Notes from Joe
By Joe Pugliese
The board and staff of the Hemophilia Alliance met last week to review 2019 performance and set objectives for 2020 and beyond. Last month we reviewed 2019 accomplishments, so I want to focus now on our goals for this year. You will see other articles later in the Newsletter with goals for various aspects of the Alliance’s work but I am happy to share goals for our group purchasing component.
Our goal in 2020 is the same as our goal since our inception. We want to continually bring incremental value to our membership and be a good partner to the manufacturers who support us. Never has this been more challenging. The dramatic changes that have and will take place in our community create excitement and fear about the future. It is easy for anyone to think about how to improve my position in the short term and worry about later when it comes. Our focus has always been on making sure all members get the full benefit of our efforts.
We also want to add a minimum of 3 new members in 2020, which means that we would then have 93% of all the HTCs in the country who dispense replacement therapies as participating members. There is nothing preventing nonparticipating members from joining, all you need is to be a federally qualified hemophilia treatment center listed on the Office of Pharmacy Affairs website with an HM designation.
My personal feeling is we need to focus on building our core business and look to expand our footprint into the broader bleeding, clotting and blood disorders. The board has tasked us with evaluating what is possible and what is in the best interest of the patients. You will be hearing more about this effort throughout the year and we invite your input into where, and how to proceed.
If we were in it for the money, we would have run the Alliance very differently from the beginning. Everything we do at the Alliance, The Alliance Pharmacy and Hemophilia Alliance Foundation is focused on supporting the HTCs and the patient community they serve. This of course requires that our manufacturing partners and our members recognize and support the inherent value of the GPO concept. This support has enabled the success we have enjoyed to date.
2020 holds great promise, as has been recently announced both national patient organizations have named new President and CEOs. The choices reflect the unique characteristics of the two organizations, yet both made groundbreaking choices in their own way. Sharon Meyers has been at Hemophilia Federation of America (HFA) for the last four years, but comes from outside the bleeding disorders community, a first for HFA. Sharon has an excellent background and is obviously very familiar with the organization she is now leading.
The National Hemophilia Foundation announced that Len Valentino MD, will be their new President and CEO. He is a first for NHF. I first met Len about 35 years ago when he founded the HTC at Rush Presbyterian in Chicago and he brings a unique skill set that I think reflects the dramatic changes the community is facing. Policy makers, insurance companies, fellow clinicians and the patient community will recognize the passion and knowledge Len brings to the position. His letter to the community may be found here.
We wish both great success in their new roles. We look forward to building on the strong relationships with both organizations we have enjoyed over the past ten years.
Marketing and Operating Strategic Plan Goals for 2020
By Sean Singh
At the planning session, the Board of Directors reviewed the 2019 goals and assessed the progress made. Based on the assessment the Board has outlined the 2020 Goals for the Marketing and Operations team to meet our membership needs. Here are the goals we will be focusing on for this year:
In addition to the webinars presented by our manufacturing partners, we will conduct webinars with CEUs for clinical staff. We encourage you to let us know if there are specific topics you would like covered.
HTC Pharmacy Operations Software Assessment:
We plan to survey our members to see what members need regarding a software system that can manage inventory, pharmacy and medical benefits billing. The system could also assist in meeting the URAC accreditation needs as more HTCs get accredited.
Survey our members to see what the need is for a consistent way for patients to report bleeds, infusions and general interaction with the HTC. There continue to be discussions about who should own the data and where it should be stored.
We will be adding a third member meeting held May 6th to 8th, 2020 in Minneapolis. This meeting will be geared to new HTC Staff members and staff/team members who have not attended an Alliance meeting. This meeting will be supported by a limited number of our manufacturing partners, and manufacturers will have an opportunity to present to the audience as part of their support. This financial support will allow the Alliance to pay for our members to attend the conference; the Alliance will cover attendees’ travel costs (airfare and transportation), accommodations and meals. There will be a limit of two attendees per center. More information will be sent via email to members.
Working with member HTC to advocate about the services and support the centers provide to the community through attendance at Chapter meetings and events. Grown the number of meetings the Alliance will attend in conjunction with the HTC member.
Continue to support members in training new HTC staff members. In addition, support the centers in their plan for long-term sustainability. Utilize Alliance team members as needed by the centers to meet our Mission: “The Hemophilia Alliance works to ensure member Hemophilia Treatment Centers have the expertise, resources and public support to sustain their integrated clinical and pharmacy services for individuals with bleeding and clotting disorders.”
Payer Team Goals for 2020
By Jeff Blake
Last week the Hemophilia Alliance Team and our Board of Directors met to discuss and develop our 2020 strategic goals. Based on the discussion, the Board and the Alliance Team finalized four (4) Payer Team strategic goals for 2020. Below is a summary of the goals.
The first is to maintain and expand our working relationships with payers – insurance companies, Medicaid Agencies, Medicaid Managed Care Organizations, Third Party Claims Administrators (TPAs), Brokers/Consultants, Self-Funded Employers, Pharmacy Benefit Managers (PBMs) and Reinsurance Carriers/Stop-Loss Vendors. This goal includes our ongoing efforts to implement our National Hemophilia Alliance Network Services (HANS) HTC PPO Network.
Our second goal is to continue to provide education and payer updates through member meetings, webinars, on-site visits, newsletters and e-blasts. Some of the topics will include:
- HANS PPO Network
- Payer activities and results
- The Alliance Pharmacy (TAP) as a potential contract pharmacy for HTCs and as a backstop for the HANS PPO Network
- Bleeding disorders product pricing and reimbursement
- Disease management program
- Insurance policy updates
- Insurance marketplace
Our third goal is to implement the Disease Management Program (DMP) model with at least one payer, Medicaid or insurance company. The DMP would provide reimbursement for clinical and pharmacy management in some form of a capitated rate, potentially a per member per month fee. This would help reduce an HTC’s dependency on pharmacy program revenue.
Our final goal is to develop and implement reimbursement and billing services to support HANS payer agreements and to offer reimbursement and billing services to member HTCs. We are actively recruiting for a reimbursement manager to support this effort.
As you can imagine, there are many activities and tactics the team will be working on to accomplish each of these goals. We will be providing updates throughout the year and look forward to working with you to accomplish the goals.
If you have any questions, please contact one of the Hemophilia Alliance team members.
2020 Advocacy and Policy Goals
By Johanna Gray and Ellen Riker
We are also very pleased to share 2020 goals for our advocacy efforts in Washington and beyond. They include:
General 340B issues: We will continue advocacy to ensure the sustainability of the federal program and HTCs ability to participate and use program income to strengthen comprehensive care for patients. We will also continue to work with our legal colleagues and community stakeholders to assist HTCs in maintaining compliance with 340B program rules. Finally, we will advocate to oppose discriminatory pricing policies implemented by public or private payers that negatively affect HTCs.
Hill Day: We will plan another successful Hill Day for Alliance members, their patients, and our bleeding disorders colleagues. Since we anticipate the introduction of legislation related to the SNF issue, we plan to structure the Hill Day slightly differently this year. This will allow people who are able to lobby (to ask for Congress to support a policy) to do so, while maintaining the educational focus of meetings for those who cannot (those folks will talk about HTCs and the importance of the 340B program more generally, as they have done in past years). We will soon be sending out additional info about the Hill Day and plan to hold a webinar to answer all of your questions. Stay tuned, but we hope to see you all in Washington in March!
Access to Care: We will continue advocacy to ensure that all bleeding disorders patients have access to the treatments and providers they need, regardless of type of insurance. This includes:
- Supporting Medicare policies that allow for the unique needs of people with hemophilia and other bleeding disorders, recognizing that Medicare policies are often the model used by private insurers;
- Advocating for Medicaid policies that allow bleeding disorders patients to access treatments and enable HTCs to provide medical and pharmacy services to Medicaid enrollees; and
- Promoting private insurance policies related to the Affordable Care Act so that patient protections are maintained and accumulator adjustors don’t impede access to care.
Novel therapies: We will evaluate and potentially create reimbursement models for gene and novel therapies to ensure that patients have access to these treatments and that interested HTCs can participate in the distribution and dispensing of the products. We will work with other stakeholders in the bleeding disorders community working on this issue.
In our busy and challenging political time, we also know that we will respond to new issues that arise throughout the year. Please feel free to contact us with any questions or additional issues or concerns affecting your HTC or your patients.