The Reimbursement Landscape Under ACA

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​Tuesday, February 11, 12:00 p.m. - 12:55 p.m. | Jade

The Affordable Care Act brings a great promise to the biotech industry and our nation as a whole. Now, a couple months in, what do we know? What pressure will ACA put on the forces that impact product reimbursement, and how will those forces respond? What can the biomedical ecosystem do to protect the industry’s pipelines? How did – and have - companies prepared? Come hear a discussion among industry representatives on this new environment under ACA, and get their take on where the law will lead one of the most important elements of biotech development.

Moderator

  • Roger Longman, Chief Executive Officer, Real Endpoints

Panelists

  • Peter Bach, MD, MAPP, Attending Physician, Memorial Sloan-Kettering Cancer Center
  • Rachel K. King, CEO, GlycoMimetics
  • J.D. Kleinke, Healthcare Business Strategist
  • Melinda Thiel, Vice President, Pharmacy, HealthFirst
  • Laurel Todd, Managing Director, Reimbursement & Health Policy, BIO

Who's Who

Peter Bach, MD, MAPP
Attending Physician, Memorial Sloan-Kettering Cancer Center

Dr. Bach’s main research interests cover healthcare policy, particularly as relates to Medicare, racial disparities in cancer care quality, and lung cancer epidemiology. His research examining quality of care for Medicare beneficiaries has demonstrated that blacks do not receive as high quality care as whites when diagnosed with lung cancer, and that the aptitude and resources of primary care physicians who treat blacks are inferior, when compared to primary care physicians who primarily treat whites. In 2007 he was the senior author on a study demonstrating that care in Medicare is highly fragmented, with the average beneficiary seeing multiple primary care physicians and specialists.

His work in lung cancer epidemiology has focused on the development and utilization of lung cancer prediction models that can be used to determine what lung cancer events populations of elderly smokers will experience over a period of time. His healthcare policy analysis includes investigations into Medicare’s approaches to cancer payment, as well as developing models of alternative reimbursement, payment systems, and coverage policies. He is funded by grants from the National Institute of Aging, a contract from the NCI, and philanthropic sources.

Rachel K. King
CEO, GlycoMimetics

Rachel King is co-founder and CEO of GlycoMimetics, Inc. (GMI), a biotechnology company which has so far raised over $60 million in venture capital financing and completed a strategic partnership with Pfizer. Before founding GMI, she was an Executive in Residence at New Enterprise Associates, one of the nation’s leading venture capital firms. Mrs. King came to NEA after serving as a Senior Vice President of Novartis Corporation. Before joining Novartis, Mrs. King spent ten years with Genetic Therapy, Inc. through the company’s early stage, initial public offering, and eventual sale to Novartis. There she held various positions, including as the Company’s CEO. Mrs. King also worked previously at ALZA Corporation in Palo Alto, California and at Bain and Company in Boston. She received her B.A degree from Dartmouth College and her MBA from Harvard Business School. Mrs. King currently serves as Chair of the Board of the Biotechnology Industry Association (“BIO”). She is also Chair of the Maryland Life Sciences Advisory Board appointed by Governor Martin O’Malley.

J.D. Kleinke
Healthcare Business Strategist

J.D. Kleinke is a medical economist, author, and entrepreneur. He has been instrumental in the creation of four health care information organizations, served on the Boards of several health care companies, and advised both sides of the political aisle on pragmatic approaches to health policy and legislation. He is the author of three books on the US health care system, and written extensively about the potential impacts of the Affordable Care Act on health care market dynamics, health venture formation, and medical innovation.

Kleinke has served as a Resident Scholar of the American Enterprise Institute, member of the Editorial Board of Health Affairs, and Adjunct Professor of the Harvard School of Public Health. He helped establish Health Grades Inc., which he served as Executive Vice Chairman of the Board. In the 1990s, he was a principal architect in the creation and rapid growth of HCIA/Solucient from a niche health care data analysis firm to a publicly traded provider of information products to health care systems, managed care organizations, and pharmaceutical companies across the U.S. and Europe. He directed the company’s pharmaceutical research unit, and its analyses of the impact of changing clinical practices on the US health care economy. Before joining HCIA, he was Director of Corporate Programs at Sheppard Pratt Health System, the largest private psychiatric hospital in the U.S. While at Sheppard Pratt, Kleinke developed and managed, at the age of 28, the nation’s first provider-based, managed mental health care system.

Kleinke is the author of Bleeding Edge: The Business of Health Care in the New Century (1998), Oxymorons: The Myth of a US Health Care System (2001), and Catching Babies (2011). His work has appeared in the Wall Street Journal, New York Times, Barron’s, Health Affairs, JAMA, the British Medical Journal, Modern Healthcare, Managed Healthcare, Forbes.com, The Health Care Blog, RealClearMarkets, and The Huffington Post.

He can be found on the Web at www.jdkonline.com and on Twitter @jdkonhealth

Roger Longman
Chief Executive Officer, Real Endpoints

Roger Longman is CEO of Real Endpoints, a start-up company focused on pharmaceutical reimbursement, and aiming to help both payers and product developers improve the value of pharmacotherapy. Its first product assesses – systematically, objectively, and transparently – the value of drugs relative to their competitors.

Until November 2009, Longman was Managing Director, Pharma at Elsevier Business Intelligence, a Reed Elsevier company. He has been involved with the health-care industry for more than 25 years.

From 1990 through 2008, Longman was co-CEO and managing director of Windhover Windhover, an information company providing sophisticated analysis and data around pharmaceutical and medical device business strategy through publications, databases and conferences. Longman co-founded and built the company through internal development (with publications such as IN VIVO, Start-Up and The RPM Report, several databases, including The Strategic Transactions Database; and a series of senior-executive conferences), and through acquisition.

In 2008, Windhover was acquired by Reed Elsevier and merged with its FDC Reports division (publishers of The Pink Sheet, The Gray Sheet and many other medical-industry newsletters), creating Elsevier Business Intelligence. Longman ran the combined group’s pharmaceutical business until he left in 2010 to begin working on Real Endpoints with Norman Selby, who had been Windhover’s chairman and lead investor.

Over the years, Mr. Longman has become recognized as an expert in biopharmaceutical strategy and often speaks at key industry events organized by important trade organizations, investment banks, venture capital firms and leading pharma and biotech companies. He lectures regularly at several leading universities and co-directed the Wharton-Windhover pharmaceutical program at The Wharton School. Mr. Longman completed his BA at Cornell University and an MA at the University of North Carolina at Chapel Hill, and then taught for three years at the European division of the University of Maryland.

Melinda Thiel
Vice President, Pharmacy, HealthFirst

Melinda Thiel is currently the Vice President of Pharmacy for Healthfirst, a not-for-profit managed care organization that’s been serving the New York and New Jersey metropolitan area since 1993. Melinda joined Healthfirst in 2012 and is responsible for the oversight of all Pharmacy related activities including Pharmacy Benefit Manager (PBM) oversight, Medication Therapy Management (MTM Oversight),Pharmacy quality measurement and formulary and utilization management activities.

Prior to Healthfirst, Melinda was the Vice President of Sales and Business Delivery for Personalized Medicine at Express Scripts (ESI). She joined Express Scripts in 1998 and started working with the Personalized Medicine and Molecular Diagnostic programs in 2009, ultimately taking over responsibility for the operations, sales and product management for the Personalized Medicine product portfolio. Previous to her role in the Personalized Medicine organization, Melinda spent time in several other areas of ESI including, Disease Management, Retail Networks and New Markets.

Prior to joining ESI, Melinda worked with various non-profit organizations to design, develop and implement Community Health Education programs. She worked at the American Lung Association and the New Jersey Thoracic Society as well as Hackensack University Medical Center. Melinda has a Bachelor’s Degree in Community Health Education and a Masters in Health Care Management.

Laurel Todd
Managing Director, Reimbursement & Health Policy, BIO

Laurel Todd is Managing Director, Reimbursement and Health Policy at the Biotechnology Industry Organization, where she directs the association's policy efforts related to Medicare, Medicaid and health reform. Prior to joining BIO, Laurel advised pharmaceutical, biotechnology, medical device, and other medical technology and physician groups on Medicare coding, coverage and reimbursement issues at HillCo Partners, LLC, a public policy consulting firm. Laurel also previously served as Special Assistant to the Deputy Administrator and Deputy Capital Markets Advisor for the Centers for Medicare & Medicaid Services (CMS) in Washington, D.C.

Laurel holds undergraduate degrees from the University of Pennsylvania and an MBA from Georgetown University.