spending has earned PAC a spot on hospital and health systems' priority list for cost-saving opportunities. The success of new care delivery models — particularly hospital-driven bundles and accountable care organizations — also is dependent on reduced utilization and episodic cost management in non-hospital settings.

 New payment models present opportunities for SNFs

New payment models present opportunities for SNFs

For skilled nursing facilities, the Medicare SNF 3-day rule can make it difficult to place the right patients in the right setting at the right time. The 3-day rule requires that a Medicare beneficiary spend three nights in a hospital as an inpatient — observation stays do not count — before becoming eligible for Medicare-covered SNF care. This rule creates a challenge for SNFs as hospital lengths of stay decline for many of the conditions that SNFs treat.

Avalere Health begins partnership with Pope Woodhead & Associates

Avalere Health will expand internationally through a partnership with Pope Woodhead & Associates, a European-based consulting firm. The latter's specialties include regulatory strategy, pricing and market access solutions for entering into the European market.

Increase understanding of MSPB at June 5 webinar

Increase understanding of MSPB at June 5 webinar

A June McKnight's webinar will focus on understanding the Medicare Spending Per Beneficiary Measure and give tools for better conversations with hospitals or PAC providers.

Seidman begins at Avalere

Seidman begins at Avalere

Avalere Health has appointed Joshua Seidman, Ph.D., to lead its new Center for Health Delivery & Payment Innovation.

Final rate notice signals continued pressure on Medicare Advantage payments

Final rate notice signals continued pressure on Medicare Advantage payments

CMS recently finalized Medicare Advantage plan payment rates for Calendar Year 2015 and announced other changes to payment and program policies for MA and Part D plans. Although the announcement included some positive changes for plans, the overall impact is mostly negative.

Avalere Health welcomes Fuller

Avalere Health welcomes Fuller

Brian Fuller began as a director at Avalere Health in early March.

Don't miss a webinar on bundled payments March 7

Don't miss a webinar on bundled payments March 7

Learn the basics of the bundled payment program offered by CMS in a webinar featuring expert Ellen Lukens.

Keeping score in 2014

Keeping score in 2014

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If new payment reform initiatives sowed the seeds of small disruptions in 2013 -- narrowing referral networks and prompting clinical integration, those seeds will start sprouting bigger disruption across multiple markets in 2014. This year ACOs will proliferate and will include SNFs in a real way. Bundled payment experiments will be beginning all over the country.

Learn how to use scorecards at Feb. 6 webinar

Learn how to use scorecards at Feb. 6 webinar

Speakers from Avalere Health will demonstrate how post-acute care providers can reduce costs and improve quality.

Fewer Medicare Advantage plans in 2014, analysis finds

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There will be fewer Medicare Advantage plans in 2014, according to a new analysis. The number of plans will drop to 2,522, which is around a 5% decrease, according to Avalere Health. Medicare Advantage can cover skilled nursing stays, and enrollment was up in 2012.

Bullock moves to Avalere Health

Bullock moves to Avalere Health

Avalere Health LLC has appointed Carrie William Bullock to its reimbursement and product commercialization services practice. Her new role will have Bullock addressing strategic and tactical issues throughout the lifecycle of medical technologies with a specific focus on diagnostics, devices, and drugs and biologics.

Eyles joins Avalere

Eyles joins Avalere

Matthew D. Eyles has joined Avalere Health as executive vice president.

New VP at Avalere

Matthew D. Eyles has joined Avalere Health as executive vice president. He arrives from Coventry Healthcare.

Savvy post-acute care providers are seeking creative partnerships with hospitals, experts say

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Post-acute care providers should be considering creative joint ventures with hospitals to best take advantage of evolving healthcare delivery and payment systems, healthcare finance and legal experts said Wednesday in an Avalere Health webcast.

Managed care: Panacea, death knell or something in between?

Managed care: Panacea, death knell or something in between?

In a nutshell, troubled long-term care operators seem to be encountering this scenario with managed care companies: initial romance, followed by heightened accountability and reduced payments.

Analysis: Medicare sequester cuts would reduce SNF payments by $9 billion over 10 years

Analysis: Medicare sequester cuts would reduce SNF payments by $9 billion over 10 years

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Skilled nursing facilities in the most populous states will be the hardest hit if Congress enacts the 2% across-the-board cut in Medicare payments to providers, two new analyses predict.

Integrated care coordination for dual eligibles lowers readmission rates in case study

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Dual eligibles in an Arizona integrated coordinated care plan had a 21% lower hospital readmission rate than their counterparts in Medicare fee-for-service programs, a new analysis reveals.

In wake of Supreme Court ruling, states weighing Medicaid options

In wake of Supreme Court ruling, states weighing Medicaid options

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Many states are considering their options in the wake of a seemingly favorable Supreme Court ruling. The nation's highest court ruled that Congress exceeded its reach when it threatened states with a total Medicaid funding cutoff if they failed to participate in an expanded Medicaid program.

Hospital readmission penalties could transform relationships with SNFs, experts say

Hospital readmission penalties could transform relationships with SNFs, experts say

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Healthcare reform efforts targeted at reducing hospital readmissions are here to stay, experts told participants in a McKnight's webcast Tuesday.

Lawmakers should weigh costs associated with dementia when coordinating care for Medicare beneficiaries, analysis suggests

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As policymakers seek to integrate care for dual eligibles, they need to consider the cost of treating beneficiaries with dementia, new data suggests.

SNFs prepare to absorb nearly $800 million in Medicare cuts

SNFs prepare to absorb nearly $800 million in Medicare cuts

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Medicare cuts scheduled to hit in January will cost skilled nursing facilities close to $800 million in fiscal year 2014, a new analysis estimates.

Ten states to absorb majority of Medicare bad debt funding cuts, report finds

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Bad debt provisions of recent legislation will cut skilled nursing facility payments by nearly $3 billion between 2012 and 2021, with a handful of states bearing the brunt of it, a report finds.

Bundled payments and dual-eligibles bring opportunities to long-term care operators, experts say

Bundled payments and dual-eligibles bring opportunities to long-term care operators, experts say

Gainsharing and caring for dual eligibles are hot topics for healthcare providers — and rightfully so — experts said Thursday.

Footloose with Medicare dollars?: Investigators concerned by sharp increase in artificial feet

Physicians and federal investigators are concerned about a dramatic surge in Medicare spending for artificial feet for beneficiaries. While the number of diabetes-related lower limb amputations is falling, Medicare spending on artificial feet grew 60% in the last few years, according to an Associated Press investigation.

As states cut Medicaid funds, nursing home group proposes bad debt fix

Forty states have either frozen or cut Medicaid-financed nursing home care for seniors between 2009 and 2011, a new survey has found.

SNFs should focus on partnerships, quality, to weather uncertain future, experts say

In order to survive an uncertain financial and regulatory environment, skilled nursing operators need to look at partnering with other healthcare systems and improving the quality of care, analysts say.

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