Managed Care Hemo

National Hemophilia Foundation

Website provided by National Hemophilia Foundation and its education partners

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Hemophilia Education for Managed Care and Payer Professionals

Expert Interviews

HTC Spotlight: Gulf States Hemophilia and Thrombophilia Center

Spotlight Participant

  • Marisela Trujillo, MSW
    Gulf States Hemophilia and Thrombophilia Center (GSHTC)
    University of Texas Health Science Center Houston

 HTC Spotlight: Kansas City Regional Hemophilia Treatment Center

Spotlight Participant

  • Shannon Carpenter, MD, MS
    Professor of Pediatrics, UMKC School of Medicine
    Hematology/Oncology, Director Kansas City Regional Hemophilia Treatment Center
    Director, Anticoagulation Management Program
    Children’s Mercy Hospital
    Kansas City, MO

 Expert Interview #6

Discussion Participants

  • James Kenney, Jr., RPh, MBA
    Manager, Specialty and Pharmacy Contracts
    Harvard Pilgrim Health Care
  • Kollet Koulianos, MBA
    Senior Director, Payer Relations
    National Hemophilia Foundation

Expert Interview #5

Discussion Participants

  • Scott McClelland, PharmD
    Vice President of Commercial & Specialty Pharmacy Programs
    Florida Blue
  • Michelle Rice
    Senior Vice President, Public Policy & Stakeholder Relations
    National Hemophilia Foundation

Expert Interview #4

Rene Acker, RPh
Principal Consultant
Outcome Strategies, LLC

Topics Addressed

  • How should managed care policies and processes be revaluated and adapted to a changing environment for high cost diseases such as hemophilia?
  • What would you say to medical directors and pharmacy directors from MCOs that would help to convince them of potential cost savings that can be achieved through a more coordinated care approach for patients with hemophilia?
  • What recommendations do you have for implementation processes that MCOs may adopt system-wide that will reduce treatment variability through promotion of comprehensive care?
  • How can the cooperation of all parties be obtained to implement required changes?
  • What recommendations do you have for those plans that lack trained staff and access to resources to better manage hemophilia?
  • How can pre-certification and prior authorization be streamlined to improve access to high quality care such as the Hemophilia Treatment Center (HTC) comprehensive care model?
  • What are some key communication methods and tools that can link health plan strategies with HTCs to improve alignment and consensus of treatment regimens, comprehensive care methodologies, and data provision?

Expert Interview #3

Jonathan Roberts, MD
Hematologist
Assistant Research Director
Bleeding and Clotting Disorders Instituten

Topics Addressed

  • From your perspective as a physician providing care for patients with hemophilia as well as a patient living with hemophilia, how have payer policies and methods evolved and adapted to a changing health care environment? How can they be improved upon?
  • As both a patient and a provider, what are some key communication methods and tools that can link health plan and/or specialty pharmacy strategies with Hemophilia Treatment Centers (HTCs) to improve alignment and consensus of treatment regimen approvals and comprehensive care methodologies?
  • What would you say to senior management from health insurance companies and other payers that would help to convince them of potential cost savings that can be achieved through the comprehensive care model delivered by a hemophilia treatment center (HTC) for your patients with hemophilia?
  • What are some of the key implementation processes needed by managed care organizations to adopt system-wide that will reduce treatment variability through the promotion of the comprehensive care model?
  • Can you recommend methods to streamline the health plan pre-certification and prior authorization processes that payers often require?
  • What would be the key job responsibilities for a dedicated contact?
  • What should be included in a standardized form to make pre-certification and prior authorization easier to complete?
  • How can the cooperation of all parties be obtained to implement required changes and what is the most important first step?

Expert Interview #2

Lynnae Mahaney, BSPharm, MBA, FASHP
Executive Director
Center for Pharmacy Practice Accreditation

Topics Addressed

  • Please provide a brief overview of the mission and goals of the Center for Pharmacy Practice Accreditation (CPPA)
  • How is the CPPA working with the National Hemophilia Foundation to improve standards of care for patients with hemophilia?
  • Are there practice quality standards for specialty pharmacies specific to hemophilia management?
  • Can you explain the CPPA’s specialty pharmacy accreditation process?
  • Based on your review and accreditation of specialty pharmacies, can you recommend ways to improve collaboration between specialty pharmacies and payers?
  • How do specialty pharmacies help to improve patient care and quality of life while containing costs?
  • What is the specialty pharmacy’s role in achieving multidisciplinary integration and improved patient care within new health care delivery models such as accountable care organizations (ACOs) and Patient-Centered Medical Homes (PCMHs)?
  • In your experience, what have been the predominant barriers to quality care for hemophilia from a specialty pharmacy perspective and how can these barriers be overcome via quality measures and/or standards of care?

Expert Interview #1

Doug Stratton
Executive Director
Indiana Comprehensive Health Insurance Association

Topics Addressed

  • How should payer policies and procedures be revaluated and adopted to a changing environment?
  • What would you say to senior management from health insurance companies and other payers that would help to convince them of the potential cost savings that can be achieved through the coordinated care of patients with hemophilia?
  • What are the key system-wide implementation processes that managed care organizations must adopt to reduce treatment variability through promotion of comprehensive care?
  • How can the cooperation of all parties be obtained to implement required changes?
  • What recommendations do you have for health plans that lack trained staff and access to resources to better manage hemophilia?
  • What are some communication recommendations that link health plan strategies with HTCs to improve comprehensive care methodologies?