Fallon Health: Getting a Grip on MDx Coverage and Payment

  • December 06, 2016
  • 2:00 PM – 3:00 PM ET
about

Payers need to have each molecular diagnostics (MDx) test specifically identified to provide efficient reimbursement and coverage decisions more transparently, improve utilization management processes, and better support new models of care.

This session will walk you through Fallon Health’s innovative approach to managing a complex and robust molecular diagnostics (MDx) program. Fallon Health has focused its attention on prior authorization and enabling the clinical staff to make informed decisions, cutting the review time by 50 percent -75 percent. Fallon Health will explain the steps taken to further enhance the existing MDx management program, including the adoption of the McKesson Diagnostics Exchange (DEX), and how to apply a similar strategy in your own organization.

What attendees will learn:

  • The benefit of unique identification for MDx testing
  • Strategies to better focus use of clinical resources (e.g., nurses and medical directors) on value-add activities
  • How to engage your lab network with new clarity

Who should attend:  Medical Directors, VP/Director of Utilization Management, Provider Relations


Speakers:


Pam Cardaci, Senior Director of Utilization and Auth Management, Fallon Health
In this position, Ms. Cardaci has oversight of all healthcare services utilization for the Commercial HMO and PPO, Managed Medicare, Managed Medicaid and Senior Care Option products in the Fallon Health portfolio of products.  Ms. Cardaci’s prior experience includes over forty years of in the healthcare industry including clinical practice as a Registered Nurse in the obstetrics and pediatrics clinical areas and managed care experience for multiple national and local payers.  Ms. Cardaci has extensive healthcare expertise and a results driven approach to utilization and case management.

She has served as vice president, clinical oversight at New York County Health Services Review Organization/MedReview in NYC, as well as senior director of utilization management at Fallon Community Health Plan in Worcester, Massachusetts (where she earned the Largest Contributor to Savings/Cost of Care Award), director of medical management at Great West in New Jersey, clinical liaison to patient financial services at Children’s Hospital of Boston and director of Health Plans, Inc./Care Management Services, Inc. in Westborough, Mass.   Ms. Cardaci also has extensive expertise in URAC and NCQA accreditations.

Ms. Cardaci earned her nursing degree from Mt. Auburn Hospital School of Nursing and a bachelor’s degree in health care administration from Almeda University, online.  She is a certified managed care nurse and a certified professional in utilization management.  Additionally she is a member of the National Association of Managed Care Nurses and the organization’s research institute. Ms. Cardaci is a lifetime member of Cambridge Who’s Who in the East and was a candidate for the Cambridge Who’s Who Professional Woman of the Year in 2007.

 

Jill Strassler,  Director of Product Management for Advanced Diagnostics, McKesson Health Solutions
Jill Strassler, the Director of Product Management for Advanced Diagnostics with McKesson Health Solutions, is charged with creating a new dialogue amongst healthcare stakeholders around alleviating the challenges of ordering, coverage and reimbursement for Molecular Diagnostics. She is responsible for the design of advanced diagnostics service solutions in the laboratory, payer and physician segments. Today that focus is on the McKesson Diagnostics Exchange and the McKesson Z-Code Identifiers.

Prior to her time with McKesson, Jill spent 14 years at Quest Diagnostics in various roles servicing many customer segments including hospital and specialty physicians. Jill also spent a total of 6 years as a Management Consultant with Ernst & Young and PricewaterhouseCoopers, LLP.

Jill received her BA from The University of Chicago and received a MBA and Master of Science in Management Information Systems from Boston University.