Perspectives on Medical Reimbursement
By JR Associates
Our VP of Global Health Policy, Jo Ellen Slurzberg, was among the nearly 200 investors, entrepreneurs, healthcare advocates and corporate executives who participated. As a panelist for the “Diagnosis and Risk Assessment” showcase, Jo Ellen joined other medical industry experts in advising CEOs from four diagnosis and risk assessment ventures: Pediatric Bioscience, Behavior Imaging Solutions, IntegraGen and Stemina.
When we asked Jo Ellen to share some topline impressions from her session, she emphasized six key takeaways:
• Diagnostics for Autism Spectrum Disorder (ASD) remains challenging. Although identification of biomarkers in novel genomic tests can improve defining risk, diagnosis in children requires a multidisciplinary approach.
• Early intervention is essential. Yet, often there is a significant time lapse between the initial suspicion of ASD and its diagnosis. This leads to delays in treatment. When gaining coverage for novel clinical lab tests used in the diagnostic process, it’s critical to link these tests with their ability to minimize delays, and ultimately improve patient outcomes.
• State mandates assuring access to ASD testing and services do not guarantee that an individual test or intervention will be covered or paid. It must meet criteria for clinical evidence and patient outcomes to be covered and paid by health insurers.
• Ultimately, the purpose of any test must pass a “so what?” inquiry. In other words, developers must demonstrate its ability to produce information that affects physician decision-making and improves patient outcomes.
• Self-pay is an early-to-market strategy. However, it may not be sustainable. For many families, high cost may be a barrier to access. Companies must prepare a reimbursement plan that focuses on gaining broad acceptance by both the clinical and payer community.
• Companies with laboratory developed tests (LDTs) must be mindful of policy changes. It’s important to understand new regulations that are introduced for FDA clearances and approvals. These changes are likely to have material implications for payer acceptance.
To talk in more detail about reimbursement issues related to diagnosis and risk assessment for Autism or other medical specialties, please call JR Associates at
1-818-344-4380. Or send an email inquiry to us at firstname.lastname@example.org.