The Q1 Productions 15th Semi-Annual Diagnostic Coverage & Reimbursement Conference takes place December 3-4 in Boston, MA. The event will bring together industry professionals and distinguished presenters from diagnostic companies and payer organizations. Mary Stevens, Director at Blue Cross and Blue Shield of Minnesota is one of the featured payer perspectives speaking at the meeting. Read on for more about Stevens’ background, experience and what she plans to cover.

 

Can you please give a brief description of your background, job title and what that entails?

My title actually describes at a high level what my role is: Director of Network Contracts, Compliance & Audit at Blue Cross and Blue Shield of Minnesota. We are a not for profit Blue Cross and Blue Shield plan and are an independent licensee of the Blue Cross and Blue Shield Association. We are the oldest health plan in Minnesota—we’ve been around over 85 years. Our mission now is very much as it was in the early years—we provide access to some of the best health coverage and best networks in the state. We treat our providers as partners and our customers as the paramount focus to bring needed care and services to those who would otherwise be underserved. My department is responsible for all aspects of provider contracting, regulatory and corporate compliance and contract audit. In Minnesota, subscriber and provider contracts require filing and approval by the state to assure they comply with all required laws and rules. We also are a heavily audited industry—in an average year, I work on over a dozen audits by outside entities such as NCQA, CMS and DHS, and we have daily, weekly and quarterly audits to assure compliance with a host of important internal controls and financial standards. These audit processes assure everyone we do business with the quality and integrity of our processes and protocols. Most of my career has involved contract documents of many kinds and the audit accuracy of those documents. I also have a financial underwriting background and would advise anyone interested in insurance to work as an underwriter at some point—you will learn most of the critical connections between different corporate functions as a result and be a well-informed employee as a result. When I first started my career in health insurance, I would not have thought that I’d become such an insurance geek but sure enough, that is exactly what I am. It is actually a very interesting business and much more complex than most people realize. As a result, I love to talk about this business to interested individuals. I had an opportunity to teach credit classes for eight years for insurance licensure and continuing education which was both great fun and a great challenge. If you want to say on your toes, teach professional people who are experts in the field. I also worked for many years with a TPA on very unique benefit plans for large self-funded employers, and that role combined with underwriting experience illustrated the infinite combination of networks, benefits, costs and rules that come into play with health insurance. It is an always changing environment which keeps things interesting. Last but not least, I know that many parts of what I do directly support value and quality in the health care that people need and receive. We are all patients in need of care at some point, so regardless of whatever one’s job is, everyone should view the world through the lens of a patient in order to see what is necessary and important. If we all keep that in mind, many decisions we make will make more sense to everyone.

 

Do you have any actionable tips for reimbursement professionals on providing health economic value through clinical trial data?

Everything must be about quality, value and affordability. As much of an old cliché as this has become, everything with health care truly does have to support the Triple Aim (I know, we are all sick of that phrase but it remains accurate….) All services must support improved quality and outcomes, must support greater affordability and must bring improved patient satisfaction. I can’t tell you how many times I have seen a presentation from a practitioner, medical equipment provider, lab or radiology provider, hospital or other provider promoting their great new service or technology but they cannot explain how (or if) it is better than an existing service or technology. Just because something is new does not mean it’s better. Remember too that most health plans are very interested in collaboration with providers. We want to hear about new technology or care that holds great promise for improvements. Clinical trials and other pilot programs can be considered for coverage when there is sufficient evidence to support further research and analysis. The devil’s in the details as the saying goes, so detailed information is crucial for beginning a discussion about a collaborative project. Always keep in mind the value proposition—we must bring value to everyone served including patients, providers and the health plans.

 

 

Why do you think it’s important for reimbursement professionals to attend the Diagnostic Coverage and Reimbursement Conference?

The world is changing too fast to think that information we all had a year ago or two years ago is sufficient. Health plans are facing new challenges virtually every day, and we are not isolated in the resulting impacts. Everyone is impacted by change and much of the change is being driven by outside forces, i.e. changes in mandates, changes in standards, changes in the opinions and attitudes of patients and providers. Just think about the health consequences of vaping. Did anyone even know what vaping was a few years ago? Now we have major illnesses and even deaths linked to what was once promoted as a safe alternative to smoking. What will be the next thing that will cause a similar concern? The aging population is also creating new challenges—millions of baby boomers are entering retirement every day. Just that change alone is forcing change in other industries and businesses. The expectations of patients, providers, regulators and employers change with regularity. A single health insurance company can administer over 200,000 different benefit plans in any given year. Multiply that volume by the number of plans and providers in the country and you can easily see how complex this universe is. We – none of us – can be an expert at everything and we can’t think that information today will be applicable tomorrow. We all need to stay on top of an ever changing environment and view that constant change as an exciting challenge and not a burden.

 

Hear more from Stevens and other payer perspectives at the upcoming Diagnostic Coverage & Reimbursement Conference.

Jessica Vallee is a Content Marketing Associate for Q1 Productions, where she is responsible for campaign planning, content development and executing marketing projects for the life sciences, pharmaceutical and food and beverage industries.