Case Examples

Managing Health Reform Implementation

 

Applied Policy facilitated a health system’s engagement in health reform implementation by drafting comments on an Accountable Care Organization initiative, creating multiple analyses of different aspects of the proposed rule and coordinating comments on the National Committee for Quality Assurance’s ACO initiative with comments on the Medicare Shared Savings Program proposed rule.

 

Medicare Coverage, Coding and Payment

 

A pharmaceutical manufacturer had filed its New Drug Application with the FDA, but needed help obtaining optimal Medicare coverage, coding and payment for its physician-administered product.  We explained the various CMS processes to the client.  We completed the coding application for the client’s review and comment and submitted the application.  We alerted the client to the positive CMS preliminary decision.  We prepared draft remarks for the client to deliver at the CMS public hearing.  We attended the hearing with the client.  After the positive CMS decision, we managed pull-through with the client to explain the decision to its customers and internal stakeholders.  Ultimately, our success increased patient access and made it easier for health care providers to be reimbursed for the product.

 

Navigating the Centers for Medicare and Medicaid Services

 

A pharmaceutical manufacturer learned from an advisory panel that hospitals would not use its product unless it was included in the Centers for Medicare & Medicaid Services Hospital Inpatient Quality Reporting initiative.  We explained the Hospital IQR to the client, developed a strategy and facilitated in contact with CMS that resulted in the product being included to the Hospital IQR and facilitating patient access.