DAY ONE | TUESDAY, FEBRUARY 11
7:30 REGISTRATION & WELCOME COFFEE
8:15 CHAIRPERSON’S OPENING REMARKS
8:30 ICE BREAKER: SHARING ELEMENTS OF A ROBUST REIMBURSEMENT STRATEGY FOR DIAGNOSTIC TESTS
Given the continual developments in the exciting and complex diagnostics industry, coverage and reimbursement professionals are experts in swiftly redesigning coverage strategies to meet new demands and obtain satisfactory payment. This interactive ice breaker will open the event with an opportunity for all participants to move around the conference room with the goal of meeting other delegates and engaging in brief practical conversations, shedding light on proven aspects of a successful reimbursement strategy. Additionally, delegates will have the opportunity to immediately build contacts with industry peers, kicking off the event networking platform.
Denise Robinson, Director, National Market Access, CAREDX, INC.
8:45 PAYER ROUNDTABLE: ILLUMINATING PAYER VIEWPOINTS ON DIAGNOSTIC TEST REIMBURSEMENT
Executives in the ever-evolving diagnostic industry must unveil public and private payer perspectives in order to secure coverage and reimbursement for products, understanding which data points will be considered most effective to demonstrate clinical utility. Given the uncertainties regarding the reopening of the NCD for NGS and the increasing complexities of prior authorization, reimbursement professionals are seeking timely knowledge on how to best position each test before various payers for favorable coverage decisions and to reduce potential roadblocks to payment. As payers increasingly require more clinical trial data than ever before, clarification is needed on appropriate endpoints to prove health economic value, ultimately enabling the industry to drive innovation.
Tom Dugan, BIODESIX
Uche Olekanma, BLUE CROSS BLUE SHIELD OF ILLINOIS, MONTANA, NEW MEXICO, OKLAHOMA & TEXAS
Mary Stevens, BLUE CROSS AND BLUE SHIELD OF MINNESOTA
Anna Wetherbee, BLUE SHIELD OF CALIFORNIA
Gabriel A. Bien-Willner, PALMETTO GBA
9:45 INSIGHT INTO MOLDX REVIEW OF EVIDENCE FOR MOLECULAR DIAGNOSTIC TESTS
- Understanding the purpose & operation of MACs
- Optimizing methods for communicating with MolDX
- Review of recent policies in molecular testing
Gabriel A. Bien-Willner, Medical Director, MOLDX & Chief Medical Officer, PALMETTO GBA
10:30 COFFEE & NETWORKING BREAK
11:00 ALL PAYERS ARE NOT ALIKE: THE VARYING EVIDENCE & COVERAGE CONSIDERATIONS FOR PRIVATE & GOVERNMENT PAYERS
Given the increasing cost of healthcare, especially in areas such as oncology, private payers are requiring that diagnostic innovators provide evidence not only of the clinical utility of their tests, but also of the economic impact. In contrast, Medicare Administrative Contractors (MACs), while requiring evidence of clinical utility to secure coverage, often do not focus on the economic impact of new diagnostics. This session will highlight the key considerations that private payers evaluate in making coverage decisions through several case examples.
Mark Girardi, Senior Vice President, BOSTON HEALTHCARE
11:45 PANEL: ELUCIDATING THE ROLE OF REAL-WORLD EVIDENCE IN THE ROUTE TO COVERAGE
- Defining RWE specific to diagnostic tests to satisfy payer demands
- Measuring the weight of real-world data in the coverage review process
- Positioning real-world evidence within the larger product value dossier
Shawn Carlson, ROCHE DIAGNOSTICS CORPORATION
Matthew Mega, NATERA
Artem Boltyenkov, SIEMENS HEALTHINEERS
Holly LaDuca, AMBRY GENETICS
Heather Brown, HEARTFLOW
12:30 LUNCHEON FOR ALL PARTICIPANTS
2:00 TRACKING, ANALYZING & APPLYING MEDICAL POLICY IN A LARGE LABORATORY SETTING
- Tracking & analyzing differing payer policies
- Applying policy insights across isolated departments
- Increasing collaboration to drive successful payment
Lola Valenciano, Associate Director, Market Access & Medical Policy
DANAHER CORPORATION, DIAGNOSTICS & LIFE SCIENCE PLATFORMS
2:30 EXCHANGE GROUPS: REVEALING & COMPARING SOLUTIONS TO TEST-SPECIFIC CHALLENGES
With an abundance of diagnostic test types on the market, as well as in development, each necessitating unique considerations when developing and implementing the strategy for optimal payment, executives need to identify drawbacks and work through challenges specific to the test category. Through a collaborative session format, delegates have the chance to gain knowledge of established methods for engaging payers and promoting interest in a particular test category, as well as of emerging practices that have resulted in successful reimbursement. Through the lens of each specific test type, professionals will explore nuanced solutions to shared challenges alongside peers.
- GROUP 1: MOLECULAR DIAGNOSTICS
- GROUP 2: LABORATORY IVDS
- GROUP 3: NEXT GENERATION SEQUENCING
- GROUP 4: COMPANION DIAGNOSTICS
Lola Valenciano, DANAHER CORPORATION
Rob Dumanois, THERMO FISHER SCIENTIFIC
L. Patrick James, QUEST DIAGNOSTICS
3:00 CLARIFYING PAYER UTILIZATION OF NCCN GUIDELINES & IMPACT ON DIAGNOSTIC INDUSTRY
In the context of the ever-expanding body of research data available from various sources, particularly in the field of oncology, CMS and private insurers face the considerable task of keeping up with research findings and trends in order to ensure the availability of best possible diagnostic options for patients. As part of the ongoing attempt to standardize guidelines for coverage and reimbursement of diagnostic tests, a growing set of payers are utilizing the National Comprehensive Cancer Network guidelines as a convenient means of remaining up-to-date and as a method for informing decisions. Industry leaders therefore need to understand the ways in which the NCCN guidelines are shaped and ultimately influence payer viewpoints, enabling industry to better strategize for reimbursement.
Dana Dilbeck, Director of Payer Relations and Reimbursement, PACIFIC EDGE DIAGNOSTICS
3:30 COFFEE & NETWORKING BREAK
4:00 PERSPECTIVES ON STREAMLINING THE APPROACH TO PRIOR AUTHORIZATION
- Monitoring differing payer expectations & incorporating into process
- Proven team structures to ensure timely prior authorization requests
- Engaging with primary care providers and promoting cooperation
- Strategies for collaborating with payers to proactively resolve roadblocks
Rob Guigley, Vice President, Market Access, AMBRY GENETICS
4:45 CASE STUDY: COLLABORATING WITH PHYSICIANS TO MEET PRIOR AUTHORIZATION REQUIREMENTS
In order to achieve reliable and swift patient access to diagnostic tests, reimbursement professionals must shrewdly manage increasing payer requirements for prior authorization. Forward-thinking industry leaders are therefore looking for new ways of interacting with physicians to foster collaborative communication and address any potential issues that may become a hindrance to payment later on. This case study provides audience members with tangible, results-oriented strategies to enhance cooperation with providers, promoting a win-win partnership and positively influencing the likelihood of patient compliance with treatment recommendations.
Elizabeth Cormier, President & CEO, PERSONA HEALTH, INC.
5:30 CLOSING REMARKS & DAY 1 CONCLUSION
6:15 CONTINUED NETWORKING: FACILITATED GROUP DINNERS
With the immense value in peer-to-peer interaction and experience sharing, we wish to provide attendees with an opportunity to continue networking after the first day of the conference. Q1 Productions will arrange dinner reservations at local restaurants close to the conference hotel for those interested in joining a group of fellow participants for dinner on February 11th. Please note that dinner expenses must be covered by each participant individually.