16th Semi-Annual Diagnostic Coverage and Reimbursement Conference

February 11-12, 2020 | San Diego, CA

Hilton Garden Inn San Diego Downtown/Bayside

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DAY ONE | TUESDAY, DECEMBER 3

7:30 REGISTRATION & WELCOME COFFEE

8:15 CHAIRPERSON’S OPENING REMARKS
Tami York Powell, Vice President, Corporate Payer and Reimbursement Strategy
EXAGEN, INC.

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.

 

9:00 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 end-points to prove health economic value, ultimately enabling the industry to drive innovation.

MODERATOR:
Tom Dugan, BIODESIX

PANELISTS:
Mary Stevens, BLUE CROSS AND BLUE SHIELD OF MINNESOTA

Peter Thurman, ANTHEM BLUE CROSS BLUE SHIELD

 

10:00 COFFEE & NETWORKING BREAK

 

10:30 PANEL: EXAMINING THE STATUS OF PLA CODING & IMPACT ON REIMBURSEMENT FOR DIAGNOSTICS
Initially expected to benefit reimbursement professionals by reducing barriers to payment caused by long waiting periods to obtain CPT codes, PLA codes are being used by diagnostic companies to bill for tests with mixed results, with CMS reimbursing PLA codes in very limited localities and commercial payer reimbursement levels remaining even less transparent. Additionally, submission of claims to a given payer without having first secured a coverage decision for the product can result in lack of payment even in cases when a specific PLA code has been obtained and properly applied. It is therefore imperative for reimbursement leaders to understand the larger outlook of PLA codes for the diagnostic industry.

  • Insight into PLA code reimbursement success
  • Beneficial timelines for pursuing PLA codes
  • Future outlook & impact on coverage decisions

Jay Ahlman, AMERICAN MEDICAL ASSOCIATION

Rob Guigley, AMBRY GENETICS

Tami York Powell, EXAGEN, INC.

Donna Polizio, GENOMIC HEALTH, INC., NOW PART OF EXACT SCIENCES CORPORATION

 

11:30 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

 

12:00 LUNCHEON FOR ALL PARTICIPANTS

 

1:30 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

Jill Dolinsky, AMBRY GENETICS

Shawn Carlson, ROCHE DIAGNOSTICS CORPORATION

Heather Brown, HEARTFLOW

 

2:30 EXCHANGE GROUPS: TEST-SPECIFIC CONSIDERATIONS IN DEMONSTRATING CLINICAL UTILITY
With the vast array of tests in the diagnostic arena, inclusion into a payer healthcare network depends largely on the evidence provided to shed light onto product-specific clinical utility. Reimbursement professionals must therefore determine the appropriate weight of elements such as real-world evidence and health economic information to convey to payers, and generate it through sound clinical testing plans. Through interactive peer-to-peer sharing within groups specific to test types, delegates will have the opportunity to dive deep into the intricacies of proving clinical utility to meet payer expectations.

  • Group 1: Molecular Diagnostics
    Denise Robinson, CAREDX, INC.
  • Group 2: Laboratory IVDs
    Shawn Carlson, ROCHE DIAGNOSTICS CORPORATION
  • Group 3: Next Generation Sequencing
    Jill Dolinsky, AMBRY GENETICS
  • Group 4: Companion Diagnostics

 

3:15 COFFEE & NETWORKING BREAK

 

3:45 PANEL: 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, AMBRY GENETICS

Jane Pine Wood, BIOREFERENCE LABORATORIES, INC.

 

4:30 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.

 

5:00 CLOSING REMARKS AND DAY 1 CONCLUSION