DAY TWO | WEDNESDAY, JULY 17
8:30 REGISTRATION & WELCOME COFFEE
8:55 CHAIRPERSON’S OPENING REMARKS
9:00 ALIGNING PRICING & REIMBURSEMENT STRATEGY: OPTIMIZING ACCESS
Increasing numbers of coverage and reimbursement decisions are being driven by a focus on product cost or price over the health economic outcome of medical technologies, resulting in a need for greater collaboration and alignment between strategic pricing executives alongside reimbursement and market access teams. Striking the balance between reimbursement knowledge, understanding of health policy and payer decision making together with the financial business requirements of product pricing, creating a sustainable level of income as well as competitive factors is considerably difficult. Forward thinking organizations are integrating a level of alignment in pricing decision making, whereby prices are optimized within reimbursement frameworks and at the same time taking into account competitive factors and the need to financially support the bottom line.
Amit Kukreja, VP Global Reimbursement & Market Access
SECOND SIGHT MEDICAL PRODUCTS
9:45 PAYER INTERVIEW: EVALUATING EVIDENCE & MEDICAL POLICY DECISION MAKING
As the delivery of healthcare in the United States continues to evolve from a volume to value-based model with a foundation in positive economic and health outcomes, commercial payers within the marketplace are responsible for evaluating medical technologies to determine the medical necessity of products and procedures for populations served. With a focus on emerging areas of concern, a payer will reflect on value-based strategies, evidence presentation, and the ways in which quality is being integrated into the payer decision making prices. Particular attention will also be focused on coverage of new medical technology, experimental devices and hub models as areas increasing interest for medical device reimbursement executives.
- Optimal delivery of product evidentiary support
- Ideal volume of supporting data
- Relevance of peer-reviewed data
- 3rd Party vs internal research
- Areas for collaboration with device manufacturers
- Integration of relevant risk-share agreements
INTERVIEWER: Tim Sheflin, BOSTON HEALTHCARE
INTERVIEWEE: Scott Flinn, BLUE SHIELD OF CALIFORNIA
10:30 COFFEE AND NETWORKING BREAK
11:00 PANEL DISCUSSION: GENERATING & POSITIONING EVIDENCE TO SECURE PRODUCT ACCESS & REIMBURSEMENT
Throughout the medical device industry, clinical evidence has been traditionally utilized to secure product clearance from regulatory authorities, focusing on the product safety and effectiveness rather than the health economic impact on patients and healthcare delivery. In an environment where payers increasingly demand real-world evidence in order to support product coverage, executives must also consider methods of generating such evidence, designing studies which both satisfy a broad range of payer demands while remaining focused on economic outcomes and cost utilization. Beyond generating relevant and timely evidence, reimbursement executives must also consider methods for positioning data which takes into account payer preferences and priorities, requiring a delicate balance and approach to data delivery.
MODERATOR: David Gregory, BAKER TILLY
Margaret-Ann Halstead, MEDLINE INDUSTRIES
Tom Dugan, BOSTON SCIENTIFIC
Joseph Sierra, MEDTRONIC
11:45 OVERTURNING NEGATIVE MEDICAL DEVICE COVERAGE DECISIONS
Medical device firms in receipt of a negative coverage determination are frequently unsure as to next steps in securing product coverage, and whether there are possibilities of turning around decisions provided by government and commercial payers. Analysis of the process undertaken by one manufacturer in reversing a coverage decision will provide participants with deep insights into remedial steps taken, data generated and provided, as well as practical methods of conveying value messages in a persuasive manner. Additional focus will include proactive, preventative measures that manufacturers can integrate in order to avoid negative coverage decisions.
Jeff Potkul, Global Director- Healthcare Economics, Policy & Reimbursement, MEDTRONIC
12:30 LUNCHEON FOR SPEAKERS, SPONSORS & ATTENDEES
1:30 BREAKOUT DISCUSSIONS: STRATEGIES FOR GLOBAL REIMBURSEMENT AND FACTORS INFLUENCING THE MARKET
As medical device manufacturers’ continue to explore expanding a product’s reach on the global market, it is imperative for reimbursement executives to have a comprehensive understanding of the regional healthcare coverage landscape and processes in order to best allocated resources to ensure product access in all markets. Strategic viewpoints look to uncover the rising importance of Health Technology Assessments and resource allocation from across the regional landscape, as overcoming delayed payments is a universally agreed upon issue that many companies are looking to explore further.
GROUP 1: EUROPE – Amit Kukreja, SECOND SIGHT MEDICAL PRODUCTS
GROUP 2: ASIA – Tina Ivovic, ABBOTT
GROUP 3: SOUTH AMERICA – Joseph Sierra, MEDTRONIC
2:15-4:15 MULTI-PART CASE STUDIES: CREATIVE APPROACHES TO SECURING DEVICE COVERAGE & REIMBURSEMENT
Traditional avenues for obtaining medical device coverage and reimbursement, such as engaging payers and health systems, increasingly delivers results below optimal levels of reimbursement, and requires executives to take new approaches to secure support for medical technologies. From leveraging patient and advocacy support groups to lobbying efforts at the local, state and national level, medical device corporations are partnering with multiple levels of stakeholders in order to drive the message of medical necessity for new and existing products. Short-form case studies highlighting recent success stories will assist medical device reimbursement executives in exploring creative avenues and approaches for securing reimbursement in an out-of-the-box scenario.
2:15 CASE STUDY: PATIENT ACCESS PROGRAMS
Sean D. Murphy, VP Global Market Access, Health Economics & Reimbursement
2:45 CASE STUDY: GOVERNMENT
Tom Dugan, Director of Payer Relations and Value Based Reimbursement
3:15 CASE STUDY: PHYSICIAN “PEER TO PEER” MEETINGS WITH PAYERS
Tina Ivovic, Senior Director of Global Field Reimbursement and Health Care Economics
3:45 Q&A PANEL DISCUSSION: INSIGHTS FROM REIMBURSEMENT EXECUTIVES
PANELISTS: Sean D. Murphy, ZIMMERBIOMET
Tom Dugan, BOSTON SCIENTIFIC
Tina Ivovic, ABBOTT
4:15 END OF CONFERENCE