Perspectives on Medical Reimbursement
By JR Associates
For years, our consultants have been featured speakers at the MDMA Annual Coverage, Reimbursement & Health Policy Conference — and the 2015 conference was no exception. Our Founder and President, Judy Rosenbloom, teamed with VP Health Policy, Jo Ellen Slurzberg, to share their expertise with the medical device manufacturing community in two sessions:
1) Introduction to Reimbursement: Getting Paid for Your Technology
On the first day of the conference, this extended workshop proved, once again, that even an introductory reimbursement session naturally leads to a discussion of advanced concepts and strategies.
As a framework for discussion, Judy and Jo Ellen outlined the core mechanics and operational aspects of coverage, coding, and payment. Then they explained how these reimbursement fundamentals influence access to innovative medical diagnostic and therapeutic products.
Next, they looked at how payers and providers evaluate clinical evidence, pricing, and payment before adopting technology — and they discussed how these processes intersect in today’s fluid healthcare environment. They also explained how the success of business plans and product commercialization depend deeply upon whether a reimbursement strategy can be implemented.
Finally, to help put this information into practice, Judy and Jo Ellen opened the session to an exchange of ideas about participants’ product-specific questions and issues.
2) Demonstrating Value to Providers
On day two, Judy and Jo Ellen joined forces with Ning Tang, MD, Senior Medical Director, Clinical Effectiveness & High Value Care, Clinical Associate Professor, Stanford Health Care. Together, they led a discussion exploring the shift in device adoption decision-making from payer coverage to provider choice.
In a lively dialogue with participants, the panel explored how provider networks and ACOs with their own insurance product and risk contracts have created rigorous assessment processes to determine if adoption and purchase of a new medical device is warranted.
Our consultants always come away from industry conferences like this with appreciation for the opportunity to share their expertise, and to learn about the challenges that are foremost on the minds of others in the medical device community.
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