20th Annual
Medical Device Coverage & Reimbursement Conference
May 23-24, 2024| Chicago, IL
Hyatt Centric Magnificent Mile
20th Annual
Medical Device Coverage & Reimbursement Conference
May 23-24, 2024
Chicago, IL
Hyatt Centric Magnificent Mile
Envisioning Reimbursement Pathways for AI-Enabled Devices & Compelling Payer Engagement While Continuously Optimizing Strategies to Meet Evolving Payer Policies & Influence Positive Coverage Determinations
Payers:
Eugean Jiwanmall
Sr. Research Analyst, Medical Policy & Technology Evaluation
INDEPENDENCE BLUE CROSS
John W. Wendling
Former CEO
PARKLAND COMMUNITY HEALTH PLAN
E. Lee Washington, MD
Senior Medical Director
AETNA NATIONAL ACCOUNTS
Timothy Law, DO
Chief Medical Officer, VP, Integrative Care Delivery
HIGHMARK
Industry Experts:
Spencer B. Bailey
VP Market Access & Reimbursement
MICROTRANSPONDER
Julie Alder Brown
Sr Director, Health Economics & Market Access
SPARK BIOMEDICAL
Kenneth Boyle
Director, US Markets, HEOR
IRHYTHM TECHNOLOGIES
Victoria Driscoll
Sr Case Manager
MAINSTAY MEDICAL
Sandra Intriago
Area Director of Reimbursement
SI-BONE
Dennis Robbins
Principal
IDEAS
Dawn Gabriele
Director, Payer Relations & Value Based Opportunities
BOSTON SCIENTIFIC
Kristen Hedstrom
VP, Market Access & Professional Education
INTEGRA LIFESCIENCES
Richard Kelsey
Sr Manager, Field Health Economics
BOSTON SCIENTIFIC
Tim Lewandowski
Sr. Manager, Post Merger Integrations
ZEISS MEDICAL TECHNOLOGIES
Jennifer Staiti
Area Reimbursement Manager Northeast
SI-BONE
Matthew Lopez
Vice President, Market Access & Payer Relations
IRHYTHM TECHNOLOGIES
Chip Moebus
Vice President, Reimbursement & Market Access
MAINSTAY MEDICAL
Colleen O’Connell
Clinical Appeals Resolution Manager
MYOMO
Jessica Pan
Director, Clinical and HEOR
AI SPECTRAL TECHNOLOGIES
Tammy Thompson
Patient Access/PICS Portal Manager
SI-BONE
April Spillane
Vice President, Health Economics
INTRINSIC THERAPEUTICS
Kirsten Tullia
Sr Vice President, Payment & Health Care Delivery Policy
ADVAMED
Mark Vesey
Director, Market Access, Americas
NIOX
Melissa Georgeoff
Chief Contracting Officer
ADVENT HOME MEDICAL
Rob Ungvary
Director, Field Reimbursement
OLYMPUS CORPORATION OF THE AMERICAS
8:00 REGISTRATION & WELCOME COFFEE
8:50 CHAIRPERSON’S OPENING REMARKS
9:00 OPENING ICE BREAKER: MAKING “V-I-P” CONNECTIONS & SHARING INSIGHTS
In this interactive kick-off session, attendees are encouraged to rate themselves as a V-”Veteran” in the industry, I-”Intermediate” or P-”Potential”, and meet with 2 other participants of different ranks in order to form a V-I-P group and build new contacts. Additionally, each participant is welcome to briefly share insight into market intelligence resources commonly used to stay abreast of continuously evolving market trends.
9:30 ADDRESSING PRACTICAL STEPS TOWARDS SECURING & APPLYING A NEW CPT CODE
• Reasoning to seek a new code vs. employing existing code
• Effective use of lengthy timelines from application to approval
• Type of studies & evidence necessary to support the claim
• Lessons learned from launching new code into the marketplace
Kristen Hedstrom, VP, Market Access & Professional Education
INTEGRA LIFESCIENCES
10:15 COFFEE & NETWORKING BREAK
10:45 WELCOMING MEDICAL DEVICES INTO THE VALUE-BASED CONTINUUM OF CARE
• Observations of medical spending & need for VBC arrangements
• Aligning device strategy with the triple aim of value-based contracting
» Improving patient outcomes
» Improving patient experience
» Controlling per capita cost of care
• Practical examples of contracts in the healthcare market
• Potential influence on market access & payer engagement
John W. Wendling, CEO
PARKLAND COMMUNITY HEALTH PLAN
11:30 PANEL DISCUSSION: FOUNDATIONAL PILLARS OF A COMPREHENSIVE AI REIMBURSEMENT STRATEGY
• Monitoring policy trends specific to AI in US & abroad
• Clinical evidence generation in line with patient population
• Campaigning for early adoption with providers
Jessica Pan, AI SPECTRAL TECHNOLOGIES
Tim Lewandowski, ZEISS MEDICAL TECHNOLOGIES
Dennis Robbins, IDEAS
12:15 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES
1:15 PRACTICAL APPROACH TO ACHIEVING COVERAGE FOR AN AI-ENABLED PRODUCT
• Evidence threshold to demonstrate efficacy & cost-effectiveness
• Campaign to encourage involvement from CMS & commercial payers
• Navigating unexplored pathways to positive coverage determination
Kenneth Boyle, Director, US Markets
HEOR
Matthew Lopez, Vice President, Market Access & Payer Relations
IRHYTHM TECHNOLOGIES
2:00 FIRERSIDE CHAT: REMAINING QUESTIONS & OBSTACLES TO ADDRESS BEFORE REACHING WIDESPREAD AI COVERAGE & ADOPTION IN THE US
• Characterization of AI technologies for coverage determination
• Creating a framework to evaluate new technologies
• Incorporation of new technologies within Physician Fee Schedule
• Importance of health equity considerations within data sets
Kirsten Tullia, ADVAMED
MODERATOR:
Dawn Gabriele, BOSTON SCIENTIFIC
2:30 PRESENTATION BY BEACONONE HEALTHCARE PARTNERS LLC
3:15 COFFEE & NETWORKING BREAK
3:45 FIRESIDE CHAT: GUIDING INDUSTRY TO EFFICIENTLY MEET EXPECTATIONS FOR POSITIVE COVERAGE DECISIONS
• Qualifying & quantifying sufficient data to support coverage
• Challenges to open communication with industry & ideas to resolve
• Explanation of reviewers options within a budget-neutral environment
• Clinical outcomes most relevant to payer coverage decisions
• Potential opportunities to create payer/provider partnerships
MODERATOR: Mark Vesey, NIOX
Eugean Jiwanmall, INDEPENDENCE BLUE CROSS
Timothy Law, HIGHMARK
Mark Vesey, NIOX
4:30 IMPORTANCE OF SECURING KOLS TO SUPPORT THE VALUE PROPOSITION
• Targeting KOLs with maximum industry influence
» Centers of excellence
» Patient population alignment
• Value demonstration to bring KOLs on board
• Effective use of peer-to-peer communications to reach payers
• Methods to position KOL data in the product value dossier
Julie Alder Brown, Sr Director, Health Economics & Market Access
SPARK BIOMEDICAL
5:15 CLOSING REMARKS & END OF DAY 1
Day Two Agenda
Friday, May 24
8:00 REGISTRATION & WELCOME COFFEE
8:20 CHAIRPERSON’S OPENING REMARKS
8:30 BUILDING & EXECUTING YOUR VALUE STORY TO DRIVE ADOPTION
• Overview of hospital purchasing process & value analysis frameworks
• Articulating value to hospitals, ASCs, & outpatient practices
• Budget impact modeling & value analysis preparation
• Economics beyond the episode of care
• Aligning therapies with health system strategic objectives
• Reimbursement support models, opportunities & challenges
Spencer B. Bailey, VP Market Access & Reimbursement
MICROTRANSPONDER
9:15 CONVEYING HEALTH EQUITY WITHIN VALUE PROPOSITION
• Addressing health equity early in product lifecycle
• Communicating equity measurements to payers
• Influence on positive coverage decisions
Lee Washington, MD, Senior Medical Director
AETNA NATIONAL ACCOUNTS
10:00 COFFEE & NETWORKING BREAK
10:30 PLENARY DISCUSSION: SEARCHING FOR COMMONALITIES AMONG MEDICAID ADMINISTRATIONS TO BROADEN TREATMENT ACCESS FOR PATIENT POPULATIONS
• Policy changes due to medicaid expansion in recent years
• Practical knowledge-share of coverage journey in single states
• Opportunities for re-use of evidence & materials with next state
Melissa Georgeoff, Chief Contracting Officer
ADVENT HOME MEDICAL
11:15 SMALL GROUP DISCUSSIONS: ADDRESSING EVOLVING ASPECTS OF SITE OF SERVICE REIMBURSEMENT
Expansion of healthcare services outside of inpatient care means payment rates must also shift to accommodate. Proposed changes attempt to meet the needs of patients and providers while fairly assigning value to new technologies. With this session participants will self-select a group based on the coverage challenge they have knowledge of and/or wish to further explore.
GROUP 1: Hospital Claims Data Impacting APC Payment Rates
April Spillane, INTRINSIC THERAPEUTICS
GROUP 2: Challenges & Opportunities Specific to In-Clinic Reimbursement
Tim Lewandowski, ZEISS MEDICAL TECHNOLOGIES
12:00 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES
1:00 ACQUIRING TRANSITIONAL PASS-THROUGH DESIGNATION FOR SUFFICIENT APC PAYMENT RATES
• Examination of device eligibility criteria
• Timeline from initial steps through implementation
• Developing a rationale to support the rate increase
• Utilization of add-on payment in marketplace
Richard Kelsey, Senior Manager, Field Health Economics
BOSTON SCIENTIFIC
1:45 CREATING EFFICIENCIES IN MANAGING APPEALS & DEMONSTRATING MEDICAL NECESSITY
• Identifying cases warranting an appeals process
• Building impactful arguments to overturn denials
• Supporting the rationale to authenticate medical necessity
• Successes in involving the patient in the process
• Lessons learned to increase efficiencies in case management
Victoria Driscoll, Sr Case Manager
MAINSTAY MEDICAL
2:30 COFFEE & NNETWORKINNG BREAK
2:45 LEVERAGING REAL WORLD EVIDENCE TO GAIN COVERAGE
• Estimation of investment & manpower to collect data
• Encouraging providers to participate in device usage
• Identifying clinical evidence most relevant to target audience
• Leveraging clinical outcomes to demonstrate economic value
• Timeline to collect adequate data for positive coverage decision
Colleen O’Connell, Clinical Appeals Resolution Manager
MYOMO
3:30 SUCCESSFUL APPEAL & APPROVAL THROUGH REIMBURSEMENT RESOURCES
• Opportunities to provide additional product details during appeals
• Communications strategies with reviewers & feedback received
• Observations of what reviewers are looking for to overturn denials
Rob Ungvary, Director, Field Reimbursement
OLYMPUS CORPORATION OF THE AMERICAS
4:15 CLOSING REMARKS & CONFERENCE CONCLUSION
Previous Attendees Include:
Senior Medical Director, AETNA
Global HEOR Manager, ALCON
Commercial Counsel, North America, ALIGN TECHNOLOGY
Director, Reimbursement & Market Access, ALLERGAN
VP, Reimbursement & Patient Services, BAXTER
Business Development and Partnerships, BLUE HEALTH INTELLIGENCE
Director, Market Access, BLUEWIND MEDICAL
Principal Health Economist, BOSTON SCIENTIFIC
Director of Healthcare Economics, CANON MEDICAL SYSTEMS USA
Head of US Operations, Remote Care, CARL ZEISS MEDITEC
Sr. Director Healthcare Economics & Market Access, COOPERSURGICAL
Director, GHER, EDWARDS LIFESCIENCES
HEOR Manager, HERAEUS MEDICAL GMBH
Sr Research Analyst, INDEPENDENCE BLUE CROSS
Director, Payor Access, INTRINSIC THERAPEUTICS
Dir. Global Access, Value & Economics-Digital Tech, INTUITIVE SURGICAL
VP, Reimbursement & Market Access, MAINSTAY MEDICAL
Sr Analyst, Healthcare Economics, Policy & Reimbursement, MEDTRONIC
Director, Government Affairs & Market Access, NEVRO CORP
Director of Market Access, Americas, NIOX PLC
Global HEMA, Sr. Manager, GI-ET Medical, Scientific Affairs, OLYMPUS
National Medical Director, OPTUM HEALTH SOLUTIONS
Counsel, OSBORNE CLARKE
President, REMINGTON MEDICAL
Market Access Manager, SPR THERAPEUTICS
Sr. Manager, Field Reimbursement and Market Access, STRYKER
Market Access Specialist, TERUMO BCT
Director, Reimbursement and Payer Relations, THERANICA
Senior Counsel, THOMPSON HINE
National Account Manager, UNITED THERAPEUTICS CORPORATION
Reimbursement & Market Access Associate, VARIAN MEDICAL SYSTEMS
Manager, CSMA, VERANEX
Director Health Economics & Value Analytics, VIZ INC
Market Access Manager, VUNO
US Reimbursement Director, W.L. GORE & ASSOCIATES
….And Many Many More
Who should attend:
Executives that will find this program of greatest relevance are those currently responsible for securing coverage for emerging technologies, broadening market access & demonstrating the safety, effectiveness and value of product lines, as well as strengthening relationships with government and commercial payers. Job titles of those executives that will find this program to be most applicable to the job function include:
• Reimbursement
• Market Access
• Health Economics
• Health Policy
• Payer Policy
