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A little help here! Ideas from payers about clinical areas ripe for innovation

8:04 am by | 3 Comments

lightbulb-ideaWhat payer problem really needs fixing? The men representing UnitedHealthcare, Aetna and Blue Cross Blue Shield of Minnesota had quick answers to moderator Lisa Suennen‘s question. The group was discussing reimbursement and how the current drive to cut costs is affecting treatment decisions and business strategy.

Each panelist named a clinical area ripe for innovation during a session at the Medtech Investing conference in Minneapolis on Wednesday.

Dr. Richard Migliori, chief of medical affairs for UnitedHealth Group, and Jim Epple, former chief operating officer of Blue Cross Blue Shield Minnesota, both said orthopedics.

“We have a continual need for improvements in that area and I would love to see more effective and more efficient options,” Migliori said.

As the only provider on the panel, Ken Paulus of Allina Health said he is looking for anything that will lower labor costs or lower the readmission rate.

Dr. Edmund Pezalla, the national medical director of pharmacy policy and strategy at Aetna, wants solutions for treatment of long-term, complex diseases that require people to be on medications for years.

“If we could get people off their meds, that would be a real breakthrough and offer a great return,” he said.

John Stenson, a principal at PricewaterhouseCoopers, and the other moderator of the session, closed the conversation by asking how entrepreneurs should start a conversation with payers.

Migliori’s answer was take credible data from credible studies to the medical policy side of the organization. Paulus agreed and said he wanted to see a case study done at a hospital or a doctor’s office, not at an academic medical center. He recommended starting with a vice president at a hospital or the medical director.

Pezalla said he would like to flip the conversation and have entrepreneurs ask payers and providers, “How can we solve some of your problems?”

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Veronica Combs

By Veronica Combs

I was the editor in chief at MedCityNews.com. I started writing and editing in the print world and joined a dotcom right before the 2000 crash. I was at TechRepublic/CNET/BNET for 7 years. Health was more interesting to me than the latest version of Windows, so I left for a startup tracking prescription drug news. A year later, MedTrackAlert was acquired by HealthCentral, so I shifted to audience research. The fun of daily news and interviewing smart people brought me to MedCity News in February 2012.
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Lisa Suennen
Lisa Suennen

Nice article Veronica.  It was refreshing to see the payers/provider systems interacting with the device manufacturers for a change!  


Dr. Edmund Pezalla, the national medical director pharmacy policy and strategy at Aetna, wants solutions for treatment of long-term complex disease that require people to be on medications for years.
“If we could get people off their meds, that would be a real breakthrough and offer a great return,” he said.

Read more: http://medcitynews.com/2013/05/a-little-help-here-ideas-from-payers-about-clinical-areas-ripe-for-innovation/#ixzz2StsfXIJD SO--off meds as opposed to what? Need clarification on this. Folks with hypertension cannot be "off meds". patients with bipolar disorder cannot be "off meds"--that constitutes noncompliance. This makes absolutely no sense. Borders on: "you've been sick too long, too complicated, we're not going to take care of you anymore.'

Veronica Combs
Veronica Combs moderator

@mousen8rI think he meant a more permanent treatment for hypertension, such as renal denervation (and yes, I know denervation is only for treatment-resistent hypertension). This treatment is still in trials but it could be a one-time procedure for hypertension, instead of an on-going treatment plan like pills. At the same event, I talked with the CEOs of intersectENT and Holaira. Both companies are working on one-time treatments that could replace daily medications, or frequent surgeries. 

That is the kind of advance Dr. Pezalla was describing - something new that is better for the patient and potentially cheaper for the system - not stopping treatment altogether. 

And, yes, you make a good point about bipolar disorder. Going off meds is not an option for people living that and some other mental health conditions.