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

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?”

Veronica Combs

I was the editor in chief at 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. More posts by Author