How you can answer three questions about your device could determine whether or not insurers will cover it.
How payors choose to provide coverage for different medical technologies can seem like a mystery, but Alan Muney, chief medical officer at cigna, shed some light on how the health insurance and health service company looks at coverage today at AdvaMed 2013.
Muney said Cigna asks three questions when considering coverage for a new device:
Muney said Cigna sets up risk-adjusted match-cased controls to look at how a device affects the total cost and outcome of care. “We would look at a much more expensive device if it took costs out of the system,” he said.
The problem, of course, is that payors’ concerns about outcomes and cost-effectiveness don’t match up with FDA’s mandate to determine safety and effectiveness.
“If FDA used payors’ criteria for coverage, then manufacturers could be assured that once FDA approved it, it would be covered by health plans,” Muney said.
Muney said Cigna also looks at how new technologies fit in with its network of providers. “We are very focused on trying to include them in any device strategy we decide on,” he said. He used the example of a telehealth network implemented by an outside company. “Those costs end up being outside of our environment,” he said.
Muney specifically called out how Cigna evaluates mobile medical apps. He said the health insurer looks at apps as a way to capture information from consumers and use that information to drive engagement with providers.
But it’s ultimately consumers and physicians, not payors, who decide whether or not to adopt apps, he said. Physicians look at whether or not apps can help them get reimbursement, while customers want apps that provide them with health data they can use.
[image courtesy of anankkml/freedigitalphotos.net]
—Jamie Hartford, managing editor