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A wave of legislation has passed in statehouses across the country requiring insurance coverage of biomarker testing. These bills have wide-ranging implications that are unfolding in real-time as they are enacted into law. They offer both the promise of expanded access to clinically valuable testing for patients as well as challenges and uncertainties related to implementation, compliance, and their ultimate impact on patient care.

In this webinar, panelists from Tempus, Foley Hoag, Blue Cross Blue Shield Association (BCBSA), and Blue Cross and Blue Shield of Louisiana (BCBSLA) discuss efforts to provide patients with affordable, evidence-based, clinically appropriate testing in the context of this emerging legislation.

The discussion will include:

• Background on key issues, including the growing use of biomarker testing in clinical care,
• The details of the legislation and the landscape of bills passed and pending, and
• Efforts to interpret and comply with the new laws, while also controlling costs and ensuring that testing is evidence-based and clinically appropriate, especially by health insurers.

Who should attend:

• Health plans seeking perspectives on how to interpret and respond to the new legislation, ensuring coverage of biomarker testing is compliant, clinically appropriate, and cost-effective
• Providers and patient advocates seeking to understand the implications of the new legislation for the clinical care of the patients they serve
• Diagnostic laboratories seeking to understand implications for the development and delivery of biomarker tests
• Policymakers and government relations professionals looking to stay up to date with legislative efforts in this space

Suzanne Belinson, PhD, MPH
VP, Commercial Markets
Tempus

Dr. Suzanne Belinson is Vice President of Commercial Markets at Tempus Labs Inc. Tempus is a technology company focused on AI-enabled diagnostics. With the world’s largest library of clinical and molecular data and an operating system to make that data accessible and useful, Tempus enables real-time, data-driven decisions to deliver personalized patient care, and in parallel, facilitate discovery, development and delivery of optimized therapeutic options for patients through distinctive solution sets. At Tempus she leads the commercial markets team whose primary responsibilities are market access, evidence development and execution of partnerships with organizations aiming to improve healthcare value and outcomes.

Previously, Dr. Belinson served as Executive Director, Clinical Markets, at the Blue Cross Blue Shield Association where she led the sales and market development as well as day to day operations of Evidence Street.

Dr. Belinson received her bachelor’s degree from Cleveland State University, a Masters in Public Health from the University of Pittsburgh, and a PhD in Epidemiology from the University of North Carolina at Chapel Hill.

Judy Mouchawar, MD, MSPH
Medical Director
Blue Cross Blue Shield Association

Dr. Judy Mouchawar is a Medical Director in the Office of Clinical Affairs of the Blue Cross Blue Shield Association. Previously, Dr. Mouchawar held Medical Director roles at Aetna and Blue Cross of Idaho. She is board-certified in Preventive Medicine and fellowship trained in Cancer Genetics and Cancer Prevention. Additionally, she is a board-certified genetic counselor. She graduated from McGill University Medical School and completed her post-graduate training at the University of Colorado.

Erik Schulwolf, JD
Associate
Foley Hoag

Erik Schulwolf specializes in advising cutting-edge life sciences companies on reimbursement and compliance issues related to their products. His practice involves extensive work with molecular diagnostic laboratories and manufacturers of diagnostic tests on issues including reimbursement from government and private payers, compliance with fraud and abuse and federal price reporting laws, and advocacy with federal and state agencies. Erik also provides reimbursement, compliance, and federal and state government strategies advice to pharmaceutical manufacturers and providers.

Larry Simon, MD, MBA
Managing Medical Director for Medical Policy and Medical Appeals
Blue Cross and Blue Shield of Louisiana

Dr. Larry Simon is the Managing Medical Director for Medical Policy and Medical Appeals for Blue Cross and Blue Shield of Louisiana (BCBSLA), where he also serves as the Medical Director for Coding and Reimbursement and Chair of the Credentialing and Medical Quality Management Committees. He is a member of the AMA CPT Editorial Panel, serving on the Executive Committee and as Co-Chair of the Molecular Pathology Advisory Group and Genomic Sequencing Procedures Workgroup. He also chairs the Medical Director’s Forum for both the Louisiana Association of Health Plans and the National Anti-Fraud Advisory Board of the Blue Cross and Blue Shield Association. Prior to joining BCBSLA, Dr. Simon served in numerous leadership roles for the American Academy of Otolaryngology, the American Medical Association, the American College of Surgeons, and the Louisiana State Medical Society.

Dr. Simon is an alumnus of Louisiana State University, Baylor College of Medicine, Rady Children’s Hospital, and the BI Moody College of Business Administration at the University of Louisiana. A diplomate of the American Board of Otolaryngology and a Fellow of the American College of Surgeons, Dr. Simon has over 15 years of experience in Health Policy and Healthcare Reform, and he has presented over 170 lectures and seminars on these topics.

A Rotarian, an animal rescuer, a member of multiple civic boards, and a patron of the arts, Dr. Simon enjoys spending his time outside of work serving his community, helping the animal shelters and abandoned dogs of Louisiana, and traveling and enjoying life with his wife and their family and friends.

Gillian Hooker, PhD, ScM, CGC (moderator)
Chief Scientific Officer
Concert Genetics

Dr. Gillian Hooker is Concert’s Chief Scientific Officer and the past President of the National Society of Genetic Counselors. She also serves as an adjunct Associate Professor with the Vanderbilt University Medical Center and leads the Research arm of the Vanderbilt Genetic Counseling Training Program. Applying her background in molecular and clinical genetics, genetic counseling and behavioral science, she is committed to overcoming the barriers to effective translation of genome science at the patient, provider and system levels. As a researcher in academic and government settings, Dr. Hooker has worked with numerous transdisciplinary teams on the front lines of genomics, developing and evaluating methods for delivering genomic information to patients and their providers. Having served as the associate director of a genetic counseling training program, she also brings significant experience in genetics education and outreach.

Dr. Hooker completed her doctoral degree in Molecular, Cellular and Developmental Biology at Yale University and her masters degree in Genetic Counseling at the Johns Hopkins School of Public Health / National Human Genome Research Institute Genetic Counseling Training Program. She grew up in Kalamazoo, Michigan and attended Kalamazoo College.

The post Webinar: Navigating State Biomarker Legislation appeared first on Concert.

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For many health plans, genetic testing feels like a moving target. The landscape of laboratories, tests, coding, evidence, and guidelines is changing too rapidly to confidently manage. Meanwhile, the lack of clear data on quality and accuracy makes it difficult to recognize and reward labs offering high-value testing.

From the lab perspective, standing out in a crowded market can be equally challenging. Even the best labs have trouble differentiating their tests, while unsafe and even fraudulent labs operate in the shadows putting patients at risk.

In response to these challenges, some health plans are taking innovative steps. Leading plans are collecting quality information beyond CLIA certification and CAP accreditation, even requiring third-party validation of test accuracy. To manage costs and streamline operations, plans are requiring transparency up-front into how tests will be coded and billed. Steps like these are enabling more testing to be performed at high-quality labs at consistent rates.

In this webinar, health plan leaders will discuss how they are approaching this complex space, and what more is needed to improve quality and experience for members.

Matt Fickie, MD
Senior Medical Director for Medical Policy
Highmark

Dr. Matt Fickie is Senior Medical Director for Medical Policy at Highmark. As the plan’s internal expert on precision medicine, Dr. Fickie focus has been on advancing the use of genetic technologies to improve health outcomes. He oversees Highmark’s Medical Policy Department which includes Highmark’s innovative Coverage with Evidence Determination program. He is also a member of the Highmark team that led the implementation of the plan’s requirement for third-party validation on NGS panels from in-network laboratories. Prior to joining Highmark, he served as an attending physician at Mount Auburn Hospital in Cambridge, MA. Dr. Fickie is board certified in internal medicine, general pediatrics, and clinical genetics.

Troy Dickinson, MBA
Principal Clinical Research Analyst-Affordability
Blue Cross and Blue Shield of Minnesota

Troy Dickinson is a Principal Clinical Research Analyst at Blue Cross and Blue Shield of Minnesota. He has served in various roles at Blue Cross throughout his 21 year career. He has been in his current role on the Affordability and Population Health team for the past 7 years focusing on ways to make healthcare more affordable.

Christy Moore, MS, CGC
Clinical Genetics Program Manager
Blue Shield of California

Christy Moore is a genetic counselor and currently manages the Genetics Program at Blue Shield of California. She has experience in prenatal and pediatric genetics, with a focus on rare disease. Prior to her current role, she has held positions in clinics, a hospital, a commercial genetic lab, and public health. She holds an MS in Human Genetics from UC Davis, and an MS in Genetic Counseling from UC Irvine.

The post Webinar: How health plans are driving safety, accuracy & affordability in genetic testing appeared first on Concert.

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The science of genetics has unlocked exciting advancements in health and life sciences. Unfortunately, enabling cost-effective access to clinically appropriate genetic testing can also be administratively frustrating and burdensome for health plans, especially medical directors and care management staff.The sheer number of tests and ambiguity in billing codes make it challenging to identify the test that was performed. Confusion about which medical policy to apply leads front-line staff to escalate cases to medical directors who then face long, complex reviews.

Meanwhile, developing and maintaining policy is a significant undertaking. Rapidly evolving evidence and testing options quickly render policies out-of-date.

Fortunately, in recent years, new solutions have emerged. Health plan leaders have combined innovative, evidence-based medical policies with tech-enabled capabilities to establish more adaptable, effective programs. In this webinar, health plan leaders will discuss their perspectives on what’s really working to manage this dynamic space.

Priscilla Alfaro, MD
VP, Payment Integrity
Blue Cross and Blue Shield of North Carolina

Dr. Priscilla Alfaro is currently Vice President of Payment Integrity for Blue Cross and Blue Shield of North Carolina. Previously, she was the Chief Medical Officer for Zelis. Prior to Zelis, she worked as the Staff VP for Quality Code Reviews and Provider Education with Anthem’s Payment Integrity (PI) team. She led a team of clinical auditors and provided strategic input and clinical guidance to SIU and the other areas within PI. Before joining Anthem, she served as the medical director for the Texas Office of Inspector General. She published an article in Health Care Fraud, Waste, and Abuse in AAP News in 2010 and made many presentations on the transition to ICD-10. From 2018- June 2019, she served as the Chairman of the Medical Advisory Board for the National Health Care Anti-Fraud Association (NHCAA). She is a Board-certified Pediatrician and spent 20 years in clinical practice. She holds many coding certifications including a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), and Certified Inpatient Coder (CIC), as well as a Certified Fraud Examiner (CFE). She is a member of the AMA, AAP (National, Texas, Hawaii chapters), AAPC, NAMAS, Texas Medical Association, Travis County Medical Society, and the Association of Certified Fraud Examiners (ACFE).

Mary Davis, MD
Chief Medical Officer
Security Health Plan

Mary Davis, MD, is Chief Medical Officer at Security Health Plan of Wisconsin, Inc. Dr. Davis is a fellow of the American Academy of Family Physicians, and has served as a Chief Medical Officer and Medical Director consultant for several years. She has held Chief Medical Officer posts at such health plans as Scott and White, Network Health Plan and Dean Health Plan and MCS, Inc., in Puerto Rico, and was Medical Director at Wellmark BCBS. She has served on many health related and volunteer boards throughout her career.

Dr. Davis earned her medical degree at Temple University School of Medicine and completed her residency at the University of Wisconsin-Madison. She practiced family medicine in Columbus, Wis., before she began her administrative work. She has completed additional training in coding, project management, communication and leadership and holds a Certified Physician Executive certification from the American Association of Physician Leadership.

Josette Gordon-Simet, MD, MBA
Chief Medical Officer
Blue Cross and Blue Shield of Nebraska

Dr. Gordon-Simet is the Chief Medical Officer for Blue Cross Blue Shield Nebraska and leads BCBSNE’s clinical initiatives, including strategic oversight of the company’s medical policies, medical review processes, population health management and equity strategies. Prior to her role as CMO, Dr. Gordon-Simet was senior medical director at BCBSNE. Previously, she was chief medical officer and vice president of medical affairs for Think Whole Person Healthcare, where she directed clinical enhancement programs. She has also been a medical director and practicing physician with CHI Health in Omaha.

Dr. Gordon-Simet is passionate about patient education and support of childhood health improvement initiatives. She is a board member of Building Health Futures, a non-profit organization focused on improving underserved children and youth’s health through collaboration and advocacy.

Dr. Gordon-Simet earned her medical degree from Temple University’s Lewis Katz School of Medicine and is board-certified in family medicine. In addition, she is a graduate of the University of Nebraska at Omaha’s Executive MBA program and holds a master’s degree in strategic finance from Bellevue University.

The post Webinar: Demystifying Genetic Test Coding & Clinical Review appeared first on Concert.