Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 3210 ACCESSFOR PATIENTS IN NEED Programs administered by the Centers for Medicare & Medicaid Services (CMS) provide health care coverage to millions of Americans, enabling patients to benefit from life-saving innovations from the medical technology industry. AdvaMed’s Payment and Health Care Delivery department works closely with CMS to ensure appropriate patient access to these innovations through efficient and predictable coverage, coding and payment processes – the importance of which is magnified when such policies are replicated by private payers. HEALTH CARE DELIVERY CHANGES As the health care system transitions away from fee-for-service toward more risk-based, integrated health care delivery models – such as CMS’s bundled payment programs and accountable care organizations – AdvaMed seeks policy changes to ensure that incentives offered to providers for achieving savings em- brace the full value of innovation in patient care, and that the formula for our health system is cost savings through medical progress, not cost savings instead of medical progress. These efforts began to pay off in February when CMS announced it would allow payment adjustments in bundling pilots to help ensure access to products receiving new-technology add-on payments. Where there are significant gaps in quality measures that can prevent the full dimension of quality from being assessed by payers, AdvaMed continued to advocate for policies to help fill those gaps. COVERAGE, CODING & PAYMENT As part of AdvaMed’s Innovation Agenda, unveiled in February, the Association worked with member companies, CMS and lawmakers on Capitol Hill to develop and advance coverage, coding and payment proposals for legislation to help accelerate patient access to next-generation treatments and cures. These proposals include a streamlined, seamless path for CMS cover- age and payment for breakthrough products; establishment of automatic coverage for FDA-approved clinical trials; expanded coverage of telehealth services including remote monitoring used in the home; a streamlined process for granting temporary outpatient and physician payment codes to new technologies, and many more. Meanwhile, AdvaMed worked with CMS to smooth imple­ men­ tation of a centralized process for coverage of FDA-approved clinical trials, which began in January. Successful AdvaMed advocacy also resulted in the American Medical Association changing the wording of Current Procedural Terminology Category III codes so that non-coverage is no longer automatic. P AY M E N T A N D H E A LT H C A R E D E L I V E R Y Restructuring CMS’ coverage and pay­ment processes to support development of new technologies that improve treatment, diagnosis or prevention, and provide prompt patient access to these technologies. Tamara Syrek Jensen, director of CMS’s Coverage and Analysis Group, discusses the evolving reimbursement landscape and coverage challenges at the AdvaMed 2015 conference in San Diego. Jo Carol Hiatt, chair of the National Product Council, Kaiser Permanente (at left); Bruce Japsen, a reporter with Forbes; Joseph Rolley, vice president, global market access, at ConvaTec; and Camille Farhat, president of American Medical Systems (at right), discuss quality of life products in the value-based care landscape at the AdvaMed 2015 conference in San Diego. INNOVATION AGENDA PILLAR 2 A D V A M E D 2 0 1 5 A N N U A L R E P O R T