AUG 10, 2016 07:30 AM PDT

Payer Perspectives: Value in Healthcare

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  • SVP & Chief Clinical Officer, ADVI
      Louis Jacques, M.D. is Chief Clinical Officer and a Senior Vice President at ADVI, a health care advisory services firm, where he is also a partner. He also serves on several institutional boards and advisory panels. Before joining ADVI in 2014, Dr. Jacques was the Director of the Coverage and Analysis Group (CAG) in the Centers for Medicare & Medicaid Services (CMS) from 2009 - 2014, where he managed Medicare fee for service coverage policy development on technologies as diverse as molecular diagnostic testing, implanted cardiac devices, advanced imaging, chemotherapeutics, wound care, and screening and preventive services. From 2004 - 2009 he was a division director within CAG, focusing on Part B drugs and diagnostic tests. Before joining CMS in 2003, he served as the Associate Dean for Curriculum at Georgetown University School of Medicine; where he also saw patients at the Lombardi Cancer Center in his practice of hospice and palliative medicine.


    Medicare is clearly moving to a pay for value paradigm, and commercial payers continue their own march away from traditional fee-for-service payment. How can you develop and articulate a persuasive value proposition for your specific product when the payers’ decisionmaking context is a much bigger picture? Successful diagnostic companies will clearly convey the impact of their test result on downstream patient outcomes. Payers expect to see evidence of patient benefit, and for diagnostic tests this means clinical utility.

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