Show Me the Money: Reimbursement in an ACA World

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Monday, February 11th, 9:00am - 9:55am

With many key provisions of the Affordable Care Act (ACA) slated to take effect in 2013 and beyond, the industry is facing sweeping changes to the managed care and reimbursement road map. Additionally, nearly 30 million more Americans will now have access to health insurance. How will this new environment affect relationships between patients, payors, providers and biopharma companies? How could changes to federal health plans and the creation of state-run insurance exchanges alter biopharma company strategy, from business development to R&D activities? This reimbursement roundtable will feature payors, providers, and other stakeholders from across the industry discussing ACA implementation and the wider reimbursement landscape.

Moderator:

  • Roger Longman, Chief Executive Officer, Real Endpoints

Panelists:

  • Peter Bach, MD, MAPP, Director, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center
  • Rena Conti, PhD, Assistant Professor of Health Policy & Economics, University of Chicago
  • Ed Pezalla, MD, MPH, National Medical Director for Pharmacy Policy and Strategy, Office of the Chief Medical Officer, Aetna
  • Cynthia Smith, Vice President, Market Access & Commercial Development, Affymax

 

Peter Bach, MD, MAPP
Director, Center for Health Policy and Outcomes, 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. He formerly served a Senior Adviser to the Administrator of the Centers for Medicare and Medicaid Services. He serves on several national committees, including the Institute of Medicine’s National Cancer Policy Forum, and the Committee on Performance Measurement of the National Committee on Quality Assurance. He chairs the Technical Expert Panel that is developing measures of cancer care quality for CMS. Along with publishing in the medical literature, Dr. Bach’s opinion pieces have appeared in numerous lay new outlets, including the New York Times, the Wall Street Journal, Forbes Online and National Public Radio.

Rena Conti, PhD
Assistant Professor of Health Policy & Economics, University of Chicago

Rena Conti, PhD, is a health economist pursuing research in two main areas: the value of new medical technology for individuals and society, and the organization and financing of medical care for vulnerable populations, including children and the mentally ill. Her current projects include estimating the economic value of new pharmacological based treatments for depression, examining the prevalence and associated costs of "off label" medication usage, investigating the impact of policies intended to incentivize medical innovation, and examining the impact of illness and treatment receipt on individuals' economic lives.

Roger Longman
Chief Executive Officer, Real Endpoints

Roger Longman has spent nearly thirty years in the healthcare industry, most recently as Managing Director, Pharma at Elsevier Business Intelligence, a Reed Elsevier company. In 1983, Longman joined The Wilkerson Group as a writer covering the pharmaceutical and biotech industries for IN VIVO. In 1989, Longman along with David Cassak bought IN VIVO, incorporating it into a new company, Windhover Information, which they built through internal development (with publications such as 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 Tan Sheet and many other medical-industry newsletters), creating Elsevier Business Intelligence. Longman ran the combined group’s pharmaceutical business until he left to begin working on Real Endpoints. 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-directs 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.

Ed Pezalla, MD, MPH
National Medical Director for Pharmacy Policy and Strategy, Office of the Chief Medical Officer, Aetna

Edmund Pezalla, M.D., MPH, is Aetna’s National Medical Director for Pharmaceutical Policy and Strategy. He is responsible for the integration of pharmacy policy and activities into Aetna’s overall strategy and operations. Dr. Pezalla also serves as the lead clinical spokesperson for Aetna in pharmacy related issues and represents Aetna on industry work groups and conferences.

Dr. Pezalla is Aetna’s leading executive on pharmaceutical development, reimbursement strategy and drug evaluation. He is active on projects with the IOM, CDC and FDA as well as MIT’s Center for Biomedical Innovation. Recently Dr. Pezalla served as a consultant for the President’s Council of Advisors on Science and Technology for their report: Propelling Innovation in Drug Discovery, Development and Evaluation.

Previously Dr. Pezalla was Chief Clinical Officer for Aetna Pharmacy Management from July 2007 to July 2010. In that role he was responsible for formulary development, quality and utilization programs and clinical strategy. Prior to joining Aetna Dr. Pezalla was VP of clinical services at Prescription Solutions, the wholly owned PBM subsidiary of United Health.

Dr. Pezalla holds a BS and MD from Georgetown University, an MPH from the University of California, and an ABD from the University of Michigan.

Cynthia Smith
Vice President, Market Access & Commercial Development, Affymax

Cynthia Smith is Vice President, Market Access & Commercial Development at Affymax, a biotechnology company in Palo Alto, CA focused on the development of novel renal and specialty therapies. At Affymax, she leads payer access, pricing, government affairs and advocacy relations. Prior to this, Cynthia served as Executive Director, Healthcare Systems Strategy at Merck, overseeing Merck’s Medicare Part D business.  She held various positions in corporate strategy and external affairs during her tenure at Merck, including worldwide crisis management during the Vioxx recall. Early in her career, Cynthia served in the White House Office of Management and Budget (OMB) under the Clinton Administration. She earned an M.B.A. from the Wharton School, University of Pennsylvania, an M.S. in public policy from the Eagleton Institute, Rutgers University, and a B.A. from the University of North Carolina, Chapel Hill.