14TH SEMI-ANNUAL DIAGNOSTIC COVERAGE & REIMBURSEMENT CONFERENCE

FEBRUARY 12-13, 2019 | SAN DIEGO, CA
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DAY ONE | TUESDAY, FEBRUARY 12

8:00 REGISTRATION & WELCOME COFFEE

8:45 CHAIRPERSON’S OPENING REMARKS

9:00 OPENING ICE BREAKER: MARKET INTELLIGENCE COLLECTION METHODS TO OPTIMIZE REIMBURSEMENT STRATEGIES
Given the rapidly evolving challenges in diagnostic coverage and need to repeatedly update strategies according to new trends, healthcare market needs 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, channels 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.

 

9:30 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, Head Global Market Access & Health Policy, ROCHE DIAGNOSTICS INTERNATIONAL

PANELISTS:
Scott Flinn, Regional Medical Director & Delivery Networking, Clinical Quality, Network & Markets Support, BLUE SHIELD OF CALIFORNIA

Eugean Jiwanmall, Senior Research Analyst, Technology Evaluation & Medical Policy, INDEPENDENCE BLUE CROSS – IBX

 

10:30 COFFEE & NETWORKING BREAK

 

11:00 CLEAR INTERPRETATION OF LABORATORY BENEFIT MANAGEMENT PROGRAMS TO MAXIMIZE POSITIVE COVERAGE
With differing requirements and evaluation processes, Laboratory Benefit Managers (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

Lon Castle, Chief Medical Officer, EVICORE HEALTHCARE

 

11:45 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 – IBX

Eugean Jiwanmall, Senior Research Analyst, Technology Evaluation & Medical Policy, INDEPENDENCE BLUE CROSS – IBX

 

12:15 PART 2: PANEL – INDUSTRY’S PERSPECTIVE

Paige Nardi, Director of Managed Care, BIODESIX, INC.

Rachel Anhorn, Director, Payer Policy & Health Outcomes, FOUNDATION MEDECINE

Mohit Mathur, Strategic Medical Advisor, BIO-REFERENCE LABORATORIES

 

12:45 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

Lon Castle, Chief Medical Officer, EVICORE HEALTHCARE

 

2:30 ANALYSIS OF GOVERNEMENT POLICY UPDATES & EFFECT ON DIAGNOSTIC COVERAGE
Among many factors influencing the healthcare market, government released policies stand a prominent position as the impact directly shapes new strategies for reimbursement frameworks. Most recently, Medicare policies including PAMA and MolDx have challenged the industry with evolving and unclear requirements, ultimately affecting reimbursement decision and rates in the public payer setting. In addition, the overall political environment and uncertain direction of the healthcare reform continue to raise questions from the industry, eager to obtain a defined vision of the evolution of the market over the coming year.

 

PART1: 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

 

3:15 COFFEE & NETWORKING BREAK

 

3:45 PART 2: 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 PART 3: POLITICAL STATUS & INFLUENCE ON MARKET

  • November mid-term elections impact
  • Insight into healthcare reform status
  • Maneuvering in an unstable market

Hannah Murphy, Executive Director, COALITION FOR 21ST CENTURY MEDICINE

 

4:45 DIAGNOSTIC INDUSTRY ADVOCACY, LOBBYING & INITIATIVES IN ENGAGING WITH GOVERNMENT
The diagnostic industry encounters a variety of limitations in reimbursement and market access pathways, notably in lengthy timelines to obtain a positive or negative decision from payers and the lack of specific innovative testing method knowledge from assessors. While reimbursement executives continue to be challenged with requirements often more suitable to the pharmaceutical sector, key opinion leaders and trade associations undertake the task of uniting and advocating for the industry with the aim of enabling a stronger recognition of diagnostic specificities and pivotal position in the overall healthcare market. Overall, moving from individual company difficulties faced in similar manners by the majority of the industry to a joint approach in tackling challenges can ultimately bring to promising results in coverage opportunities.

  • Legislative & regulatory agenda for 2019
  • Trade association advocacy core focus points
  • Engaging with Congress & the government

Danielle Scelfo, Senior Director, Health Policy & Reimbursement, HOLOGIC, INC.

 

5:30 CLOSING REMARKS & DAY 1 CONCLUSION

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We hope to see you at the conference!

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