14TH SEMI-ANNUAL DIAGNOSTIC COVERAGE & REIMBURSEMENT CONFERENCE

FEBRUARY 12-13, 2019 | SAN DIEGO, CA

HILTON GARDEN INN SAN DIEGO DOWNTOWN/BAYSIDE

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DAY ONE | TUESDAY, FEBRUARY 12

7:30 REGISTRATION & WELCOME COFFEE

8:15 CHAIRPERSON’S OPENING REMARKS

8:30 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.

MODERATOR: Stephen Hull, HULL ASSOCIATES

 

9:00 ALIGNING CODING AND EVIDENCE PATHWAYS TO SECURE COVERAGE IN THE AGE OF PLA CODING
PLA coding has presented Dx innovators with an accelerated path to securing novel codes and the ability to bill payers with greater specificity. These codes are now available for emerging tests, some of which lack evidence of robust clinical utility, exposing tests to the risk of explicit non-coverage policies. This presentation will highlight the need to evaluate the evidence needed to communicate value and align evidence development with coding and billing timelines to optimize coverage.

Shivang Doshi, Director, BOSTON HEALTHCARE

 

9:30 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

 

10:30 COFFEE & NETWORKING BREAK

 

11:00 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

11:45 PART 2: PANEL – INDUSTRY’S PERSPECTIVE
MODERATOR:
Dr. Anita Chawla, Managing Principal, ANALYSIS GROUP, INC.

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

Mohit Mathur, Strategic Medical AdvisorBIOREFERENCE LABORATORIES

Vanessa DePalma, Vice President, Payer & Business Strategy, MERIDIAN BIOSCIENCE

 

12:15 LUNCHEON FOR ALL PARTICIPANTS

 

1:15 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

Vanessa DePalma, Vice President, Payer & Business Strategy, MERIDIAN BIOSCIENCE

Martin E. Adelson, PhD, GENESIS BIOTECHNOLOGY GROUP

 

2:00 DIAGNOSTIC INDUSTRY ADVOCACY, LOBBYING & INITIATIVES IN ENGAGING WITH GOVERNMENT
The 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 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.

 

2:45 COFFEE & NETWORKING BREAK

 

3:15 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.

PART 1: 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

 

3:45 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 INDUSTRY CASE STUDY: STRATEGIZING FOR FAVORABLE COVERAGE DECISIONS
As market demands fluctuate, and private and public payer coverage decisions vary based on ever-changing requirements, test manufacturers and laboratories continue to strive for meaningful improvements to reimbursement strategies. Although multiple routes exist to achieve the end goal, budgetary and time constraints demand that reimbursement professionals plan proactively to anticipate next all necessary steps towards favorable coverage. Via a short and incisive case study, industry members are invited to view successful approaches from an insider perspective and learn about creative, actionable solutions to shared obstacles in the path to obtaining reimbursement.

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

 

5:30 CLOSING REMARKS & DAY 1 CONCLUSION

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We hope to see you at the conference!

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