DAY TWO | WEDNESDAY, FEBRUARY 13
8:30 REGISTRATION & COFFEE
8:40 CHAIRPERSON’S OPENING REMARKS
8:45 STRATEGIC CONSIDERATIONS FOR MANAGING THE INCREASING PATIENT COST-SHARE TREND
High Deductible Healthcare Plans continue to grow in frequency despite some industry expectations that they may slow down. Patients are now the #3 payer in diagnostics behind Medicare & Medicaid. Because laboratories often times have little to no interaction with patients before services are rendered, strategies need to be developed to communicate financial responsibility in a way that will result in price transparency and increased reimbursement. In this presentation you will learn how to:
- Interact and communicate with patients in an era of growing healthcare consumerism
- Reduce the administrative burden on providers to accurately disclose financial responsibility and perform insurance clearance (coverage and authorizations)
- Improve collections by establishing expectations with the patient to capture payments up front
Walt Williams, Director of Revenue Optimization and Strategy, QUADAX, INC.
9:30 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
Mark Girardi, BOSTON HEALTHCARE ASSOCIATES
Robert Bruce, Vice President – Reimbursement, CLINICAL GENOMICS
Paul Sheives, Director, Federal Health Policy & Reimbursement, ROCHE DIAGNOSTICS CORPORATION
Zachary Hochstetler, AMA
Leslie Prellwitz, AMA
10:30 COFFEE & NETWORKING BREAK
11:00 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.
Markus Ott, Head Global Market Access & Health Policy, ROCHE DIAGNOSTICS INTERNATIONAL
Eugean Jiwanmall, Senior Research Analyst, Technology Evaluation & Medical Policy, INDEPENDENCE BLUE CROSS – IBX
Scott Flinn, Regional Medical Director & Delivery Networking Clinical Quality, Network & Market Support
BLUE SHIELD OF CALIFORNIA
12:00 EXCHANGE GROUPS: SHARING SOLUTIONS TO TEST-SPECIFIC CHALLENGES
With the expansion of IVDs into new testing methods and an overall wide variety in diagnostic types, reimbursement executives face different challenges from one category to another, ultimately shaping unique methods to secure successful coverage. This peer-to-peer learning session allows participants to share creative strategies and solutions uniquely applicable to distinct IVD test methods, ensuring an optimized approach to each test category and maximized take-away. To enable the exchange, the audience will break into smaller groups, each focusing on a specific IVD category as listed below, with the possibility of adding further groups and test types as deemed necessary by the audience.
Group 1: Next Generation Sequencing:
Julie Ramage, National Account Director, Diagnostics, PFIZER ONCOLOGY
Group 2: Molecular Diagnostics:
Nicholas Potter, Director, Reimbursement & Medical Affairs, EPIGENOMICS, INC.
Group 3: Companion Diagnostics:
Lindsay Mateo, Senior Vice President Commercial Operations, NAVICAN
Group 4: Laboratory IVDs:
Farogh Nazari, Senior Consultant & Head of Continuing Education, SIEMENS HEALTHINEERS
*Additional groups may be formed on site to address further IVD categories.
12:30 LUNCHEON FOR ALL PARTICIPANTS
1:30 SECURING SUCCESSFUL REIMBURSEMENT AFTER A NEGATIVE COVERAGE DECISION
- Preliminary reimbursement strategy walk-through
- Clarifying the rationale for payer decline
- Identifying gaps in satisfying payer requirements
- Restructuring evidence & value demonstration
- Obtaining coverage at the following attempt
Jill Blanchard, Market Access Manager, Payer Network Contracting, EXACT SCIENCES
Xiaoming (Melody) Lu, MD, MS, Medical Science Liaison – West Coast, EXACT SCIENCES
2:15 EXCHANGE GROUPS: NEW CATEGORIES OF INNOVATIVE TESTS & FOLLOW-ON REIMBURSEMENT CHALLENGES
Through small group discussions focused on peer to peer exchange and interaction, participants are given the opportunity to dive deeper into a topic related to specific challenges with ascending trends progressively disrupting diagnostic tests’ access to coverage, and prone to shape new policies. All participants are given the opportunity to select a topic among those listed below to dive into in a perspective-sharing manner. Gathering with peers experiencing the same challenges, and engaging in debates and brainstorming provides invaluable insights into practical approaches to complex reimbursement dilemmas.
Group 1: Consumer genetic tests:
Natalie Cummins, SVP of Marketing & Payer Relations, BIOREFERENCE LABORATORIES
Group 2: mHealth & mobile diagnosis:
Stephen Floe, Director, Corporate Strategy, ATIVA MEDICAL
3:00 CLOSING REMARKS & CONFERENCE CONCLUSION