12th Annual Medical Device Coverage and Reimbursement Conference

July 18-19, 2016 | Alexandria, VA
Download AgendaRegister Now

Our Sponsors

 

 

 

 

 

 

 

 

 

 

 

 

DAY ONE

7:45 REGISTRATION & MORNING COFFEE

8:15 WELCOME & CHAIRPERSONS OPENING

8:30 KEYNOTE ROUND-TABLE: THE IMPACT OF MEDICAL DEVICE REIMBURSEMENT ON COST, INNOVATION AND HEALTH OUTCOMES:
EXECUTIVE LEVEL REIMBURSEMENT PROFESSIONALS WILL DISCUSS:

  • Perspectives and opportunities in reimbursement policy challenges
  • Reimbursement cuts in CMS & commercial payer healthcare spending
  • Overcoming the misalignment between value & reimbursement rates
  • Explore potential reimbursement policy models for the future

Scott Reid, Vice President, Reimbursement, SMITH & NEPHEW

Tonya Dowd, MPH, Vice President, Reimbursement, ENTEROMEDICS

Mitchell Sugarman, VP of Health Economics, Policy and Payment, MEDTRONIC

Leslie Wise, VP, Global Healthcare Economics, ANGIODYNAMICS

Cara Bachenheimer, Senior Vice President of Government Relations
INVACARE CORPORATION

 

9:15 EFFECTIVELY SECURING CLINICAL EVIDENCE THROUGH EARLY-PHASE HIGH LEVEL DECISION MAKING
Providing the appropriate clinical evidence in order to secure reimbursement for a medical device begins with high level, clinical trial decision making in early stage product development. Innovators wishing to bring medical devices to market must think ahead about the clinical data needed to secure regulatory approval as well as the evidence required to generate positive coverage decisions from government and commercial payers. Designing clinical studies to yield evidence that payers, providers and key stakeholders are seeking begins internally from the top down.

  • Executive level input on coverage & evidence
  • Study design development and decision making
  • Key market access considerations in trial design
  • Data for regulatory vs. reimbursement vs. providers

Tonya Dowd, MPH, Vice President, Reimbursement, ENTEROMEDICS

Paul Just, Director, Global Healthcare Economics, SMITH & NEPHEW

Darcy Krzynowek, Principal Consultant, GFK MARKET ACCESS

 

10:30 COFFEE & NETWORKING BREAK

 

11:00 MEDICAL POLICY ROUND-TABLE: UNDERSTANDING COMMERCIAL PAYER POLICIES AND PROCESSES

  • Commercial payer insight on developing medical policies
  • Recommendations on accessing medical policy staff
  • Shared perspectives on:
    • Coverage policies for novel devices
    • Establishing clinical evidence
    • Published clinical evidence
  • Policies on experimental and investigational devices
  • Viewpoints on establishing medical necessary
  • Evaluate coverage determination guidelines
  • Updates to medical policy: Reviews and changes

Laurence Clark, M.D., FACP, Medical Director, NATIONAL GOVERNMENT SERVICES

James Cross, MD, VP, National Medical Policy and Operations, AETNA

Robert LoNigro, MD, MS, CMO, CELTICARE HEALTH PLAN

Joyce Grissom, MD, Chief Medical Director & VP Healthcare Operations
HEALTH NET FEDERAL SERVICES

 

11:45 MASTERING A MOVING TARGET: PAYER PERSPECTIVES ON MEDICAL DEVICE COVERAGE & REIMBURSEMENT
All commercial payers follow a specific set of guidelines regarding medical device reimbursement, resulting in varying clinical requirements and medical policies from payer to payer. Adding to the time-consuming and labor-intensive responsibility of securing coverage across multiple organizations is the uncertainty surrounding internal commercial payer review processes. Medical device reimbursement professionals are keen to gain further knowledge regarding the evaluation processes of payers so that in turn, more targeted evidence and data demonstrating medical value and cost effectiveness can be provided.

  • Getting a foot in the doors with commercial payers
    • Accessing commercial payers
    • Communication strategy
    • Technology review
  • Processes for determining coverage & non-coverage
  • Viewpoints on sufficient vs. non-sufficient studies
  • Medicare:  National vs. Local Coverage

Mark Domyahn, Formerly the Senior Director, Healthcare Economics, ST. JUDE MEDICAL, INC

Yasemin Dalgali, Director, Health Economics and Reimbursement, AUGMENIX, INC.

 

12:30 LUNCHEON FOR SPEAKERS, SPONSORS & ATTENDEES

 

2:00 CASE STUDY: USING THE EXTERNAL APPEALS PROCESS TO INFLUENCE COVERAGE & PAYMENT BY MANAGED CARE ORGANIZATIONS
Medical device organizations are challenged with ensuring that the necessary steps have been taken to meet all evidentiary and economic requirements to secure reimbursement, however when a device is denied coverage it can leave a company in a challenging position. In order to be successful in the appeals process, reimbursement professionals must think outside the box in regards to creating an appeals strategy to drive a positive coverage decision. Through case study, attendees will gain first-hand insight on one company’s success in overcoming coverage denial and ultimately establishing a positive managed care coverage policy.

Janet S. Fike MHA, FACHE, COC, CPMA, Director of Reimbursement and Market Access
TORAX MEDICAL

 

2:45 ESTABLISHING PERFORMANCE-BASED RISK SHARING AGREEMENTS WITH PAYERS
There is a growing interest among payers and medical device manufacturers for performance based risk sharing arrangements (PBRSAs) where the price, level, and nature of reimbursement is related to the performance of the product in either the research or real world environment. PBRSAs are often established when the device manufacturer and the payer have different opinions regarding the clinical utility or value of a test and the developer is seeking a higher price than the payer is willing to cover given the evidence provided. Attendees will gain cross industry insight on performance-based risk-sharing arrangements for medical device technologies.

  • Review PBRSAs and an organizational taxonomy
  • Drivers and barriers to PBRSA for devices
  • Exploration of informative case examples

Leslie Wise, VP, Global Healthcare Economics, ANGIODYNAMICS

 

3:15 COFFEE & NETWORKING BREAK

 

3:45 PANEL: NEXT STEPS FOR DME REIMBURSEMENT IN A COMPETITIVE BIDDING ENVIRONMENT
Medicare’s Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is a program of much debate and varying opinions; CMS claims the program is an “essential tool that changes the amount Medicare pays while maintaining beneficiary access to items and services and quality of care.” Device manufacturers, economists and patient advocacy groups have been critical of the program sighting that product quality will deteriorate and supply shortages will become common. As CMS expands competitive bidding to rural areas and reimbursement is reduced up to 45%, reimbursement executives question how to compete in a restricted environment.

Sean D. Murphy, Senior Director, Healthcare Policy & Payer Relations
EBI LLC, A ZIMMER BIOMET COMPANY

Cara Bachenheimer, Senior Vice President of Government Relations
INVACARE CORPORATION

 

4:30 ACO ROUNDTABLE: ESTABLISHING MUTUALLY BENEFICIAL PARTNERSHIPS
According to an analysis from consulting firm Oliver Wyman, nearly 7 in 10 Americans now live in an area served by an ACO and 44 percent live in areas served by at least two; these factors are significantly shifting the way medical device companies are doing business with healthcare providers. If positioned correctly, and evidence supporting the device is established, ACO’s will recognize the value of a device and in turn, implement it within the organization, resulting in a positive partnership for all parties involved. In order to achieve this partnership, reimbursement executives must understand how to properly access ACO’s, the metrics used by ACO’s to make decisions, such as cost reduction and quality outcomes, and how a device will uphold to those standards.

  • Goals of ACOs as related to medical devices
  • Accessing ACO’s and building partnerships
  • Metrics & standards used in decision making
  • Review the next generation ACO model

Amit Rastogi, Interim Chief Executive Officer
NORTHEAST MEDICAL GROUP (YALE NEW HAVEN HEALTH)

Ahmed Haque, West Virginia & Delaware Executive Director
ALEDADE WEST VIRGINIA ACO, LLC

George Bone, Medical Director
SOUTHERN MARYLAND INTEGRATED CARE, LLC

 

5:15 CLOSING REMARKS AND DAY ONE CONCLUSION

Share This