Institute For The Future

By the way, who is going to pay?

As we pursue are research for Health Care 2020, my colleague, Rachel Maguire, is is always asking our team to consider the question, "Who is going to pay?"  I forgot to mention in yesterday's item about CardioNet that in October 2008, the company announced that Humana, a national third-party payor, had upgraded the CardioNet System to "covered benefit" status (an important step up from "experimental-investigational").

 

Humana's 11 million covered members will have access to coverage for prescriptions . . . With the addition of Humana, CardioNet now has secured direct contracts with payors covering 188 million lives or 75% of targeted covered lives. The Humana decision follows a similar decision from another large third-party payor representing 16 million lives that we announced in March 2008.

 

Then, in November, the Centers for Medicare and Medicaid Services adopted reimbursement rates and Category I CPT codes for the CardioNet System.  These new billing codes will make life simpler for physicians and payors by aloowing for automated claims adjudication.  Looking to its future, CadioNet declared

 

A Category I CPT code, along with reimbursement, provides strong validation of our system for commercial payors that do not currently cover the CardioNet System, while also creating a simplified and stable reimbursement environment for physicians. We believe this will result in broadened physician use and expanded commercial payor coverage of our system, solidifying its foundation for future growth.

 

So I guess that in this case, I can tell Rachel how CardioNet will be paid for (at least under our current health care system) in the future.