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Mosaic Health Care Consultants Case Studies
Computer-Aided Detection (CAD) in Mammography
  • Obtained category I CPT code for CAD with screening mammography
  • Increased Medicare reimbursement
  • Expanded CPT code to include CAD with diagnostic mammography
  • Received positive assessment from Blue Cross Blue Shield Technology Evaluation Committee (TEC)
  • Expanded CPT code and Medicare coverage to include CAD with digital mammography
  • Built detailed pro forma economic model used in sales process
  • Operated reimbursement hot line to assist customers with local coverage and payment issues
  • Expanded insurance market from 30% of covered lives to over 90%
  • Reimbursement activities drove rapid sales growth (over 100% volume increase per year)
Human papillomavirus (HPV) Testing for Cervical Cancer Screening
  • Developed U.S. and German economic models for use of HPV testing in triage of abnormal Pap smears
  • Developed U.S. economic model for use of HPV testing for cervical cancer screening
  • Developed U.S. and international HPV testing reimbursement "tool kits" summarizing the existing HPV clinical literature, treatment guidelines, and reimbursement coding and payment rates
  • Conducted on-site explanation of benefits (EOB) review at multiple U.S. laboratories to determine HPV payment rates and coverage status
New Surgical Technique for Breast Cancer and Benign Breast Tumors
  • Developed and submitted new technology ambulatory payment classification (APC) application to Medicare for new surgical technique for breast cancer
  • Worked with leading breast surgeons to develop and submit CPT application to the American Medical Association (AMA) for new surgical technique for benign breast lesions
  • Worked with leading breast surgeons to develop and submit CPT application to the AMA for new surgical technique for breast cancer
Health Plan and PBM Strategies under the Medicare Modernization Act of 2003
  • Interviewing national and regional health plans and PBMs to understand their potential strategies for offering Medicare Part D products under the guidelines of the Medicare Modernization Act
  • Working with key executives and medical directors in large, national health plans to decipher their decision-making process for offering, structuring, and implementing a Medicare Part D plan
  • Conducting extensive primary and secondary research on potential industry strategies to address critical issues related to offering a Medicare Part D plan, including structuring the drug benefit, implementing effective drug utilization procedures, mitigating the risk of serving the dual eligibles, and achieving profitability under Part D
Prostate Cancer Outcomes Registry
  • Initiated large prospective multi-year outcomes registry sponsored by leading manufacturer of therapeutics for prostate cancer therapeutics
  • Developed physician-reported instruments to collect clinical and economic data
  • Responsible for all aspects of site recruitment, data collection, data analysis, and data reporting through both benchmarking reports and peer-reviewed publications.
  • Co-authored study in Urology related to development of registry
  • To date, more than 70 abstracts and 40 publications have been published based on data from CaPSURE
  • Co-authored three publications related to prospective trial to screen for anxiety among patients attending 70 primary care clinics
  • Compared different reporting formats for feeding back information from patient-reported screening instruments to physicians
  • Presented findings at Meeting of Agency For Health Care Policy and Research in Washington, DC
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