Payer Update, January 2021

Payer Update

Payer Team Goals for 2021
by Jeff Blake

Earlier this month the Hemophilia Alliance Team and our Board of Directors met to discuss and develop our 2021 strategic goals. Based on the discussion, the Board and the Alliance Team finalized five (5) Payer Team strategic goals for 2021. Below is a summary of the goals:

The first is to grow Hemophilia Alliance Network Services (HANS) presence with our member HTCs and Payers, PBMs, Employers, Insurance Brokers and continue to seek regional and national payer agreements between HANS and Payers. We currently have 36 HANS PPO Agreements with member HTCs, and we want to increase this to more than 50 member HTCs.

Our second goal is the continued development of a Disease Management Program (DMP) with the goal of impacting at least one Medicaid program during 2021. We will be conducting an HTC pharmacy cost to dispense survey and cost to provide the HTC comprehensive care story. This will provide us with the critical data and information to rollout a Disease Management Program with payers.

Our third goal is to expand our billing and revenue cycle management services that we started providing during 2020. We will continue to assist member HTCs with individual reimbursement issues with payers and our plan is to begin offering billing, prior authorization, and revenue cycle management services to our members.

Our fourth goal is to identify, develop and enhance key collaborations with organizations impacting the hemophilia community and use our collective voice to impact payer relations and policy at the local, regional, and national levels. We will continue our collaborative efforts with NHF and HFA and work on opportunities to expand our collaborations.

Our final goal is to create relevant policy/position statements and provide education to member HTCs on important issues and trends impacting payment or financial stability of HTCs. Some topics will include:

  • Gene Therapy
  • Hemlibra impact – lower reimbursement and margins
  • Acquisition models – improving HTC performance through the GPO and contract pharmacies
  • PBM regulation at the state level
  • As you can imagine, there are many activities and tactics the team will be working on to accomplish each of these goals and we will provide updates on our progress throughout the year. We look forward to working with you to accomplish the goals.

    If you have any questions, please contact one of the Hemophilia Alliance team members.


Also in this Issue…

Notes from Joe
· Keep Going

Legal and Washington Update
· Washington Bureau Goals

Alliance Update
· Operations Team Goals
· 2021 Meeting Schedule