An early reimbursement strategy is key to securing early funding, designing clinical trials, developing sufficient clinical evidence to meet differing payer criteria, and creating a sustainable business plan. Yet health care policies, goals, and trends are changing rapidly to focus on additional objectives such as bundled payments, outcomes (quality of care), patient-centered care, alternative delivery sites (e.g., home-based care instead of hospital stays), preventive care, and controlling costs. These changes dramatically impact health care delivery, and require that product developers be nimble enough to adjust to frequently changing parameters.
Providers and suppliers need to be convinced that new products meet their own metrics for care and costs, including in many cases, the application of pathway-driven methodologies – which may result in additional barriers to entry. Payer policies are in flux with respect to coverage and reimbursement methodology – for example, beginning in 2018, Medicare will link its clinical laboratory payments to commercial payer rates. Product developers must plan for the future, and determine how to have the data necessary to satisfy the why and how of business success. This session will address emerging trends and how to assemble the data to develop and adapt a viable – and adaptable – reimbursement strategy.
Anita J. Chawla, PhD, Managing Principal, Analysis Group
Mark McCoy, MBA, Senior Director, Reimbursement, Guardant Health, Inc.
Amber Trivedi, MS, CGC, Senior Vice President, Market Development and Innovation, InformedDNA
MODERATOR: Judith A. Waltz, Partner, Foley & Lardner LLP