With complex rules and logic, risk adjustment submissions are challenging. Make sure your risk adjustable claims make their way all the way from intake to submission regardless of the source of your claims, be they generated in-house or by a vendor. We recently helped a plan recoup $20M in missed risk adjustment reimbursement through a stringent review of their data. Contact us to find out how we can help analyze your data at every step of the process to improve the accuracy and completeness of your risk adjustment submissions: https://lnkd.in/ejepc_X6 #riskadjustment #healthplans
Avalere
Business Consulting and Services
Washington, DC 15,604 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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💡 NEW ANALYSIS 💡 #AvalereExperts Kylie Stengel, Kelly Brantley, Nadia Mercado, and Shruthi Donthi examined historic trends to assess whether the recent decrease in LIS benchmark plan options under the #IRA correlates with more LIS enrollees paying premiums for their #PartD coverage. They found that that from 2023 to 2024, the number of LIS enrollees paying a Part D premium increased by more than 1 million. Read their detailed findings: https://lnkd.in/eCcnKaq8 #InflationReductionAct #Medicare #MedicarePartD
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While the FDA’s final rule on #LDTs was released in April, the impact is still being felt across the industry. #AvalereExpert Laura T. Housman, MPH, MBA, DrPH(c) shares her perspective on how stakeholders should take advantage of this new landscape. Read her article in MedTech Intelligence: https://lnkd.in/e5Ke2UFD #labdevelopedtests #diagnostics #healthpolicy
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In overturning Chevron deference, the Supreme Court opened several questions on the future of #healthpolicy, with wide-ranging implications for life sciences firms, health plans, provider groups, patient organizations, and other #healthcare stakeholders. Tap into Avalere’s deep bench of #healthpolicy experts with extensive experience in federal agencies and rulemaking to navigate what the rule means for you. Connect with us here: https://lnkd.in/eV3uymgQ #lifesciences #lifesciencesindustry #healthplans #patients #providers #ChevronDeference
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The 2025 plan year has been extraordinarily tumultuous, and there are multiple reasons a health plan’s estimate of the #NAMBA may be less precise than in other years. In a new Insight, #AvalereExperts Emily Gillen, PhD, Kirsten Stryker Blasch, Nadia Mercado, and Sean Creighton explain how the drivers of this uncertainty--combined with increased plan liability under the #IRA--necessitate plans to strategize for their Rebate Reallocation process. Read their analysis: https://lnkd.in/etd5wthU
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In the second installment of our Health Plan series, #AvalereExperts examine how clinical care will shift in reaction to changes in demographics, technology, and environmental factors. Read the latest from Eric Levine, Michael Lutz, Shelby Harrington, Chani S. Seals, and Kirsten Stryker Blasch: https://lnkd.in/eUKhj44e Read the first Insight in this series, how plans can evolve their approaches to provider contracting and utilization management for the future.: https://lnkd.in/ecYKtZCH
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As #lifesciences companies consider their #HEOR budgets for the coming year, leaders have the opportunity to revisit their portfolio’s research and evidence needs in order to support their company’s overall commercialization strategy. In a new Insight, Taylor Schwartz, Laura T. Housman, MPH, MBA, DrPH(c), Nancy El Hoyek, Josephine Lloyd, and Nicole Betor detail the top 5 elements of a robust HEOR strategy: https://lnkd.in/epsnvH9q
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Avalere reposted this
Avalere Health CEO Jon Koch attended ISPOR—The Professional Society for Health Economics and Outcomes Research 2024 to hear how life sciences and medical device companies are approaching whole-person health – an all-encompassing way of understanding the patient’s entire lived experience. Learn how effective and holistic data integration can make this a reality in Jon’s article with Pharmaceutical Executive: https://bit.ly/3S3FwHF #WeAreAvalereHealth #AvalereHealth #MarketAccess #HealthCareMarketing #HEOR
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#AvalereExpert Sean Creighton recently spoke with Modern Healthcare about how the Supreme Court's overturn of Chevron deference may impact the Dual Eligible-Special Needs Plan market, and the potential for future litigation. Read the article: https://lnkd.in/g3dvC_hp Connect with Sean and other #healthplans experts: https://avalere.com/plans #Chevrondeference #healthpolicy #dualeligibles #DSNPs #Medicare #Medicaid
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In overturning Chevron deference, the Supreme Court opened several questions on the future of #healthpolicy, with wide-ranging implications for life sciences firms, health plans, provider groups, patient organizations, and other #healthcare stakeholders. Tap into Avalere’s deep bench of #healthpolicy experts with extensive experience in federal agencies and rulemaking to navigate what the rule means for you. Connect with us here: https://lnkd.in/eV3uymgQ. #lifesciences #lifesciencesindustry #healthplans #patients #providers #ChevronDeference
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