That depends on where you sit.
This Q&A session, with an active Regional Medical Director involved in traditional health plan policy and payment development, as well as emerging value-based models, reveals important information and attitudes toward coverage of new/existing technologies and standards of evidence.
Presenting clinical evidence to payers is the most efficient method of gaining coverage. But when this strategy is unsuccessful or hits a wall, a ground-up approach is required, relying on consistent and steady support from local physician champions that demonstrates broad acceptance of a technology.
No matter how tortuous the path to durable coverage and adequate payment for a new technology, the bedrock of the entire reimbursement process relies on the clinical evidence of safety and effectiveness. This inaugural blog post is the first in a series focused on the key reimbursement issues in this fluid health care environment.