Non-invasive prenatal screening (NIPS) uses a sample of maternal blood to look at cell-free fetal DNA and screen for Down syndrome and other chromosome problems. While this is typically a covered benefit for high-risk pregnancies, some health insurance providers have questioned the value of the test in low-risk pregnancies.
This webinar will report on the outcome of a novel partnership between Harvard Pilgrim Health Care (HPHC) and Illumina. HPHC and Illumina entered a performance-based risk sharing agreement to expand coverage for NIPS for low risk pregnancies. Over the study period, they assessed the change in screening and diagnostic test utilization that resulted from the coverage change to a baseline year. The study was overseen by the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and approved by the Colorado Multiple Institutional Review Board (COMIRB).
Dr. Michael Sherman
Chief Medical Officer and Senior Vice President
for Health Services
Harvard Pilgrim Health Care
Dr. Michael Sherman is Chief Medical Officer and Senior Vice President for Health Services at Harvard Pilgrim Health Care, a leading not-for-profit health plan insuring 1.2 million members in Massachusetts, New Hampshire, Maine, and Connecticut. Widely recognized as a pioneer in the development of outcomes-based payment agreements for pharmaceutical and diagnostics, Dr. Sherman is credited with cementing Harvard Pilgrim’s position as a leader among insurers in crafting agreements with pharmaceutical companies that tie payments for a drug to its performance.
In 2018, he received Xconomy’s “Contrarian Award” for his contributions, which include having signed the nation’s first such payment model for a gene therapy, helping pave the way for the development of innovative financing models. Since joining Harvard Pilgrim in 2011, Dr. Sherman has focused the organization on introducing innovative outcomes-based reimbursement models that more effectively engage providers, pharmaceutical companies, and diagnostics companies. In addition to provider engagement strategy and pharmacy management, he is also responsible for medical trend management, clinical policy and utilization management, disease and care management services, quality, and wellness offerings.
R. Brett McQueen
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
R. Brett McQueen is an Assistant Professor at the University of Colorado (CU) Skaggs School of Pharmacy and Pharmaceutical Sciences, is a member in the Center for Pharmaceutical Outcomes Research, and investigator with Pharmaceutical Value (pValue). His research interests include decision-analytic modeling applications and methodology, applied microeconometrics in health, and novel value assessment methods. Brett has current funding in micro-costing health interventions, evaluating performance-based risk sharing agreements, and estimating patient and payer preferences for various pharmaceuticals. He is the course director for “Pharmaceutical Economics” in the Pharmaceutical Outcomes Research PhD program at CU.
Director, AMR Payer Partner & Field Market Access Lead
Trish Brown is a board certified, licensed genetic counselor with over two decades of experience in clinical genetics. She is currently the Director, AMR Payer Partner & Field Market Access Lead at Illumina. Ms. Brown is experienced in commercialization of genomic tests, operations, and lab benefit management.
Prior to joining Illumina, she has held executive leadership roles at distinguished corporations such as LabCorp and Medco, and the entrepreneurial successes DNA Direct, Fabric Genomics and BeaconLBS.