13TH SEMI-ANNUAL DIAGNOSTIC COVERAGE AND REIMBURSEMENT CONFERENCE

DECEMBER 6-7, 2018 | BOSTON, MA

HILTON BACK BAY

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DAY ONE | THURSDAY, DECEMBER 6

7:45 REGISTRATION & WELCOME COFFEE

8:30 CHAIRPERSONS’ OPENING REMARKS
Markus Ott, Head Global Market Access & Health Policy
ROCHE DIAGNOSTICS INTERNATIONAL

8:40 OPENING ICE BREAKER: MARKET INTELLIGENCE COLLECTION METHODS TO OPTIMIZE REIMBURSEMENT STRATEGY
Given the rapidly evolving challenges in diagnostic coverage and necessary updates to strategies according to new trends and payer requirements, professionals are continuously in search of valuable means to collect detailed intelligence into factors impacting the diagnostic market. This interactive ice breaker will open the event with an opportunity for all participants to move around the confer¬ence room with the goal of meeting other delegates and engaging in swift discussion aimed towards sharing insights into preferred informative platforms and media pertinent to the healthcare market and diagnostic coverage. Furthermore, participants in this warm-up session are also given the opportunity to build contacts with industry peers, kicking off the event networking platform.

Eric Lam, PhD, Director, Market Access, HULL ASSOCIATES

 

9:20 ROUNDTABLE: UNVEILING & COMPARING PAYERS’ PERSPECTIVES ON DIAGNOSTIC REIMBURSEMENT REQUIREMENTS
Diagnostic reimbursement professionals must shrewdly navigate the distinct requirements and evaluation methods employed by different payer organizations, especially as the use of Laboratory Benefit Management companies and continued development of next generation sequencing tests contribute additional uncertainty. Clarification is needed in determining different definitions of clinical utility from the commercial versus public payers’ perspectives, predicting and analyzing success of particular evidence points, as well as the best approach to respectful and advantageous communication with medical directors. While innovation is key to improving patient care, enhanced understanding of how it is perceived by payers in terms of cost-benefit impact is crucial as executives continue to seek coverage approval in a continuously changing diagnostic environment.

MODERATOR:
Markus Ott, ROCHE DIAGNOSTICS INTERNATIONAL

PANELISTS:
Scott Flinn, BLUE SHIELD OF CALIFORNIA

Kenneth J. Snow, AETNA

Eugean Jiwanmall, INDEPENDENCE BLUE CROSS – IBX

 

10:20 COFFEE & NETWORKING BREAK

 

10:50 CLEAR INTERPRETATION OF LABORATORY BENEFIT MANAGEMENT PROGRAMS TO MAXIMIZE POSITIVE COVERAGE
With differing requirements and evaluation processes, LBMs continue to challenge reimbursement executives in the route towards securing reimbursement. Established as preliminary test evaluators for payers, the industry is eager to unveil various LBM scrutiny processes and obtain a deeper understanding of scientific and economic evidence to demonstrate. Participants will benefit from a broad perspective on LBMs as well as a more granular view of one company’s evaluation methods.

  • Defining evidence from the LBM’s perspective
  • Inside look at the test evaluation process
  • Tailoring evidence collection to individual LBMs

Mitchell I. Burken, Associate Medical Director, Genetics, EVICORE HEALTHCARE

 

11:35 EVIDENCE TARGET – DEFINING CLINICAL STUDY DESIGN & OUTCOMES QUALITY

  • Clinical utility from the payer’s perspective
  • Pros & cons of study types:
    • Randomized controlled trials
    • Real world evidence study
    • Additional clinical designs
  • Determining evidence end-points
  • Rationale for non-RCT evidence

PART 1: PAYER’S PERSPECTIVE
Eugean Jiwanmall, Senior Research Analyst, Technology Evaluation & Medical Policy, INDEPENDENCE BLUE CROSS – IBX

12:05 PART 2: PANEL – INDUSTRY’S PERSPECTIVE

Ben Eckert, ADAPTIVE BIOTECHNOLOGIES

Paige Nardi, BIODESIX, INC.

Rachel Anhorn, FOUDNATION MEDICINE

Mohit Mathur, BIO-REFERENCE LABORATORIES

 

12:35 LUNCHEON FOR ALL PARTICIPANTS

 

1:45 PANEL: IMPACT OF PRIOR AUTHORIZATION ON DIAGNOSTIC TEST REIMBURSEMENT

  • Debating payers’ rationale in increasing PA demands
  • Potential for PA automation & harmonization
  • Opportunities in outsourcing PAs to service providers

Rob Dumanois, Manager, Reimbursement & Payer Strategy, THERMO FISHER SCIENTIFIC

Jerry Conway, Executive Vice President, CDX DIAGNOSTICS

Mitchell I. Burken, Associate Medical Director, Genetics, EVICORE HEALTHCARE

Sharon West, VP Legal & Regulatory Affairs, AMERICAN CLINICAL LABORATORY ASSOCIATION

 

2:30 HOW TO PROACTIVELY MANAGE AR TO COMBAT DOWNWARD REIMBURSEMENT PRESSURE

  • AR strategy impactful tools & reengineering
  • Achieving 10-20% improvement in net collections
  • Methods to enhance productivity by 20-35%
  • Practical steps to optimize revenue cycle
  • Strategy focus: visibility & repeatable processes

Joni Crumrine, Senior Analyst, TELCOR

 

3:15 COFFEE & NETWORKING BREAK

 

3:45 ANALYSIS OF GOVERNEMENT POLICY UPDATES & EFFECT ON DIAGNOSTIC COVERAGE
PART 1: MEDICARE RECENT DEVELOPMENTS

  • Reimbursement according to 2018 CLFS
  • Analysis of 2018 update to the 14-day rule
  • Update to MolDx & navigating the system

Rob Dumanois, Manager, Reimbursement & Payer Strategy, THERMO FISHER SCIENTIFIC

 

4:15 ANALYSIS OF GOVERNMENT POLICY UPDATES & EFFECT ON DIAGNOSTIC COVERAG

PART 2: PAMA & UPCOMING NEW PAYMENT RATES

  • Addressing test declines’ impact on payment rates
  • Understanding the reporting procedure & timeframe
  • Accrued industry engagement to ensure relevant rates
  • ACLA advocacy for a transparent approach to PAMA

Daniel Holsinger, Director of Reimbursement Services, GENOVA DIAGNOSTICS

Brian Carey, Partner, FOLEY HOAG

 

5:00 PANEL: ADDRESSING DIAGNOSTIC CODING CHALLENGES & OPPORTUNITIES IN PLA APPLICATION
The diagnostic industry continues to face challenges in obtaining codes specifically defining the scientific purpose of a test, resulting in the use of more general codes applied to a variety of products, and potentially irrelevant reimbursement rates. In order to better categorize and identify diagnostics for payers, the AMA has recently established PLA codes meant to provide enhanced description of ADLTs and CDLTs in particular, and assist in securing pertinent coverage. Laboratories as well as test developers are currently investigating benefits and limitations of the new code set and application process, in addition to potential opportunities in the use of PLAs for other test types.

  • Addressing the lack of test-specific CPTs
  • Risks associated with the use of general CPTs
  • Pros & cons in the application of PLA codes
  • Clarifying which tests are eligible to PLAs

MODERATOR:
Markus Ott, ROCHE DIAGNOSTICS INTERNATIONAL

PANELISTS:
Jay Ahlman, AMERICAN MEDICAL ASSOCIATION

Jeff Salzman, CAREDX, INC.

Robert Bruce, CLINICAL GENOMICS

 

5:45 CLOSING REMARKS & DAY 1 CONCLUSION

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