Reflection | Diana Zabala

Blog Post 1 - Thursday

Today we met with representatives from the Connected Health Initiative, America’s Health Insurance Plans (AHIP), nursing advocate Winifred Carson-Smith, and the Centers for Medicare and Medicaid Services (CMS). I feel that learning about the process for moving innovative screening technologies upstream from all of these different perspectives was fruitful; I enjoyed being able to discuss commercialization, regulation, and provider acceptance both in general and as they apply to the Pocket Colposcope in particular.

Common themes emerged throughout the day even as they were discussed from widely varying viewpoints. For innovative technologies (particularly those without a recognizable precedent or those which might be considered disruptive), securing a code for reimbursement is at the top of the priority list. Essentially if a new health technology can’t make money move, it will not be implemented no matter how effective it might be at improving health outcomes. Without a CPT code, providers can’t be reimbursed for services conducted using the product. Issues regarding reimbursement are even less straightforward for technologies tailored towards telemedicine – state-based medical licensing laws complicate efforts to outsource interpretation of screening results from medically underserved areas. Though there are ongoing efforts to address the issue, coding and reimbursement for medical services are generally not tailored to accommodate telehealth. One of the problems is that telehealth is often not accepted in principle; insurers are not yet convinced that virtual visits are of similar quality to in-person clinic visits, and they fear that need for a second visit will drive up costs. However, emerging research is promising, showing that in 90% of cases a second visit is not required.

As a student I feel that I benefited from the exposure to representatives from prominent health regulatory and insurance representatives by developing a sense for what factors makes a health technology implementable. It is often my instinct to view initiatives from the lens of global and public health - namely, how to implement a project in such a way that will benefit the patient population being served. However, it also necessary to view initiatives from the lens of an entrepreneurial businessperson in order to address the needs of all stakeholders involved.

Blog Post 2 - Friday

Today we met with the Prevent Cancer Foundation and an employee at the Margolis Center for Health Policy who previously worked at the Food and Drug Administration under their pharmaceutical division. Unlike yesterday, in which meetings often seemed to share themes and flowed right into each other, these meetings were very distinct from each other in nature. That being said, if I had to pick a day that was most Pocket-centered, it would be this one. In previous meetings we tended to ask more generally about moving innovative technologies upstream or how to navigate telehealth technologies while referring to the Pocket Colposcope as a case study - yet the nature of our Thursday meetings allowed us to dig more specifically into the benefits and challenges of applying the Pocket Colposcope for cancer screening and prevention rurally and internationally, as well as how the device fits into the general scheme of market approval and risk-management.

What I took away from the experience was a reinforcement of the multifaceted nature of advocacy-focused health initiatives. There is a lot to balance. One needs to take into account not only market approval, commercialization, and reimbursement, but also how to ensure the device is implemented in a way that will reach the underserved populations we hope to serve. Beyond reach, we are also interested in whether having access to this technology helps women to cultivate sense of autonomy and empowerment in reproductive health. Navigating these different facets among various stakeholders is an art that requires practice and dedication.

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