12TH SEMI-ANNUAL DIAGNOSTIC COVERAGE AND REIMBURSEMENT CONFERENCE WEST

FEBRUARY 6-7, 2018 | SAN DIEGO, CA

HILTON GARDEN INN SAN DIEGO BAYSIDE

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DAY ONE | TUESDAY, FEBRUARY 6

7:30 REGISTRATION & WELCOME COFFEE

8:15 CHAIRPERSONS’ OPENING REMARKS
Lauren Feldman, Director, ADVI

8:30 OPENING ICE BREAKER: SHARING KEY COMPONENTS OF A ROBUST DIAGNOSTIC REIMBURSEMENT STRATEGY
The opening ice breaker will kick-off the event with an opportunity for all participants to move around the conference room with the goal of meeting other delegates and engaging in short and targeted discussion. In this interactive session, participants are encouraged to briefly share perspectives on the main drivers of an impactful diagnostic reimbursement strategy, without delving into details nor proprietary information but rather highlighting key components that have benefited the company in obtaining successful reimbursement. Participants in this warm-up session are also given the opportunity to build contacts with industry peers at the very start of the event, kicking off the program networking platform.

LEAD MODERATOR:
Kurt Matthes, TELCOR

MODERATORS:
Vanessa DePalma, MERIDIAN BIOSCIENCE

 

8:50 SUCCESSFUL INDUSTRY & PAYER PARTNERSHIPS
Diagnostic reimbursement executives are continuously challenged by a variety of obstacles, most commonly relevant to product integration in a competitive market. In the effort of advancing life-improving tests to patients and HCPs, forward thinking companies have established proactive strategies to engage and directly collaborate with payers in order to facilitate, streamline and expedite access to reimbursement. This session will present industry and payer collaboration case studies, focusing on the practical steps taken to initiate and achieve the partnership as well as encountered pitfalls and lessons learned.

AETNA HEALTH PLAN & MERIDIAN BIOSCIENCE CASE STUDY:  DIAGNOSTIC DEVELOPMENT TO MEDICAL POLICY COVERAGE & IMPLEMENTATION

  • Diagnostic technology:  What is important to Payers
  • Guideline review & Clinical benefits: Patient, physician, lab & payer
  • Dossier, FDA, Palmetto, PAMA considerations
  • Financial Impact: Commercial, Medicaid, ACO, 5 star metrics on re-admissions
  • Medical Policy Development: Commercial & ACO
  • Education: Dear Provider communication, lab outreach, web portal

Rebecca Smith, Director, Clinical Insights & Analytics, AETNA

Vanessa DePalma, VP, Business Strategy & Payer Markets, MERIDIAN BIOSCIENCE

 

9:35 CAREFIRST BCBS & EXOSOME DIAGNOSTICS CASE STUDY: NOVEL PRIVATE PAYER/INNOVATOR COLLABORATION FOR EVIDENCE DEVELOPMENT

  • Structure & Value Drivers
  • Key Design Considerations for Measuring Clinical Utility in a Real World Setting
  • Applications Beyond Initial Project

Tom McLain, COO, EXOSOME DIAGNOSTICS

 

10:05 COFFEE & NETWORKING BREAK

 

10:30 COST EFFECTIVE & VALUE-BASED EVIDENCE DEVELOPMENT
One of the more significant barriers to obtaining coverage and reimbursement for a new or established advanced diagnostic is the high cost of evidence development establishing clinical relevance. Creative approaches and a multi-prong strategy are critical to successfully balance evidence development with budget limitations and internal/investor pressure to broadly launch commercially.

  • Clearly defining and staying within intended use
  • From study to publication:
    • Value-based utility
    • Traditional studies
    • Value-based contracting
  • Advocacy through KOLs & relevant societies
  • Relevant patient-level appeals

Gordon Brown, Managing Partner, A&R CONSULTANTS LLC
Presented by QUADAX, INC.

 

11:15 PAYER ROUND-TABLE: PERSPECTIVES ON DIAGNOSTIC REIMBURSEMENT
Reimbursement approvals are determined within each private payer organization through specific review mechanisms, creating confusion for reimbursement executives in terms of applicable evidence to exhibit. As payers will take into account Laboratory Benefit Management Provider and in-house HTA reviews to process the approval or decline, but also further analyze cost-benefit ratios pertinent to the market’s needs, reimbursement executives must ensure a clear understanding of payer expectations and evidence requirements in order to develop comprehensive value pitches that will be relevant to decision-makers. In addition, with the recent and ongoing shift towards value-based reimbursement schemes, the industry is eager to obtain enhanced clarity on payers’ perspectives of value demonstration and reimbursement approval processes.

MODERATOR: Mark Rayan, MDXHEALTH

PANELISTS:
David Hochheiser, BLUE CROSS BLUE SHIELD OF LOUISIANA

Jeff Mason, UNITED HEALTHCARE

Rebecca Smith, AETNA

Mary Stevens, BLUE CROSS BLUE SHIELD OF MINNESOTA

 

12:15 CLARIFYING THE SHIFT IN LABS’ APPROACH: COMMERCIALIZATION & COVERAGE FOR NOVEL DIAGNOSTICS TODAY & TOMORROW

  • Changing industry requirements for coverage & how lab process flows must adapt
  • Opportunity to optimize integration in health systems to facilitate better care & coverage
  • Critical updates on regulatory requirements in 2018 & beyond for diagnostic companies

Kyle Fetter, Executive VP & General Manager of Diagnostic Services, XIFIN

 

12:30 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES

 

1:30 CLARIFYING LABORATORY BENEFIT MANAGEMENT PROVIDER’S ROLE & COLLABORATION WITH INDUSTRY
With the continued increase in annual healthcare spending per capita, health insurers have been prompted to better control spending and unnecessary medical product use. Laboratory Benefit Management Providers – LBMPs offer services to insurers to ensure network access and reimbursement is granted solely to diagnostics that meet unmet or under represented patient needs, as well as innovative tests enabling significant improved patient outcomes. To establish successful partnerships and efficient collaborations between the industry and LBMPs, it is necessary to have a clear understanding of the position of benefit managers within the overall reimbursement decision-making process.

  • LBMP diagnostic review mechanism
  • Added value of LBMP in network management
  • Practical approach to contracting with LBMPs

Jerry L. Garner, VP Payer Relations, BIO-REFERENCE LABORATORIES

 

2:00 PAYERS & DIAGNOSTICS: COMING TO CONSENSUS

  • Key concepts to diagnostics-payer partnerships
  • Alva10: Specific challenges of the diagnostics industry
  • BCBS MN: Specific challenges of the payer industry
  • Examples & applications

Lena Chaihorsky, VP Payer Innovation, ALVA10

Mary Stevens, Director of Network Contracts, Compliance & Audit, BLUE CROSS BLUE SHIELD OF MINNESOTA

 

2:45 AVOIDING THE VALLEY OF REIMBURSEMENT DEATH: CAUSES & SOLUTIONS
With the goal of obtaining reimbursement for new diagnostics, preventing common payer access denials and descending in “the valley of reimbursement death”, this short and targeted case study will demonstrate how impactful prominence was given to a manufacturer’s flagship products through payer education, ultimately securing reimbursement and enabling company acquisition by one of the largest device organizations in the world.

Sajini Thomas, President & Founder, GLOBAL INTEGRATED REIMBURSEMENT SERVICES

 

3:00 COFFEE & NETWORKING BREAK

 

3:30 NATURE, QUALITY & VOLUME OF EVIDENCE NECESSARY TO SUPPORT REIMBURSEMENT
With payer requests for meaningful scientific and economic data pertinent to the diagnostic test, reimbursement executives are commonly collecting evidence from clinical teams to ultimately support value dossiers. Forward-thinking corporations have initiated collaborations with clinical teams and continue to develop studies integrating health economic outcomes to address and streamline preparation of value pitches. In this proactive effort, it is critical to determine what type of evidence can be used to demonstrate product effectiveness and cost-benefit ratios specific to the target market, in addition to the overall amount of data to convey to decision makers in order to establish and meet target evidence end-points.

Ammar Qadan, VP Global Market Access, ILLUMINA

Brock Schroeder, Director, Health Economic & Outcomes Research, ILLUMINA

 

4:15 CLINICAL STUDY DESIGNS ESTABLISHING CLINICAL UTILITY & ROBUST EVIDENCE

  • Bridging the gap with clinical teams:
    • Study design impact on evidence generation
    • Educating clinical teams on evidence for reimbursement
  • Defining clinical utlity & how to demonstrate it
  • RCT & diagnostics: applicability & evidence relevance
  • Results with cohort, prospective/restrospective & more
  • Ideal study design & results for payers

John Hanna, Chief Commercial Officer, VERACYTE

 

5:00 PEER REVIEWED EVIDENCE (PRE) VERSUS REAL WORLD EVIDENCE (RWE): WHAT IS THEIR RELATIVE VALUE AND WHEN ARE THEY BEST USED

  • Payer Acceptability
  • Relative value vs. relative (monetary and temporal) costs of generating PRE vs RWE
  • Disseminating results with high internal versus high external validity
  • How can PRE and RWE be used together

MODERATOR:
John Peabody, MD, PhD, QURE HEALTHCARE

PANELISTS:
Jeffrey Jones, SKYLINE DX

Jerry L. Garner, BIO-REFERENCE LABORATORIES

Ali Samiian, ABBOTT

 

5:45 CLOSING REMARKS & DAY ONE CONCLUSION

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We hope to see you at the conference!

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