SamaCare is joined by DENT CCO, Christine Mann, fresh off her multiple
trips to DC educating healthcare policymakers on patient access issues. Tune in for a
candid discussion on the challenges and opportunities in delivering specialty care to
patients across rheumatology, neurology, ambulatory infusion centers and behavioral
health practices.
You’ll hear:
Christine Mann is Chief Commercial Officer of DENT Neurologic Institute, Executive
Director of DENT Infusion Centers, Executive Director, Behavioral Health and
Interventional Medicine, Managing Director, NeuroNet GPO and Founding Member, Vice
President on the National Infusion Center Association (NICA) Board of Directors, and
Founding Member of National Organization of Rheumatology Managers (NORM).
Kip Theno: Welcome to the Road to Care podcast hosted by SamaCare, where we will talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today and where we see it evolving. SamaCare's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together, we can simply make things right.
Today our first guest is none other than Christine Mann. Christine is Chief Commercial Officer of DENT,Executive Director of DENT Infusion Centers, Executive Director, Behavioral Health and Interventional Medicine, Managing Director, Neuronet GPO and Founding Member, Vice President on the NICA Board of Directors, and Founding Member of NORM.
Kip Theno: Now,Christine, I've known you a long time. That was a lot. Your business cards must be fun to make. What are they like eight by tens, Christine? Like, how do you do that?
Christine Mann: Actually, you know what, Kip, they have asked me to go electronic with that. SoI can just send over the information and save a few trees. [00:01:00] And thanks so much for having me. Really thrilled to be a part of it.
Kip Theno: No, thank you, Christine. You've been a great friend to us for a long time here at SamaCare and a key opinion later in the industry. The first question we'd love to hear is, Your journey, right?
Let's talk about your career in infusion from rheumatology to DENT. and where it went from there.
So I was lucky enough to be hired to start with a rheumatology practice back when my son was born. So it started as a part time gig in healthcare. I didn't really have a lot of healthcare experience, but I thoughtI have an MBA, , I'll figure it out.
My first day in was a day where somebody had brought lunch. The doctor said to me, can you go in there and tell that guy that we like his product, but we don't give it here. We send patients to the hospital. And I couldn't even get past that sentence because I kept saying somebody's bringing us lunch? That's pretty cool. I didn't know people brought lunch in healthcare.Now I get breakfast, lunch and dinner here. So we talked about this medication and [00:02:00] delivering this infusion in the practice, and it was really back a few years ago. It was unheard of to do that.But I sat down with the representative.
I worked with our nurse manager there at the rheumatology practices and we figured out that it was a great medication and you could do it inside a physician practice. And what was really astounding to everybody was we are the most cost effective way to deliver those infusion therapies.
There's some things certainly that are important and given in a hospital setting, but a hospital setting is a different facility and they can bill differently than a private practice. So that's how we started out with one chair, got six chairs, added another. Building and more chairs within rheumatology.
And that went great for a long time. There was a lot of great therapies available for those patients. Fast forward a few years and DENT came and said, we'd like to expand our infusion as well. And I looked at the pipeline for [00:03:00] neurology 10 years ago.It was pretty robust, and it remains robust. So, I came to DENT and we started doing infusions here in a bigger capacity than what they had.
And the journey to the chair materialized from that.
Kip Theno: Wow. We work, as you know, very closely, with Neuronet, Neuronet GPO. Talk about that, the forming of Neuronet, Neuronet GPO, the goals of the organization.
Christine Mann: Because we really believe that the outpatient sector is the best place to get some of these drugs and this neurological care, we started an organization called Neuronet. We wanted to make sure that neurology practices understood that. We wanted other neurology practices around the country to thrive on that.And sometimes a lot of places didn't have the resources and certainly didn't have the buying power. There's 2 branches of it. There's a GPO, which is a buying group, so we all band together and purchase under one roof. We bring that to a [00:04:00] distributor and we're able to get some better pricing.
We were able to get inventory systems for all the members ofthe organization and we stick together and we help one another, especially whena new product comes out or something changes within that journey to the chair..
The journey to the chair, getting a patient from the time they see a physician or a provider that says I'm going to put you on an infusion oran injection that's given within a practice or an ambulatory infusion center--there's a lot of stakeholders in that process from the provider until that last bill is paid. We can actually have this revenue streamlined in practice, but we can also take care of patients together within the confines of the practice.
Kip Theno: Yeah, yeah, for sure. And we've talked about this, Christine, you know, my background before the earth cooled, many years ago was in cardiology, interventional side, and there was a time when, before VAT committees, value analysis committees, and where even [00:05:00] legislation and other things kind of took over to, to dictate clinical behavior, cardiologists, as an example, would use the device or the medication that they wanted, and if anything got in their way, they'd burn the OR down. That was the substance back then. And I've seen that change a little bit, and I'd love to hear from you, how has medicine and business of medicine changed from everything you just said, and utilization management, and doctor choices, step edits, the new biologics coming out.
There's just so much that's happening, it seems, at light speed. What can you talk to me about that?
Christine Mann: Yeah, you're right about that, Kip. There has been a lot of changes and so we can't forget that everybody is a partner in this and we all need to work together. So we are sympathetic to some degree with payers understanding that their budgets are blown out of the water right now with these, while we're getting so much better at diagnosing people earlier in their disease state and getting them on therapy faster, there's some great new therapies that have been developed and continue to come out.
They're expensive. And we have to figure out [00:06:00] how do we best work with payers to get the right patient on the right therapy. Make sure that everybody's being reimbursed appropriately. You talk about capacity constraints. There's so many new drugs that are we running out of space here atDENT.
We're adding eight more chairs and a couple months. We're building out some new space so that we have more capacity to take care of our patients here within the practice. But we're also, as I said, working with payers to make sure that we can understand what their expectations are in terms of prior auth site of care constraints, out of pocket costs for patients, there's a lot to it.
It's not as simple. It never was really simple, but it certainly wasn't as complex as it is today.
Kip Theno: Yeah, andI think it's changed a lot in the word complex. You can't say it better than that. By the way, we don't see the payer as the villain.
They're not. And we see you, the clinicians, the site of care, the patients as the heroes of the story. SamaCare as a technology partner, a guide, right? But it's the [00:07:00]complexities that A to Z process of getting those patients on those new therapies or even the main staple therapies that's become really difficult, especially on the medical benefits side.
What are some thoughts that you have or advice that you have in dealing with the changes that continue to occur?
Christine Mann: Well, the first part of that is you really got to keep up on the changes and understand what payer policies might be. There could be step edits in the way, what you have to do to get through those.
We have quarterly meetings with our local payer plans and their executives so that we stay in lockstep on the expectations of both sides. I think that's really important to make sure that you understand those policies.One of the things we talked about before Kip is the complexities of the prior authorization.
I remember when we talk about the rheumatology drugs, it was a lot easier to get a prior authorization. One page, fill it out, send it in. It got approved for a longer period of [00:08:00]time. There were no constraints on how many units you could give to a patient, in a certain amount of time. Or there weren't a lot of step edits in the way.
Now, those things are really important for payers. Utilization management is what we term it as, to make sure that everybody is getting on the right therapy at the right time. We don't always agree as providers that payers have the right policy in place, but nonetheless, we need to be cognizant of those so that we don't add extended time on to making sure a patient gets in the chair.
Kip Theno: There's a disconnect, I think between the manufacturers and even the public education on what's out there and what power that they have themselves.
And then the payers and the providers, and you mentioned all the new therapies. I think every day you wake up to a new therapy in some specialty, whether it be a lifesaving drug or therapy or a rare disease drug or therapy, and it's coming very quickly. What are some of the [00:09:00] challenges and opportunities and stakeholders in patient care?
Because I know you also work and communicate with pharmaceutical manufacturers. Talk about that process.
Christine Mann: We do. And it's exciting to bring a new product, not only to market, but to get it into your center and get it to a patient as soon as possible. As you know, you talked about some of these complexities.
One of the things that we didn't have as much years ago was direct to consumer advertising. So patients come in demanding certain therapies, and we're left to explain that sometimes you can't just hop to a specific new therapy that's come out. There might be something within your benefit structure that you have to try and fail something else before you can get on that therapy.
Right? That's just one of the nuances when it comes to new therapies. You have to get it on a payer formulary. We have to understand how to provide that therapy within our center. So we require clinical training.There's got to be policies and protocols set up and put into place, you have to understand who's carrying that.
Sometimes [00:10:00] a manufacturer works with only one distributor. It's called single source distribution that makes it a little harder. Also, if you're adding therapies and these therapies are not inexpensive, you have to make sure you got the right credit line with the right distributor. So all of those things go into all of those thoughts go into making sure that.
We understand the product. We can get the product. We have the patient population. We have the payers that are going to reimburse us forgiving that product. Put that all together. Sometimes that takes a little bit of time. As you know, Kip, I like to be one of the first in the country to deliver new therapies and we pride ourselves on some of the really exciting therapies we've brought here to Western New York, but we certainly share that information with greater good of Neuronet.
We were just talking yesterday on a call. About a new product that was recently launched. So it's not always Simple, but it certainly is worthwhile, especially when a patient benefits from some new latest greatest therapy
Kip Theno: [00:11:00] Yeah, and I know you do and you're plugged into that You know, in another installment a bunch of questions came in about: “What if there is this evidence based medicine new therapy, but it doesn't yet have a code how do we handle that because, the patient then is waiting for something that might be better than what they have now or might literally change their course of care?”
How do you guys handle that over there?
Christine Mann: Right.Sometimes drugs get launched. I've seen a few new drugs recently get launched and have what they call a J code or a code that depicts to the payer what medication their member has gotten when they're in an infusion center or a practice. But oftentimes it's six months before a code is given, a permanent code is what we call it, for that medication.
Payers have made it really difficult to bill without a J code as well now. It's an, it's an unclassified code that we use. We have to do a lot more on the claim form to indicate what that therapy was. I mean, we could have a [00:12:00] couple of drugs going right now at the same time here at DENT with an unclassified code.
So there's a lot more description that needs to be done on the claim form with the prior authorization, all of the steps that we talked about.It really is more difficult. And so sometimes patients don't get that therapy because payers have made it so difficult to use an unclassified code.
Unfortunately, we can't get that medication to people quick enough.
It used to be a lot simpler and we were always in the forefront of making it happen. But even for us here at DENT, it has become more difficult to navigate that unclassified code. But if we believe a patient really needs to get on that therapy as soon as possible, we will move heaven and earth to make that happen here.
Kip Theno: It certainly needs to be done and being in the prior authorization space, there's no uniformity between payers even with the same drug. And as an example, you can have 10 payers, three of them might ask you some questions but they approve it 99-100% of the [00:13:00] time. And then the other seven will deny it 99% of the time just out of the gate because that's the algorithm. And that gets frustrating.
What are some of the tools, data, analytics, arrows in your quiver that you guys use to help partner with payers and communicate with them and try to create more of uniform standards across the board?
Christine Mann: I don't know that we can be as effective in creating uniform standards, Kip. I would like to think so, but we do try to have that dialogue with the payers.
The other thing to remember is there's a lot of unique challenges now within the payer groups, because employer groups carve out certain benefit plans, right? Then you've got PBMs in the middle helping to shape and carve out what policies and what medications should be delivered within different plans.
So I often tell my staff, we could have two people standing in front of you with blue cross blue shield cards, but the benefit structures are very different within each of those plans. Different than we've had to navigate before, and it definitely makes it a [00:14:00] lot more challenging. You try to pick up the phone and have a conversation to find out exactly what your patient's benefit is, and if this drug is covered.
And it's really difficult sometimes to get to the right person at that payer to get that information to get the patient treated. So those are definitely some nuances that we've been seeing and trying to work through to navigate around. And sometimes it's really successful and other times it isn't
Kip Theno: right.
And obviously we can't do it alone. We probably say this a million times. There's no silver bullet. There's a lot of lead bullets, right?You need a lot of folks like you out there preaching the gospel and pushing the needle. I read a, a study, by the healthcare financial management association,Christine, that said that three fourths of healthcare executives said that they will invest in revenue cycle, automation technologies, AI, machine learning tech partners throughout the next year or two.
And yet only one out of 10 said that they'd actually made any of those investments. So love to get your lens on [00:15:00]that of technology partners, technology today. How is that helping you guys enable and empower better patient care? And what are some suggestions you have for the audience?
Christine Mann: Well, as you know, Kip, we started partnering with SamaCare about four years ago and it was an extremely exciting initiative and I couldn't tell you what a difference it made here.
It was one of the first big technologies that we adopted hereat DENT. And it was really in the infusion clinic to start.
It has been a huge, addition to helping us streamline that workflow and making it so much more efficient. Being able to get the right form to fil lout electronically right away has been really, a great experience gets the patient in the chair a lot quicker. But when you talk about making sure you know all these different policies, knowing what prior auth form to fill out for different parts of a Blue Cross Blue Shield plan that could span across the country I think you guys have been a great partner [00:16:00]and helping us make sure that we're filling out the right form and now we're not having to fax it in it's automatically going and we can, if somebody who's doing a prior auth happens to be on vacation, anybody can log into the system.We didn't have some of those features before and it was much more of a manual arduous task. Streamlining that process has helped patients get in the chair a lot quicker. We're just embarking on incorporating WeInfuse into our workflow specifically for infusion to start. We're adopting WeInfuse into the infusion center here at DENT, because we want to make sure that we're not scheduling somebody who's prior auth may have expired and we're making sure we have the right inventory in place. There's a whole bunch of great new technology within that software that we're implementing to help us get patients on medication quicker, doing it much more efficiently internally.
It's hard to find really good folks to come in and [00:17:00] show up for work every day. So we want to make sure their job, I don't want to say is as easy as possible, but certainly as streamlined as possible.
Kip Theno: And Christine, you, you do your diligence probably more than anybody. And I want to ask that question. How do you find technology partners, how do they get on your radar, and what is your vetting process?
Christine Mann: We try some things out. We like to say we're a pilot school here at DENT. We're a pilot center. We'll try things out and we're very supportive. Our administrative team is very supported by the physician owners here at DENT. And so they do allow us some latitude and autonomy to try things out.
Sometimes it works really well and sometimes it doesn't, but you have to give it a try and you have to be able to accept things and maybe not everybody is technically oriented as we'd like them to be, but certainly we want everybody to be open minded about trying new things to see what can work and what doesn't.
So we brought in a lot of [00:18:00]different things, things that we've adapted and that have stayed and other things that maybe they weren't as great as we thought they were originally.When you say, how does it get to you, we find these companies and sometimes they find us.
Kip Theno: Yeah.Yeah. Definitely. It's got to be a two way street there.
Kip Theno: I want to switch gears to a topic I'm very excited to hear about because you've also heard me say, legislation it works at a glacial pace, right?
And unfortunately a glacial pace isn't really good enough for patient care intent aside But you were just in dc advocating to improve patient access talk about that, like what's that experience like, the legislation experience, your conversations, where are the policymakers getting it right, where could they improve, and then what can we do together to needle them a little bit.
Christine Mann: So this was my second trip to the Hill. And it's really, it's incredible. It's amazing. There's so much going on in the nation's Capitol and they're responsible for so many things. So it helped me understand that it [00:19:00] takes a lot of us to help move some of these policies or to help people understand some of these policies.
So you've got people in the Senate and the Congress voting on certain bills. Sometimes they don't really know the downstream effect. And so when we have the opportunity to sit with their staff and explain some of maybe the unintended consequences or things, how their constituents or how patients are affected by some of the healthcare bills that are swirling and waiting for approval and waiting for vote.
It's great to have people who represent , like myself, represent from the practice. I see patients on a day to day basis. I see patients in our clinic. I see the patients that come in for infusion and I live and breathe it every day. So to bring those experiences to people who are making decisions on these policies has been really incredible.
And we had a great run last week, we had my group specifically had eight meetings throughout the day. We walked over 13, 000 steps. We [00:20:00] were pretty busy. But it's really an experience to be able to tell that side of the story because sometimes they don't understand what they're voting on, or they don't understand the implications that it might have to people that live in their districts , or all of us collectively.
Kip Theno: Well kudos for tracking your steps, you know, remote patient monitoring. It's pretty cool technology these days. Do they does it seem when you're there that they're listening that the lawmakers get it or do you see that there's a disconnect.What's your feeling?
Christine Mann:Sometimes there is a disconnect.
So when we talked about infusion therapy, there were people that thought that was reserved for cancer centers and chemotherapy. And we dial it back and say, you know, you have people that have multiple sclerosis, you have people that might have rheumatoid arthritis, ulcerative colitis, Crohn's disease.
We're treating, we're giving those medications in our offices too, to those patients and they could be in their 20s, 30s, 40s, you know, it's not just cancer patients. It goes [00:21:00] so far beyond that. And these are professional people that are going to work and taking care of families like you and I Kip or we now have Alzheimer's drugs that we're offering to our senior population.
So it encompasses a lot of different people. And I don't know that sometimes that's understood when you talk about infusion therapy. So we did a lot of educating around that, a lot of educating about certain bills ,and how we might be affected more importantly, how patients are affected, right? You don't want to be, you have to stop therapy for anybody, but specifically somebody young that has a family to take care of. They're trying to keep their job. So we'd like to have evening hours. We'd like to have Saturday hours, but we also need to make sure that we're getting paid adequately to do that. So those conversations were real and very well received.
I thought. The people that we met with were educated in what we were discussing, they were engaged. They took a lot of notes. So I hope it makes a difference. I really do.
Kip Theno: Well, thank you [00:22:00] for doing that. It takes a village. You've got the manufacturers, you've got the payers, you've got organizations like SamaCare.
You've got thought leaders like yourself. How do you get other people engaged and involved in that? I'm, not sure everybody knows how to do it and you've been up to the hill twice. What advice can you give to some of our listeners?
Christine Mann: I think anybody could have the opportunity to go I am fortunate enough to sit on the board of the National Infusion Center Association (NICA), and as a board, we're invited. NICA puts this day on for us. They work with an organization called Heart Health Strategies in Washington that arranges all of these meetings. And I think through trade associations and groups like that, people get in front of the right people and are able to deliver the right messages. So that's how this particular Hill Day got put together.
But I'm sure there's other ways that people could get together and do some advocacy for patients. There's a lot of great, like the Alzheimer's association, the MS association.
Kip Theno: We've got a newswire that goes out [00:23:00] every month. We're doing these podcasts, anything else you can suggest to us, to the listeners, I know they'd appreciate it.
And you know, you haven't stopped there. Christine said, we talked about technology. We talked about technology partners, legislation, and thinking about bettering patient care. Tell us a little bit about CareNet. What is that?
Christine Mann: SoCare Net is a brand new organization that we put together to follow the model of Neuronet.
Neuronet has been so successful in getting neurology practices across the country together, not only for some buying power, but for sharing such intellect and information to better patient care. Move to CareNet is really looking at the behavioral health sector. We here at DENT, we have a behavioral health clinic.
We have 15 providers in that clinic and we're still booking out months. There's a lot of patients in our communities across the country that need help in the behavioral health sector. We're working with Janssen on an [00:24:00] amazing product called Spravato. It's nota new product, but it's a new product for behavioral health and psychiatrists to actually be able to deliver in their office.
So we've spent the last couple of years trying to help educate other practices on how to bring this medication to their practice and to their patients. One of the things that Janssen had said to us back a few months ago was only 2% of the patient population with severe depression are able to access this medication.
Oh, wow. What a better way to try to do more educating and advocating for this patient population, then to start something like CareNet.CareNet is clinical access, reaching everyone in a network of people that are understanding and learning how to be able to prescribe the medication and give the medication within their practices Kip.
We're just about to launch. We're ready to go on all fronts. We are partnering with [00:25:00] Cencora on this, and we're really excited to be able to help bring our knowledge to the collective community and psychiatry and help people understand how to get their patients in and get them on therapy.
This is just the first of, I'm sure, many, but to get that healthcare sector ready is really exciting, and we're hoping that's whatCareNet comes together to do
Kip Theno: Wow. Well, my potato math, you know, 2% leaves 98% on the table. So anything SamaCare can do to partner with you on that, you know, we're all in Christine. Part of the genesis of SamaCare was almost 5 out of 10 patients don't get on the right therapy at the right time because of the process.
Christine Mann: I certainly appreciate it. And I'm counting on it.
Kip Theno: Well, here's the final jeopardy question, the $20,000 question, right? The future of healthcare, where do you see it going? Open forum, Christine, what's the future of healthcare and prior auths.
I wish I had a magic ball to see what it looks like. I do know that there's [00:26:00] a lot of new therapies in the pipeline. A lot of those therapies will get approved and bedelivered within a provider setting, whether it's an injection or an infusion and I'll inhale that product.
However you give that product, it'll be done in the confines of, a prescribing provider. So we need to be ready for that. We need to make sure that we have the capacity to do that and the understanding of how to bring those in. Having said that, we're getting so much better at diagnosing patients earlier.
So quicker start to get on these therapies. The therapies are not inexpensive. So that's where I talked about in the beginning, how we really got to partner with our payers to understand what they're thinking, what their policies might look like and what we could bring to the table so that we can continue to evolve those therapies and bring them to the patients that need them.
But it's exciting. There's a lot of robust things and there's biomarkers that will tell us if somebody's on the right [00:27:00] therapy, if it is working for them, some testing before somebody initiates therapy while they're on it, maybe helping them get off of it at some point. So it's an exciting time to be in medicine, but it's also, like I said, it's very expensive.
It's a 3 trillion part of healthcare, and we all have to be good stewards of that and make sure that we're all partnering and working together because it could be anybody that needs any of these things.
Kip Theno: You know, our tagline for the podcast is together, we can make things right.
And we'd love being on the journey with you, Christine. How can folks out there contact you or Neuronet?
Christine Mann: We're actually launching our brand new website in the next couple of days.
So it's Neuronet.com. DENT Neurologic Institute also has a website that I'm on with an email address and a cell phone number. I'm onLinkedIn as well. Feel free to reach out. I'd love to hear from people.
The more we band together and help one another the stronger we'll be and the more patients [00:28:00] that we'll be able to help
Kip Theno: Thank you Christine for joining The Road to Care podcast.
Christine Mann:Thanks Kip.
Kip Theno: Thank you for joining the Road to Care podcast hosted by SamaCare, the leader in prior authorization technology and services. We're through a script to therapy operating system. We enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced and recorded by Jamestown.
Together, we can make healthcare right. Here are some of the outstanding
healthcare organizations and associations championing patient health mentioned in
this episode:
SamaCare is joined by DENT CCO, Christine Mann, fresh off her multiple
trips to DC educating healthcare policymakers on patient access issues. Tune in for a
candid discussion on the challenges and opportunities in delivering specialty care to
patients across rheumatology, neurology, ambulatory infusion centers and behavioral
health practices.
You’ll hear:
Christine Mann is Chief Commercial Officer of DENT Neurologic Institute, Executive
Director of DENT Infusion Centers, Executive Director, Behavioral Health and
Interventional Medicine, Managing Director, NeuroNet GPO and Founding Member, Vice
President on the National Infusion Center Association (NICA) Board of Directors, and
Founding Member of National Organization of Rheumatology Managers (NORM).
Kip Theno: Welcome to the Road to Care podcast hosted by SamaCare, where we will talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today and where we see it evolving. SamaCare's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together, we can simply make things right.
Today our first guest is none other than Christine Mann. Christine is Chief Commercial Officer of DENT,Executive Director of DENT Infusion Centers, Executive Director, Behavioral Health and Interventional Medicine, Managing Director, Neuronet GPO and Founding Member, Vice President on the NICA Board of Directors, and Founding Member of NORM.
Kip Theno: Now,Christine, I've known you a long time. That was a lot. Your business cards must be fun to make. What are they like eight by tens, Christine? Like, how do you do that?
Christine Mann: Actually, you know what, Kip, they have asked me to go electronic with that. SoI can just send over the information and save a few trees. [00:01:00] And thanks so much for having me. Really thrilled to be a part of it.
Kip Theno: No, thank you, Christine. You've been a great friend to us for a long time here at SamaCare and a key opinion later in the industry. The first question we'd love to hear is, Your journey, right?
Let's talk about your career in infusion from rheumatology to DENT. and where it went from there.
So I was lucky enough to be hired to start with a rheumatology practice back when my son was born. So it started as a part time gig in healthcare. I didn't really have a lot of healthcare experience, but I thoughtI have an MBA, , I'll figure it out.
My first day in was a day where somebody had brought lunch. The doctor said to me, can you go in there and tell that guy that we like his product, but we don't give it here. We send patients to the hospital. And I couldn't even get past that sentence because I kept saying somebody's bringing us lunch? That's pretty cool. I didn't know people brought lunch in healthcare.Now I get breakfast, lunch and dinner here. So we talked about this medication and [00:02:00] delivering this infusion in the practice, and it was really back a few years ago. It was unheard of to do that.But I sat down with the representative.
I worked with our nurse manager there at the rheumatology practices and we figured out that it was a great medication and you could do it inside a physician practice. And what was really astounding to everybody was we are the most cost effective way to deliver those infusion therapies.
There's some things certainly that are important and given in a hospital setting, but a hospital setting is a different facility and they can bill differently than a private practice. So that's how we started out with one chair, got six chairs, added another. Building and more chairs within rheumatology.
And that went great for a long time. There was a lot of great therapies available for those patients. Fast forward a few years and DENT came and said, we'd like to expand our infusion as well. And I looked at the pipeline for [00:03:00] neurology 10 years ago.It was pretty robust, and it remains robust. So, I came to DENT and we started doing infusions here in a bigger capacity than what they had.
And the journey to the chair materialized from that.
Kip Theno: Wow. We work, as you know, very closely, with Neuronet, Neuronet GPO. Talk about that, the forming of Neuronet, Neuronet GPO, the goals of the organization.
Christine Mann: Because we really believe that the outpatient sector is the best place to get some of these drugs and this neurological care, we started an organization called Neuronet. We wanted to make sure that neurology practices understood that. We wanted other neurology practices around the country to thrive on that.And sometimes a lot of places didn't have the resources and certainly didn't have the buying power. There's 2 branches of it. There's a GPO, which is a buying group, so we all band together and purchase under one roof. We bring that to a [00:04:00] distributor and we're able to get some better pricing.
We were able to get inventory systems for all the members ofthe organization and we stick together and we help one another, especially whena new product comes out or something changes within that journey to the chair..
The journey to the chair, getting a patient from the time they see a physician or a provider that says I'm going to put you on an infusion oran injection that's given within a practice or an ambulatory infusion center--there's a lot of stakeholders in that process from the provider until that last bill is paid. We can actually have this revenue streamlined in practice, but we can also take care of patients together within the confines of the practice.
Kip Theno: Yeah, yeah, for sure. And we've talked about this, Christine, you know, my background before the earth cooled, many years ago was in cardiology, interventional side, and there was a time when, before VAT committees, value analysis committees, and where even [00:05:00] legislation and other things kind of took over to, to dictate clinical behavior, cardiologists, as an example, would use the device or the medication that they wanted, and if anything got in their way, they'd burn the OR down. That was the substance back then. And I've seen that change a little bit, and I'd love to hear from you, how has medicine and business of medicine changed from everything you just said, and utilization management, and doctor choices, step edits, the new biologics coming out.
There's just so much that's happening, it seems, at light speed. What can you talk to me about that?
Christine Mann: Yeah, you're right about that, Kip. There has been a lot of changes and so we can't forget that everybody is a partner in this and we all need to work together. So we are sympathetic to some degree with payers understanding that their budgets are blown out of the water right now with these, while we're getting so much better at diagnosing people earlier in their disease state and getting them on therapy faster, there's some great new therapies that have been developed and continue to come out.
They're expensive. And we have to figure out [00:06:00] how do we best work with payers to get the right patient on the right therapy. Make sure that everybody's being reimbursed appropriately. You talk about capacity constraints. There's so many new drugs that are we running out of space here atDENT.
We're adding eight more chairs and a couple months. We're building out some new space so that we have more capacity to take care of our patients here within the practice. But we're also, as I said, working with payers to make sure that we can understand what their expectations are in terms of prior auth site of care constraints, out of pocket costs for patients, there's a lot to it.
It's not as simple. It never was really simple, but it certainly wasn't as complex as it is today.
Kip Theno: Yeah, andI think it's changed a lot in the word complex. You can't say it better than that. By the way, we don't see the payer as the villain.
They're not. And we see you, the clinicians, the site of care, the patients as the heroes of the story. SamaCare as a technology partner, a guide, right? But it's the [00:07:00]complexities that A to Z process of getting those patients on those new therapies or even the main staple therapies that's become really difficult, especially on the medical benefits side.
What are some thoughts that you have or advice that you have in dealing with the changes that continue to occur?
Christine Mann: Well, the first part of that is you really got to keep up on the changes and understand what payer policies might be. There could be step edits in the way, what you have to do to get through those.
We have quarterly meetings with our local payer plans and their executives so that we stay in lockstep on the expectations of both sides. I think that's really important to make sure that you understand those policies.One of the things we talked about before Kip is the complexities of the prior authorization.
I remember when we talk about the rheumatology drugs, it was a lot easier to get a prior authorization. One page, fill it out, send it in. It got approved for a longer period of [00:08:00]time. There were no constraints on how many units you could give to a patient, in a certain amount of time. Or there weren't a lot of step edits in the way.
Now, those things are really important for payers. Utilization management is what we term it as, to make sure that everybody is getting on the right therapy at the right time. We don't always agree as providers that payers have the right policy in place, but nonetheless, we need to be cognizant of those so that we don't add extended time on to making sure a patient gets in the chair.
Kip Theno: There's a disconnect, I think between the manufacturers and even the public education on what's out there and what power that they have themselves.
And then the payers and the providers, and you mentioned all the new therapies. I think every day you wake up to a new therapy in some specialty, whether it be a lifesaving drug or therapy or a rare disease drug or therapy, and it's coming very quickly. What are some of the [00:09:00] challenges and opportunities and stakeholders in patient care?
Because I know you also work and communicate with pharmaceutical manufacturers. Talk about that process.
Christine Mann: We do. And it's exciting to bring a new product, not only to market, but to get it into your center and get it to a patient as soon as possible. As you know, you talked about some of these complexities.
One of the things that we didn't have as much years ago was direct to consumer advertising. So patients come in demanding certain therapies, and we're left to explain that sometimes you can't just hop to a specific new therapy that's come out. There might be something within your benefit structure that you have to try and fail something else before you can get on that therapy.
Right? That's just one of the nuances when it comes to new therapies. You have to get it on a payer formulary. We have to understand how to provide that therapy within our center. So we require clinical training.There's got to be policies and protocols set up and put into place, you have to understand who's carrying that.
Sometimes [00:10:00] a manufacturer works with only one distributor. It's called single source distribution that makes it a little harder. Also, if you're adding therapies and these therapies are not inexpensive, you have to make sure you got the right credit line with the right distributor. So all of those things go into all of those thoughts go into making sure that.
We understand the product. We can get the product. We have the patient population. We have the payers that are going to reimburse us forgiving that product. Put that all together. Sometimes that takes a little bit of time. As you know, Kip, I like to be one of the first in the country to deliver new therapies and we pride ourselves on some of the really exciting therapies we've brought here to Western New York, but we certainly share that information with greater good of Neuronet.
We were just talking yesterday on a call. About a new product that was recently launched. So it's not always Simple, but it certainly is worthwhile, especially when a patient benefits from some new latest greatest therapy
Kip Theno: [00:11:00] Yeah, and I know you do and you're plugged into that You know, in another installment a bunch of questions came in about: “What if there is this evidence based medicine new therapy, but it doesn't yet have a code how do we handle that because, the patient then is waiting for something that might be better than what they have now or might literally change their course of care?”
How do you guys handle that over there?
Christine Mann: Right.Sometimes drugs get launched. I've seen a few new drugs recently get launched and have what they call a J code or a code that depicts to the payer what medication their member has gotten when they're in an infusion center or a practice. But oftentimes it's six months before a code is given, a permanent code is what we call it, for that medication.
Payers have made it really difficult to bill without a J code as well now. It's an, it's an unclassified code that we use. We have to do a lot more on the claim form to indicate what that therapy was. I mean, we could have a [00:12:00] couple of drugs going right now at the same time here at DENT with an unclassified code.
So there's a lot more description that needs to be done on the claim form with the prior authorization, all of the steps that we talked about.It really is more difficult. And so sometimes patients don't get that therapy because payers have made it so difficult to use an unclassified code.
Unfortunately, we can't get that medication to people quick enough.
It used to be a lot simpler and we were always in the forefront of making it happen. But even for us here at DENT, it has become more difficult to navigate that unclassified code. But if we believe a patient really needs to get on that therapy as soon as possible, we will move heaven and earth to make that happen here.
Kip Theno: It certainly needs to be done and being in the prior authorization space, there's no uniformity between payers even with the same drug. And as an example, you can have 10 payers, three of them might ask you some questions but they approve it 99-100% of the [00:13:00] time. And then the other seven will deny it 99% of the time just out of the gate because that's the algorithm. And that gets frustrating.
What are some of the tools, data, analytics, arrows in your quiver that you guys use to help partner with payers and communicate with them and try to create more of uniform standards across the board?
Christine Mann: I don't know that we can be as effective in creating uniform standards, Kip. I would like to think so, but we do try to have that dialogue with the payers.
The other thing to remember is there's a lot of unique challenges now within the payer groups, because employer groups carve out certain benefit plans, right? Then you've got PBMs in the middle helping to shape and carve out what policies and what medications should be delivered within different plans.
So I often tell my staff, we could have two people standing in front of you with blue cross blue shield cards, but the benefit structures are very different within each of those plans. Different than we've had to navigate before, and it definitely makes it a [00:14:00] lot more challenging. You try to pick up the phone and have a conversation to find out exactly what your patient's benefit is, and if this drug is covered.
And it's really difficult sometimes to get to the right person at that payer to get that information to get the patient treated. So those are definitely some nuances that we've been seeing and trying to work through to navigate around. And sometimes it's really successful and other times it isn't
Kip Theno: right.
And obviously we can't do it alone. We probably say this a million times. There's no silver bullet. There's a lot of lead bullets, right?You need a lot of folks like you out there preaching the gospel and pushing the needle. I read a, a study, by the healthcare financial management association,Christine, that said that three fourths of healthcare executives said that they will invest in revenue cycle, automation technologies, AI, machine learning tech partners throughout the next year or two.
And yet only one out of 10 said that they'd actually made any of those investments. So love to get your lens on [00:15:00]that of technology partners, technology today. How is that helping you guys enable and empower better patient care? And what are some suggestions you have for the audience?
Christine Mann: Well, as you know, Kip, we started partnering with SamaCare about four years ago and it was an extremely exciting initiative and I couldn't tell you what a difference it made here.
It was one of the first big technologies that we adopted hereat DENT. And it was really in the infusion clinic to start.
It has been a huge, addition to helping us streamline that workflow and making it so much more efficient. Being able to get the right form to fil lout electronically right away has been really, a great experience gets the patient in the chair a lot quicker. But when you talk about making sure you know all these different policies, knowing what prior auth form to fill out for different parts of a Blue Cross Blue Shield plan that could span across the country I think you guys have been a great partner [00:16:00]and helping us make sure that we're filling out the right form and now we're not having to fax it in it's automatically going and we can, if somebody who's doing a prior auth happens to be on vacation, anybody can log into the system.We didn't have some of those features before and it was much more of a manual arduous task. Streamlining that process has helped patients get in the chair a lot quicker. We're just embarking on incorporating WeInfuse into our workflow specifically for infusion to start. We're adopting WeInfuse into the infusion center here at DENT, because we want to make sure that we're not scheduling somebody who's prior auth may have expired and we're making sure we have the right inventory in place. There's a whole bunch of great new technology within that software that we're implementing to help us get patients on medication quicker, doing it much more efficiently internally.
It's hard to find really good folks to come in and [00:17:00] show up for work every day. So we want to make sure their job, I don't want to say is as easy as possible, but certainly as streamlined as possible.
Kip Theno: And Christine, you, you do your diligence probably more than anybody. And I want to ask that question. How do you find technology partners, how do they get on your radar, and what is your vetting process?
Christine Mann: We try some things out. We like to say we're a pilot school here at DENT. We're a pilot center. We'll try things out and we're very supportive. Our administrative team is very supported by the physician owners here at DENT. And so they do allow us some latitude and autonomy to try things out.
Sometimes it works really well and sometimes it doesn't, but you have to give it a try and you have to be able to accept things and maybe not everybody is technically oriented as we'd like them to be, but certainly we want everybody to be open minded about trying new things to see what can work and what doesn't.
So we brought in a lot of [00:18:00]different things, things that we've adapted and that have stayed and other things that maybe they weren't as great as we thought they were originally.When you say, how does it get to you, we find these companies and sometimes they find us.
Kip Theno: Yeah.Yeah. Definitely. It's got to be a two way street there.
Kip Theno: I want to switch gears to a topic I'm very excited to hear about because you've also heard me say, legislation it works at a glacial pace, right?
And unfortunately a glacial pace isn't really good enough for patient care intent aside But you were just in dc advocating to improve patient access talk about that, like what's that experience like, the legislation experience, your conversations, where are the policymakers getting it right, where could they improve, and then what can we do together to needle them a little bit.
Christine Mann: So this was my second trip to the Hill. And it's really, it's incredible. It's amazing. There's so much going on in the nation's Capitol and they're responsible for so many things. So it helped me understand that it [00:19:00] takes a lot of us to help move some of these policies or to help people understand some of these policies.
So you've got people in the Senate and the Congress voting on certain bills. Sometimes they don't really know the downstream effect. And so when we have the opportunity to sit with their staff and explain some of maybe the unintended consequences or things, how their constituents or how patients are affected by some of the healthcare bills that are swirling and waiting for approval and waiting for vote.
It's great to have people who represent , like myself, represent from the practice. I see patients on a day to day basis. I see patients in our clinic. I see the patients that come in for infusion and I live and breathe it every day. So to bring those experiences to people who are making decisions on these policies has been really incredible.
And we had a great run last week, we had my group specifically had eight meetings throughout the day. We walked over 13, 000 steps. We [00:20:00] were pretty busy. But it's really an experience to be able to tell that side of the story because sometimes they don't understand what they're voting on, or they don't understand the implications that it might have to people that live in their districts , or all of us collectively.
Kip Theno: Well kudos for tracking your steps, you know, remote patient monitoring. It's pretty cool technology these days. Do they does it seem when you're there that they're listening that the lawmakers get it or do you see that there's a disconnect.What's your feeling?
Christine Mann:Sometimes there is a disconnect.
So when we talked about infusion therapy, there were people that thought that was reserved for cancer centers and chemotherapy. And we dial it back and say, you know, you have people that have multiple sclerosis, you have people that might have rheumatoid arthritis, ulcerative colitis, Crohn's disease.
We're treating, we're giving those medications in our offices too, to those patients and they could be in their 20s, 30s, 40s, you know, it's not just cancer patients. It goes [00:21:00] so far beyond that. And these are professional people that are going to work and taking care of families like you and I Kip or we now have Alzheimer's drugs that we're offering to our senior population.
So it encompasses a lot of different people. And I don't know that sometimes that's understood when you talk about infusion therapy. So we did a lot of educating around that, a lot of educating about certain bills ,and how we might be affected more importantly, how patients are affected, right? You don't want to be, you have to stop therapy for anybody, but specifically somebody young that has a family to take care of. They're trying to keep their job. So we'd like to have evening hours. We'd like to have Saturday hours, but we also need to make sure that we're getting paid adequately to do that. So those conversations were real and very well received.
I thought. The people that we met with were educated in what we were discussing, they were engaged. They took a lot of notes. So I hope it makes a difference. I really do.
Kip Theno: Well, thank you [00:22:00] for doing that. It takes a village. You've got the manufacturers, you've got the payers, you've got organizations like SamaCare.
You've got thought leaders like yourself. How do you get other people engaged and involved in that? I'm, not sure everybody knows how to do it and you've been up to the hill twice. What advice can you give to some of our listeners?
Christine Mann: I think anybody could have the opportunity to go I am fortunate enough to sit on the board of the National Infusion Center Association (NICA), and as a board, we're invited. NICA puts this day on for us. They work with an organization called Heart Health Strategies in Washington that arranges all of these meetings. And I think through trade associations and groups like that, people get in front of the right people and are able to deliver the right messages. So that's how this particular Hill Day got put together.
But I'm sure there's other ways that people could get together and do some advocacy for patients. There's a lot of great, like the Alzheimer's association, the MS association.
Kip Theno: We've got a newswire that goes out [00:23:00] every month. We're doing these podcasts, anything else you can suggest to us, to the listeners, I know they'd appreciate it.
And you know, you haven't stopped there. Christine said, we talked about technology. We talked about technology partners, legislation, and thinking about bettering patient care. Tell us a little bit about CareNet. What is that?
Christine Mann: SoCare Net is a brand new organization that we put together to follow the model of Neuronet.
Neuronet has been so successful in getting neurology practices across the country together, not only for some buying power, but for sharing such intellect and information to better patient care. Move to CareNet is really looking at the behavioral health sector. We here at DENT, we have a behavioral health clinic.
We have 15 providers in that clinic and we're still booking out months. There's a lot of patients in our communities across the country that need help in the behavioral health sector. We're working with Janssen on an [00:24:00] amazing product called Spravato. It's nota new product, but it's a new product for behavioral health and psychiatrists to actually be able to deliver in their office.
So we've spent the last couple of years trying to help educate other practices on how to bring this medication to their practice and to their patients. One of the things that Janssen had said to us back a few months ago was only 2% of the patient population with severe depression are able to access this medication.
Oh, wow. What a better way to try to do more educating and advocating for this patient population, then to start something like CareNet.CareNet is clinical access, reaching everyone in a network of people that are understanding and learning how to be able to prescribe the medication and give the medication within their practices Kip.
We're just about to launch. We're ready to go on all fronts. We are partnering with [00:25:00] Cencora on this, and we're really excited to be able to help bring our knowledge to the collective community and psychiatry and help people understand how to get their patients in and get them on therapy.
This is just the first of, I'm sure, many, but to get that healthcare sector ready is really exciting, and we're hoping that's whatCareNet comes together to do
Kip Theno: Wow. Well, my potato math, you know, 2% leaves 98% on the table. So anything SamaCare can do to partner with you on that, you know, we're all in Christine. Part of the genesis of SamaCare was almost 5 out of 10 patients don't get on the right therapy at the right time because of the process.
Christine Mann: I certainly appreciate it. And I'm counting on it.
Kip Theno: Well, here's the final jeopardy question, the $20,000 question, right? The future of healthcare, where do you see it going? Open forum, Christine, what's the future of healthcare and prior auths.
I wish I had a magic ball to see what it looks like. I do know that there's [00:26:00] a lot of new therapies in the pipeline. A lot of those therapies will get approved and bedelivered within a provider setting, whether it's an injection or an infusion and I'll inhale that product.
However you give that product, it'll be done in the confines of, a prescribing provider. So we need to be ready for that. We need to make sure that we have the capacity to do that and the understanding of how to bring those in. Having said that, we're getting so much better at diagnosing patients earlier.
So quicker start to get on these therapies. The therapies are not inexpensive. So that's where I talked about in the beginning, how we really got to partner with our payers to understand what they're thinking, what their policies might look like and what we could bring to the table so that we can continue to evolve those therapies and bring them to the patients that need them.
But it's exciting. There's a lot of robust things and there's biomarkers that will tell us if somebody's on the right [00:27:00] therapy, if it is working for them, some testing before somebody initiates therapy while they're on it, maybe helping them get off of it at some point. So it's an exciting time to be in medicine, but it's also, like I said, it's very expensive.
It's a 3 trillion part of healthcare, and we all have to be good stewards of that and make sure that we're all partnering and working together because it could be anybody that needs any of these things.
Kip Theno: You know, our tagline for the podcast is together, we can make things right.
And we'd love being on the journey with you, Christine. How can folks out there contact you or Neuronet?
Christine Mann: We're actually launching our brand new website in the next couple of days.
So it's Neuronet.com. DENT Neurologic Institute also has a website that I'm on with an email address and a cell phone number. I'm onLinkedIn as well. Feel free to reach out. I'd love to hear from people.
The more we band together and help one another the stronger we'll be and the more patients [00:28:00] that we'll be able to help
Kip Theno: Thank you Christine for joining The Road to Care podcast.
Christine Mann:Thanks Kip.
Kip Theno: Thank you for joining the Road to Care podcast hosted by SamaCare, the leader in prior authorization technology and services. We're through a script to therapy operating system. We enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced and recorded by Jamestown.
Together, we can make healthcare right. Here are some of the outstanding
healthcare organizations and associations championing patient health mentioned in
this episode:
SamaCare is joined by DENT CCO, Christine Mann, fresh off her multiple
trips to DC educating healthcare policymakers on patient access issues. Tune in for a
candid discussion on the challenges and opportunities in delivering specialty care to
patients across rheumatology, neurology, ambulatory infusion centers and behavioral
health practices.
You’ll hear:
Christine Mann is Chief Commercial Officer of DENT Neurologic Institute, Executive
Director of DENT Infusion Centers, Executive Director, Behavioral Health and
Interventional Medicine, Managing Director, NeuroNet GPO and Founding Member, Vice
President on the National Infusion Center Association (NICA) Board of Directors, and
Founding Member of National Organization of Rheumatology Managers (NORM).
Kip Theno: Welcome to the Road to Care podcast hosted by SamaCare, where we will talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today and where we see it evolving. SamaCare's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together, we can simply make things right.
Today our first guest is none other than Christine Mann. Christine is Chief Commercial Officer of DENT,Executive Director of DENT Infusion Centers, Executive Director, Behavioral Health and Interventional Medicine, Managing Director, Neuronet GPO and Founding Member, Vice President on the NICA Board of Directors, and Founding Member of NORM.
Kip Theno: Now,Christine, I've known you a long time. That was a lot. Your business cards must be fun to make. What are they like eight by tens, Christine? Like, how do you do that?
Christine Mann: Actually, you know what, Kip, they have asked me to go electronic with that. SoI can just send over the information and save a few trees. [00:01:00] And thanks so much for having me. Really thrilled to be a part of it.
Kip Theno: No, thank you, Christine. You've been a great friend to us for a long time here at SamaCare and a key opinion later in the industry. The first question we'd love to hear is, Your journey, right?
Let's talk about your career in infusion from rheumatology to DENT. and where it went from there.
So I was lucky enough to be hired to start with a rheumatology practice back when my son was born. So it started as a part time gig in healthcare. I didn't really have a lot of healthcare experience, but I thoughtI have an MBA, , I'll figure it out.
My first day in was a day where somebody had brought lunch. The doctor said to me, can you go in there and tell that guy that we like his product, but we don't give it here. We send patients to the hospital. And I couldn't even get past that sentence because I kept saying somebody's bringing us lunch? That's pretty cool. I didn't know people brought lunch in healthcare.Now I get breakfast, lunch and dinner here. So we talked about this medication and [00:02:00] delivering this infusion in the practice, and it was really back a few years ago. It was unheard of to do that.But I sat down with the representative.
I worked with our nurse manager there at the rheumatology practices and we figured out that it was a great medication and you could do it inside a physician practice. And what was really astounding to everybody was we are the most cost effective way to deliver those infusion therapies.
There's some things certainly that are important and given in a hospital setting, but a hospital setting is a different facility and they can bill differently than a private practice. So that's how we started out with one chair, got six chairs, added another. Building and more chairs within rheumatology.
And that went great for a long time. There was a lot of great therapies available for those patients. Fast forward a few years and DENT came and said, we'd like to expand our infusion as well. And I looked at the pipeline for [00:03:00] neurology 10 years ago.It was pretty robust, and it remains robust. So, I came to DENT and we started doing infusions here in a bigger capacity than what they had.
And the journey to the chair materialized from that.
Kip Theno: Wow. We work, as you know, very closely, with Neuronet, Neuronet GPO. Talk about that, the forming of Neuronet, Neuronet GPO, the goals of the organization.
Christine Mann: Because we really believe that the outpatient sector is the best place to get some of these drugs and this neurological care, we started an organization called Neuronet. We wanted to make sure that neurology practices understood that. We wanted other neurology practices around the country to thrive on that.And sometimes a lot of places didn't have the resources and certainly didn't have the buying power. There's 2 branches of it. There's a GPO, which is a buying group, so we all band together and purchase under one roof. We bring that to a [00:04:00] distributor and we're able to get some better pricing.
We were able to get inventory systems for all the members ofthe organization and we stick together and we help one another, especially whena new product comes out or something changes within that journey to the chair..
The journey to the chair, getting a patient from the time they see a physician or a provider that says I'm going to put you on an infusion oran injection that's given within a practice or an ambulatory infusion center--there's a lot of stakeholders in that process from the provider until that last bill is paid. We can actually have this revenue streamlined in practice, but we can also take care of patients together within the confines of the practice.
Kip Theno: Yeah, yeah, for sure. And we've talked about this, Christine, you know, my background before the earth cooled, many years ago was in cardiology, interventional side, and there was a time when, before VAT committees, value analysis committees, and where even [00:05:00] legislation and other things kind of took over to, to dictate clinical behavior, cardiologists, as an example, would use the device or the medication that they wanted, and if anything got in their way, they'd burn the OR down. That was the substance back then. And I've seen that change a little bit, and I'd love to hear from you, how has medicine and business of medicine changed from everything you just said, and utilization management, and doctor choices, step edits, the new biologics coming out.
There's just so much that's happening, it seems, at light speed. What can you talk to me about that?
Christine Mann: Yeah, you're right about that, Kip. There has been a lot of changes and so we can't forget that everybody is a partner in this and we all need to work together. So we are sympathetic to some degree with payers understanding that their budgets are blown out of the water right now with these, while we're getting so much better at diagnosing people earlier in their disease state and getting them on therapy faster, there's some great new therapies that have been developed and continue to come out.
They're expensive. And we have to figure out [00:06:00] how do we best work with payers to get the right patient on the right therapy. Make sure that everybody's being reimbursed appropriately. You talk about capacity constraints. There's so many new drugs that are we running out of space here atDENT.
We're adding eight more chairs and a couple months. We're building out some new space so that we have more capacity to take care of our patients here within the practice. But we're also, as I said, working with payers to make sure that we can understand what their expectations are in terms of prior auth site of care constraints, out of pocket costs for patients, there's a lot to it.
It's not as simple. It never was really simple, but it certainly wasn't as complex as it is today.
Kip Theno: Yeah, andI think it's changed a lot in the word complex. You can't say it better than that. By the way, we don't see the payer as the villain.
They're not. And we see you, the clinicians, the site of care, the patients as the heroes of the story. SamaCare as a technology partner, a guide, right? But it's the [00:07:00]complexities that A to Z process of getting those patients on those new therapies or even the main staple therapies that's become really difficult, especially on the medical benefits side.
What are some thoughts that you have or advice that you have in dealing with the changes that continue to occur?
Christine Mann: Well, the first part of that is you really got to keep up on the changes and understand what payer policies might be. There could be step edits in the way, what you have to do to get through those.
We have quarterly meetings with our local payer plans and their executives so that we stay in lockstep on the expectations of both sides. I think that's really important to make sure that you understand those policies.One of the things we talked about before Kip is the complexities of the prior authorization.
I remember when we talk about the rheumatology drugs, it was a lot easier to get a prior authorization. One page, fill it out, send it in. It got approved for a longer period of [00:08:00]time. There were no constraints on how many units you could give to a patient, in a certain amount of time. Or there weren't a lot of step edits in the way.
Now, those things are really important for payers. Utilization management is what we term it as, to make sure that everybody is getting on the right therapy at the right time. We don't always agree as providers that payers have the right policy in place, but nonetheless, we need to be cognizant of those so that we don't add extended time on to making sure a patient gets in the chair.
Kip Theno: There's a disconnect, I think between the manufacturers and even the public education on what's out there and what power that they have themselves.
And then the payers and the providers, and you mentioned all the new therapies. I think every day you wake up to a new therapy in some specialty, whether it be a lifesaving drug or therapy or a rare disease drug or therapy, and it's coming very quickly. What are some of the [00:09:00] challenges and opportunities and stakeholders in patient care?
Because I know you also work and communicate with pharmaceutical manufacturers. Talk about that process.
Christine Mann: We do. And it's exciting to bring a new product, not only to market, but to get it into your center and get it to a patient as soon as possible. As you know, you talked about some of these complexities.
One of the things that we didn't have as much years ago was direct to consumer advertising. So patients come in demanding certain therapies, and we're left to explain that sometimes you can't just hop to a specific new therapy that's come out. There might be something within your benefit structure that you have to try and fail something else before you can get on that therapy.
Right? That's just one of the nuances when it comes to new therapies. You have to get it on a payer formulary. We have to understand how to provide that therapy within our center. So we require clinical training.There's got to be policies and protocols set up and put into place, you have to understand who's carrying that.
Sometimes [00:10:00] a manufacturer works with only one distributor. It's called single source distribution that makes it a little harder. Also, if you're adding therapies and these therapies are not inexpensive, you have to make sure you got the right credit line with the right distributor. So all of those things go into all of those thoughts go into making sure that.
We understand the product. We can get the product. We have the patient population. We have the payers that are going to reimburse us forgiving that product. Put that all together. Sometimes that takes a little bit of time. As you know, Kip, I like to be one of the first in the country to deliver new therapies and we pride ourselves on some of the really exciting therapies we've brought here to Western New York, but we certainly share that information with greater good of Neuronet.
We were just talking yesterday on a call. About a new product that was recently launched. So it's not always Simple, but it certainly is worthwhile, especially when a patient benefits from some new latest greatest therapy
Kip Theno: [00:11:00] Yeah, and I know you do and you're plugged into that You know, in another installment a bunch of questions came in about: “What if there is this evidence based medicine new therapy, but it doesn't yet have a code how do we handle that because, the patient then is waiting for something that might be better than what they have now or might literally change their course of care?”
How do you guys handle that over there?
Christine Mann: Right.Sometimes drugs get launched. I've seen a few new drugs recently get launched and have what they call a J code or a code that depicts to the payer what medication their member has gotten when they're in an infusion center or a practice. But oftentimes it's six months before a code is given, a permanent code is what we call it, for that medication.
Payers have made it really difficult to bill without a J code as well now. It's an, it's an unclassified code that we use. We have to do a lot more on the claim form to indicate what that therapy was. I mean, we could have a [00:12:00] couple of drugs going right now at the same time here at DENT with an unclassified code.
So there's a lot more description that needs to be done on the claim form with the prior authorization, all of the steps that we talked about.It really is more difficult. And so sometimes patients don't get that therapy because payers have made it so difficult to use an unclassified code.
Unfortunately, we can't get that medication to people quick enough.
It used to be a lot simpler and we were always in the forefront of making it happen. But even for us here at DENT, it has become more difficult to navigate that unclassified code. But if we believe a patient really needs to get on that therapy as soon as possible, we will move heaven and earth to make that happen here.
Kip Theno: It certainly needs to be done and being in the prior authorization space, there's no uniformity between payers even with the same drug. And as an example, you can have 10 payers, three of them might ask you some questions but they approve it 99-100% of the [00:13:00] time. And then the other seven will deny it 99% of the time just out of the gate because that's the algorithm. And that gets frustrating.
What are some of the tools, data, analytics, arrows in your quiver that you guys use to help partner with payers and communicate with them and try to create more of uniform standards across the board?
Christine Mann: I don't know that we can be as effective in creating uniform standards, Kip. I would like to think so, but we do try to have that dialogue with the payers.
The other thing to remember is there's a lot of unique challenges now within the payer groups, because employer groups carve out certain benefit plans, right? Then you've got PBMs in the middle helping to shape and carve out what policies and what medications should be delivered within different plans.
So I often tell my staff, we could have two people standing in front of you with blue cross blue shield cards, but the benefit structures are very different within each of those plans. Different than we've had to navigate before, and it definitely makes it a [00:14:00] lot more challenging. You try to pick up the phone and have a conversation to find out exactly what your patient's benefit is, and if this drug is covered.
And it's really difficult sometimes to get to the right person at that payer to get that information to get the patient treated. So those are definitely some nuances that we've been seeing and trying to work through to navigate around. And sometimes it's really successful and other times it isn't
Kip Theno: right.
And obviously we can't do it alone. We probably say this a million times. There's no silver bullet. There's a lot of lead bullets, right?You need a lot of folks like you out there preaching the gospel and pushing the needle. I read a, a study, by the healthcare financial management association,Christine, that said that three fourths of healthcare executives said that they will invest in revenue cycle, automation technologies, AI, machine learning tech partners throughout the next year or two.
And yet only one out of 10 said that they'd actually made any of those investments. So love to get your lens on [00:15:00]that of technology partners, technology today. How is that helping you guys enable and empower better patient care? And what are some suggestions you have for the audience?
Christine Mann: Well, as you know, Kip, we started partnering with SamaCare about four years ago and it was an extremely exciting initiative and I couldn't tell you what a difference it made here.
It was one of the first big technologies that we adopted hereat DENT. And it was really in the infusion clinic to start.
It has been a huge, addition to helping us streamline that workflow and making it so much more efficient. Being able to get the right form to fil lout electronically right away has been really, a great experience gets the patient in the chair a lot quicker. But when you talk about making sure you know all these different policies, knowing what prior auth form to fill out for different parts of a Blue Cross Blue Shield plan that could span across the country I think you guys have been a great partner [00:16:00]and helping us make sure that we're filling out the right form and now we're not having to fax it in it's automatically going and we can, if somebody who's doing a prior auth happens to be on vacation, anybody can log into the system.We didn't have some of those features before and it was much more of a manual arduous task. Streamlining that process has helped patients get in the chair a lot quicker. We're just embarking on incorporating WeInfuse into our workflow specifically for infusion to start. We're adopting WeInfuse into the infusion center here at DENT, because we want to make sure that we're not scheduling somebody who's prior auth may have expired and we're making sure we have the right inventory in place. There's a whole bunch of great new technology within that software that we're implementing to help us get patients on medication quicker, doing it much more efficiently internally.
It's hard to find really good folks to come in and [00:17:00] show up for work every day. So we want to make sure their job, I don't want to say is as easy as possible, but certainly as streamlined as possible.
Kip Theno: And Christine, you, you do your diligence probably more than anybody. And I want to ask that question. How do you find technology partners, how do they get on your radar, and what is your vetting process?
Christine Mann: We try some things out. We like to say we're a pilot school here at DENT. We're a pilot center. We'll try things out and we're very supportive. Our administrative team is very supported by the physician owners here at DENT. And so they do allow us some latitude and autonomy to try things out.
Sometimes it works really well and sometimes it doesn't, but you have to give it a try and you have to be able to accept things and maybe not everybody is technically oriented as we'd like them to be, but certainly we want everybody to be open minded about trying new things to see what can work and what doesn't.
So we brought in a lot of [00:18:00]different things, things that we've adapted and that have stayed and other things that maybe they weren't as great as we thought they were originally.When you say, how does it get to you, we find these companies and sometimes they find us.
Kip Theno: Yeah.Yeah. Definitely. It's got to be a two way street there.
Kip Theno: I want to switch gears to a topic I'm very excited to hear about because you've also heard me say, legislation it works at a glacial pace, right?
And unfortunately a glacial pace isn't really good enough for patient care intent aside But you were just in dc advocating to improve patient access talk about that, like what's that experience like, the legislation experience, your conversations, where are the policymakers getting it right, where could they improve, and then what can we do together to needle them a little bit.
Christine Mann: So this was my second trip to the Hill. And it's really, it's incredible. It's amazing. There's so much going on in the nation's Capitol and they're responsible for so many things. So it helped me understand that it [00:19:00] takes a lot of us to help move some of these policies or to help people understand some of these policies.
So you've got people in the Senate and the Congress voting on certain bills. Sometimes they don't really know the downstream effect. And so when we have the opportunity to sit with their staff and explain some of maybe the unintended consequences or things, how their constituents or how patients are affected by some of the healthcare bills that are swirling and waiting for approval and waiting for vote.
It's great to have people who represent , like myself, represent from the practice. I see patients on a day to day basis. I see patients in our clinic. I see the patients that come in for infusion and I live and breathe it every day. So to bring those experiences to people who are making decisions on these policies has been really incredible.
And we had a great run last week, we had my group specifically had eight meetings throughout the day. We walked over 13, 000 steps. We [00:20:00] were pretty busy. But it's really an experience to be able to tell that side of the story because sometimes they don't understand what they're voting on, or they don't understand the implications that it might have to people that live in their districts , or all of us collectively.
Kip Theno: Well kudos for tracking your steps, you know, remote patient monitoring. It's pretty cool technology these days. Do they does it seem when you're there that they're listening that the lawmakers get it or do you see that there's a disconnect.What's your feeling?
Christine Mann:Sometimes there is a disconnect.
So when we talked about infusion therapy, there were people that thought that was reserved for cancer centers and chemotherapy. And we dial it back and say, you know, you have people that have multiple sclerosis, you have people that might have rheumatoid arthritis, ulcerative colitis, Crohn's disease.
We're treating, we're giving those medications in our offices too, to those patients and they could be in their 20s, 30s, 40s, you know, it's not just cancer patients. It goes [00:21:00] so far beyond that. And these are professional people that are going to work and taking care of families like you and I Kip or we now have Alzheimer's drugs that we're offering to our senior population.
So it encompasses a lot of different people. And I don't know that sometimes that's understood when you talk about infusion therapy. So we did a lot of educating around that, a lot of educating about certain bills ,and how we might be affected more importantly, how patients are affected, right? You don't want to be, you have to stop therapy for anybody, but specifically somebody young that has a family to take care of. They're trying to keep their job. So we'd like to have evening hours. We'd like to have Saturday hours, but we also need to make sure that we're getting paid adequately to do that. So those conversations were real and very well received.
I thought. The people that we met with were educated in what we were discussing, they were engaged. They took a lot of notes. So I hope it makes a difference. I really do.
Kip Theno: Well, thank you [00:22:00] for doing that. It takes a village. You've got the manufacturers, you've got the payers, you've got organizations like SamaCare.
You've got thought leaders like yourself. How do you get other people engaged and involved in that? I'm, not sure everybody knows how to do it and you've been up to the hill twice. What advice can you give to some of our listeners?
Christine Mann: I think anybody could have the opportunity to go I am fortunate enough to sit on the board of the National Infusion Center Association (NICA), and as a board, we're invited. NICA puts this day on for us. They work with an organization called Heart Health Strategies in Washington that arranges all of these meetings. And I think through trade associations and groups like that, people get in front of the right people and are able to deliver the right messages. So that's how this particular Hill Day got put together.
But I'm sure there's other ways that people could get together and do some advocacy for patients. There's a lot of great, like the Alzheimer's association, the MS association.
Kip Theno: We've got a newswire that goes out [00:23:00] every month. We're doing these podcasts, anything else you can suggest to us, to the listeners, I know they'd appreciate it.
And you know, you haven't stopped there. Christine said, we talked about technology. We talked about technology partners, legislation, and thinking about bettering patient care. Tell us a little bit about CareNet. What is that?
Christine Mann: SoCare Net is a brand new organization that we put together to follow the model of Neuronet.
Neuronet has been so successful in getting neurology practices across the country together, not only for some buying power, but for sharing such intellect and information to better patient care. Move to CareNet is really looking at the behavioral health sector. We here at DENT, we have a behavioral health clinic.
We have 15 providers in that clinic and we're still booking out months. There's a lot of patients in our communities across the country that need help in the behavioral health sector. We're working with Janssen on an [00:24:00] amazing product called Spravato. It's nota new product, but it's a new product for behavioral health and psychiatrists to actually be able to deliver in their office.
So we've spent the last couple of years trying to help educate other practices on how to bring this medication to their practice and to their patients. One of the things that Janssen had said to us back a few months ago was only 2% of the patient population with severe depression are able to access this medication.
Oh, wow. What a better way to try to do more educating and advocating for this patient population, then to start something like CareNet.CareNet is clinical access, reaching everyone in a network of people that are understanding and learning how to be able to prescribe the medication and give the medication within their practices Kip.
We're just about to launch. We're ready to go on all fronts. We are partnering with [00:25:00] Cencora on this, and we're really excited to be able to help bring our knowledge to the collective community and psychiatry and help people understand how to get their patients in and get them on therapy.
This is just the first of, I'm sure, many, but to get that healthcare sector ready is really exciting, and we're hoping that's whatCareNet comes together to do
Kip Theno: Wow. Well, my potato math, you know, 2% leaves 98% on the table. So anything SamaCare can do to partner with you on that, you know, we're all in Christine. Part of the genesis of SamaCare was almost 5 out of 10 patients don't get on the right therapy at the right time because of the process.
Christine Mann: I certainly appreciate it. And I'm counting on it.
Kip Theno: Well, here's the final jeopardy question, the $20,000 question, right? The future of healthcare, where do you see it going? Open forum, Christine, what's the future of healthcare and prior auths.
I wish I had a magic ball to see what it looks like. I do know that there's [00:26:00] a lot of new therapies in the pipeline. A lot of those therapies will get approved and bedelivered within a provider setting, whether it's an injection or an infusion and I'll inhale that product.
However you give that product, it'll be done in the confines of, a prescribing provider. So we need to be ready for that. We need to make sure that we have the capacity to do that and the understanding of how to bring those in. Having said that, we're getting so much better at diagnosing patients earlier.
So quicker start to get on these therapies. The therapies are not inexpensive. So that's where I talked about in the beginning, how we really got to partner with our payers to understand what they're thinking, what their policies might look like and what we could bring to the table so that we can continue to evolve those therapies and bring them to the patients that need them.
But it's exciting. There's a lot of robust things and there's biomarkers that will tell us if somebody's on the right [00:27:00] therapy, if it is working for them, some testing before somebody initiates therapy while they're on it, maybe helping them get off of it at some point. So it's an exciting time to be in medicine, but it's also, like I said, it's very expensive.
It's a 3 trillion part of healthcare, and we all have to be good stewards of that and make sure that we're all partnering and working together because it could be anybody that needs any of these things.
Kip Theno: You know, our tagline for the podcast is together, we can make things right.
And we'd love being on the journey with you, Christine. How can folks out there contact you or Neuronet?
Christine Mann: We're actually launching our brand new website in the next couple of days.
So it's Neuronet.com. DENT Neurologic Institute also has a website that I'm on with an email address and a cell phone number. I'm onLinkedIn as well. Feel free to reach out. I'd love to hear from people.
The more we band together and help one another the stronger we'll be and the more patients [00:28:00] that we'll be able to help
Kip Theno: Thank you Christine for joining The Road to Care podcast.
Christine Mann:Thanks Kip.
Kip Theno: Thank you for joining the Road to Care podcast hosted by SamaCare, the leader in prior authorization technology and services. We're through a script to therapy operating system. We enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced and recorded by Jamestown.
Together, we can make healthcare right. Here are some of the outstanding
healthcare organizations and associations championing patient health mentioned in
this episode:
SamaCare is joined by DENT CCO, Christine Mann, fresh off her multiple
trips to DC educating healthcare policymakers on patient access issues. Tune in for a
candid discussion on the challenges and opportunities in delivering specialty care to
patients across rheumatology, neurology, ambulatory infusion centers and behavioral
health practices.
You’ll hear:
Christine Mann is Chief Commercial Officer of DENT Neurologic Institute, Executive
Director of DENT Infusion Centers, Executive Director, Behavioral Health and
Interventional Medicine, Managing Director, NeuroNet GPO and Founding Member, Vice
President on the National Infusion Center Association (NICA) Board of Directors, and
Founding Member of National Organization of Rheumatology Managers (NORM).
Kip Theno: Welcome to the Road to Care podcast hosted by SamaCare, where we will talk with key opinion leaders, physicians, administrators, manufacturers, venture capitalists, and legislators to get their insights on the state of healthcare today and where we see it evolving. SamaCare's prior authorization platform is free to clinics, ensuring patients get on the right therapy at the right time.
Together, we can simply make things right.
Today our first guest is none other than Christine Mann. Christine is Chief Commercial Officer of DENT,Executive Director of DENT Infusion Centers, Executive Director, Behavioral Health and Interventional Medicine, Managing Director, Neuronet GPO and Founding Member, Vice President on the NICA Board of Directors, and Founding Member of NORM.
Kip Theno: Now,Christine, I've known you a long time. That was a lot. Your business cards must be fun to make. What are they like eight by tens, Christine? Like, how do you do that?
Christine Mann: Actually, you know what, Kip, they have asked me to go electronic with that. SoI can just send over the information and save a few trees. [00:01:00] And thanks so much for having me. Really thrilled to be a part of it.
Kip Theno: No, thank you, Christine. You've been a great friend to us for a long time here at SamaCare and a key opinion later in the industry. The first question we'd love to hear is, Your journey, right?
Let's talk about your career in infusion from rheumatology to DENT. and where it went from there.
So I was lucky enough to be hired to start with a rheumatology practice back when my son was born. So it started as a part time gig in healthcare. I didn't really have a lot of healthcare experience, but I thoughtI have an MBA, , I'll figure it out.
My first day in was a day where somebody had brought lunch. The doctor said to me, can you go in there and tell that guy that we like his product, but we don't give it here. We send patients to the hospital. And I couldn't even get past that sentence because I kept saying somebody's bringing us lunch? That's pretty cool. I didn't know people brought lunch in healthcare.Now I get breakfast, lunch and dinner here. So we talked about this medication and [00:02:00] delivering this infusion in the practice, and it was really back a few years ago. It was unheard of to do that.But I sat down with the representative.
I worked with our nurse manager there at the rheumatology practices and we figured out that it was a great medication and you could do it inside a physician practice. And what was really astounding to everybody was we are the most cost effective way to deliver those infusion therapies.
There's some things certainly that are important and given in a hospital setting, but a hospital setting is a different facility and they can bill differently than a private practice. So that's how we started out with one chair, got six chairs, added another. Building and more chairs within rheumatology.
And that went great for a long time. There was a lot of great therapies available for those patients. Fast forward a few years and DENT came and said, we'd like to expand our infusion as well. And I looked at the pipeline for [00:03:00] neurology 10 years ago.It was pretty robust, and it remains robust. So, I came to DENT and we started doing infusions here in a bigger capacity than what they had.
And the journey to the chair materialized from that.
Kip Theno: Wow. We work, as you know, very closely, with Neuronet, Neuronet GPO. Talk about that, the forming of Neuronet, Neuronet GPO, the goals of the organization.
Christine Mann: Because we really believe that the outpatient sector is the best place to get some of these drugs and this neurological care, we started an organization called Neuronet. We wanted to make sure that neurology practices understood that. We wanted other neurology practices around the country to thrive on that.And sometimes a lot of places didn't have the resources and certainly didn't have the buying power. There's 2 branches of it. There's a GPO, which is a buying group, so we all band together and purchase under one roof. We bring that to a [00:04:00] distributor and we're able to get some better pricing.
We were able to get inventory systems for all the members ofthe organization and we stick together and we help one another, especially whena new product comes out or something changes within that journey to the chair..
The journey to the chair, getting a patient from the time they see a physician or a provider that says I'm going to put you on an infusion oran injection that's given within a practice or an ambulatory infusion center--there's a lot of stakeholders in that process from the provider until that last bill is paid. We can actually have this revenue streamlined in practice, but we can also take care of patients together within the confines of the practice.
Kip Theno: Yeah, yeah, for sure. And we've talked about this, Christine, you know, my background before the earth cooled, many years ago was in cardiology, interventional side, and there was a time when, before VAT committees, value analysis committees, and where even [00:05:00] legislation and other things kind of took over to, to dictate clinical behavior, cardiologists, as an example, would use the device or the medication that they wanted, and if anything got in their way, they'd burn the OR down. That was the substance back then. And I've seen that change a little bit, and I'd love to hear from you, how has medicine and business of medicine changed from everything you just said, and utilization management, and doctor choices, step edits, the new biologics coming out.
There's just so much that's happening, it seems, at light speed. What can you talk to me about that?
Christine Mann: Yeah, you're right about that, Kip. There has been a lot of changes and so we can't forget that everybody is a partner in this and we all need to work together. So we are sympathetic to some degree with payers understanding that their budgets are blown out of the water right now with these, while we're getting so much better at diagnosing people earlier in their disease state and getting them on therapy faster, there's some great new therapies that have been developed and continue to come out.
They're expensive. And we have to figure out [00:06:00] how do we best work with payers to get the right patient on the right therapy. Make sure that everybody's being reimbursed appropriately. You talk about capacity constraints. There's so many new drugs that are we running out of space here atDENT.
We're adding eight more chairs and a couple months. We're building out some new space so that we have more capacity to take care of our patients here within the practice. But we're also, as I said, working with payers to make sure that we can understand what their expectations are in terms of prior auth site of care constraints, out of pocket costs for patients, there's a lot to it.
It's not as simple. It never was really simple, but it certainly wasn't as complex as it is today.
Kip Theno: Yeah, andI think it's changed a lot in the word complex. You can't say it better than that. By the way, we don't see the payer as the villain.
They're not. And we see you, the clinicians, the site of care, the patients as the heroes of the story. SamaCare as a technology partner, a guide, right? But it's the [00:07:00]complexities that A to Z process of getting those patients on those new therapies or even the main staple therapies that's become really difficult, especially on the medical benefits side.
What are some thoughts that you have or advice that you have in dealing with the changes that continue to occur?
Christine Mann: Well, the first part of that is you really got to keep up on the changes and understand what payer policies might be. There could be step edits in the way, what you have to do to get through those.
We have quarterly meetings with our local payer plans and their executives so that we stay in lockstep on the expectations of both sides. I think that's really important to make sure that you understand those policies.One of the things we talked about before Kip is the complexities of the prior authorization.
I remember when we talk about the rheumatology drugs, it was a lot easier to get a prior authorization. One page, fill it out, send it in. It got approved for a longer period of [00:08:00]time. There were no constraints on how many units you could give to a patient, in a certain amount of time. Or there weren't a lot of step edits in the way.
Now, those things are really important for payers. Utilization management is what we term it as, to make sure that everybody is getting on the right therapy at the right time. We don't always agree as providers that payers have the right policy in place, but nonetheless, we need to be cognizant of those so that we don't add extended time on to making sure a patient gets in the chair.
Kip Theno: There's a disconnect, I think between the manufacturers and even the public education on what's out there and what power that they have themselves.
And then the payers and the providers, and you mentioned all the new therapies. I think every day you wake up to a new therapy in some specialty, whether it be a lifesaving drug or therapy or a rare disease drug or therapy, and it's coming very quickly. What are some of the [00:09:00] challenges and opportunities and stakeholders in patient care?
Because I know you also work and communicate with pharmaceutical manufacturers. Talk about that process.
Christine Mann: We do. And it's exciting to bring a new product, not only to market, but to get it into your center and get it to a patient as soon as possible. As you know, you talked about some of these complexities.
One of the things that we didn't have as much years ago was direct to consumer advertising. So patients come in demanding certain therapies, and we're left to explain that sometimes you can't just hop to a specific new therapy that's come out. There might be something within your benefit structure that you have to try and fail something else before you can get on that therapy.
Right? That's just one of the nuances when it comes to new therapies. You have to get it on a payer formulary. We have to understand how to provide that therapy within our center. So we require clinical training.There's got to be policies and protocols set up and put into place, you have to understand who's carrying that.
Sometimes [00:10:00] a manufacturer works with only one distributor. It's called single source distribution that makes it a little harder. Also, if you're adding therapies and these therapies are not inexpensive, you have to make sure you got the right credit line with the right distributor. So all of those things go into all of those thoughts go into making sure that.
We understand the product. We can get the product. We have the patient population. We have the payers that are going to reimburse us forgiving that product. Put that all together. Sometimes that takes a little bit of time. As you know, Kip, I like to be one of the first in the country to deliver new therapies and we pride ourselves on some of the really exciting therapies we've brought here to Western New York, but we certainly share that information with greater good of Neuronet.
We were just talking yesterday on a call. About a new product that was recently launched. So it's not always Simple, but it certainly is worthwhile, especially when a patient benefits from some new latest greatest therapy
Kip Theno: [00:11:00] Yeah, and I know you do and you're plugged into that You know, in another installment a bunch of questions came in about: “What if there is this evidence based medicine new therapy, but it doesn't yet have a code how do we handle that because, the patient then is waiting for something that might be better than what they have now or might literally change their course of care?”
How do you guys handle that over there?
Christine Mann: Right.Sometimes drugs get launched. I've seen a few new drugs recently get launched and have what they call a J code or a code that depicts to the payer what medication their member has gotten when they're in an infusion center or a practice. But oftentimes it's six months before a code is given, a permanent code is what we call it, for that medication.
Payers have made it really difficult to bill without a J code as well now. It's an, it's an unclassified code that we use. We have to do a lot more on the claim form to indicate what that therapy was. I mean, we could have a [00:12:00] couple of drugs going right now at the same time here at DENT with an unclassified code.
So there's a lot more description that needs to be done on the claim form with the prior authorization, all of the steps that we talked about.It really is more difficult. And so sometimes patients don't get that therapy because payers have made it so difficult to use an unclassified code.
Unfortunately, we can't get that medication to people quick enough.
It used to be a lot simpler and we were always in the forefront of making it happen. But even for us here at DENT, it has become more difficult to navigate that unclassified code. But if we believe a patient really needs to get on that therapy as soon as possible, we will move heaven and earth to make that happen here.
Kip Theno: It certainly needs to be done and being in the prior authorization space, there's no uniformity between payers even with the same drug. And as an example, you can have 10 payers, three of them might ask you some questions but they approve it 99-100% of the [00:13:00] time. And then the other seven will deny it 99% of the time just out of the gate because that's the algorithm. And that gets frustrating.
What are some of the tools, data, analytics, arrows in your quiver that you guys use to help partner with payers and communicate with them and try to create more of uniform standards across the board?
Christine Mann: I don't know that we can be as effective in creating uniform standards, Kip. I would like to think so, but we do try to have that dialogue with the payers.
The other thing to remember is there's a lot of unique challenges now within the payer groups, because employer groups carve out certain benefit plans, right? Then you've got PBMs in the middle helping to shape and carve out what policies and what medications should be delivered within different plans.
So I often tell my staff, we could have two people standing in front of you with blue cross blue shield cards, but the benefit structures are very different within each of those plans. Different than we've had to navigate before, and it definitely makes it a [00:14:00] lot more challenging. You try to pick up the phone and have a conversation to find out exactly what your patient's benefit is, and if this drug is covered.
And it's really difficult sometimes to get to the right person at that payer to get that information to get the patient treated. So those are definitely some nuances that we've been seeing and trying to work through to navigate around. And sometimes it's really successful and other times it isn't
Kip Theno: right.
And obviously we can't do it alone. We probably say this a million times. There's no silver bullet. There's a lot of lead bullets, right?You need a lot of folks like you out there preaching the gospel and pushing the needle. I read a, a study, by the healthcare financial management association,Christine, that said that three fourths of healthcare executives said that they will invest in revenue cycle, automation technologies, AI, machine learning tech partners throughout the next year or two.
And yet only one out of 10 said that they'd actually made any of those investments. So love to get your lens on [00:15:00]that of technology partners, technology today. How is that helping you guys enable and empower better patient care? And what are some suggestions you have for the audience?
Christine Mann: Well, as you know, Kip, we started partnering with SamaCare about four years ago and it was an extremely exciting initiative and I couldn't tell you what a difference it made here.
It was one of the first big technologies that we adopted hereat DENT. And it was really in the infusion clinic to start.
It has been a huge, addition to helping us streamline that workflow and making it so much more efficient. Being able to get the right form to fil lout electronically right away has been really, a great experience gets the patient in the chair a lot quicker. But when you talk about making sure you know all these different policies, knowing what prior auth form to fill out for different parts of a Blue Cross Blue Shield plan that could span across the country I think you guys have been a great partner [00:16:00]and helping us make sure that we're filling out the right form and now we're not having to fax it in it's automatically going and we can, if somebody who's doing a prior auth happens to be on vacation, anybody can log into the system.We didn't have some of those features before and it was much more of a manual arduous task. Streamlining that process has helped patients get in the chair a lot quicker. We're just embarking on incorporating WeInfuse into our workflow specifically for infusion to start. We're adopting WeInfuse into the infusion center here at DENT, because we want to make sure that we're not scheduling somebody who's prior auth may have expired and we're making sure we have the right inventory in place. There's a whole bunch of great new technology within that software that we're implementing to help us get patients on medication quicker, doing it much more efficiently internally.
It's hard to find really good folks to come in and [00:17:00] show up for work every day. So we want to make sure their job, I don't want to say is as easy as possible, but certainly as streamlined as possible.
Kip Theno: And Christine, you, you do your diligence probably more than anybody. And I want to ask that question. How do you find technology partners, how do they get on your radar, and what is your vetting process?
Christine Mann: We try some things out. We like to say we're a pilot school here at DENT. We're a pilot center. We'll try things out and we're very supportive. Our administrative team is very supported by the physician owners here at DENT. And so they do allow us some latitude and autonomy to try things out.
Sometimes it works really well and sometimes it doesn't, but you have to give it a try and you have to be able to accept things and maybe not everybody is technically oriented as we'd like them to be, but certainly we want everybody to be open minded about trying new things to see what can work and what doesn't.
So we brought in a lot of [00:18:00]different things, things that we've adapted and that have stayed and other things that maybe they weren't as great as we thought they were originally.When you say, how does it get to you, we find these companies and sometimes they find us.
Kip Theno: Yeah.Yeah. Definitely. It's got to be a two way street there.
Kip Theno: I want to switch gears to a topic I'm very excited to hear about because you've also heard me say, legislation it works at a glacial pace, right?
And unfortunately a glacial pace isn't really good enough for patient care intent aside But you were just in dc advocating to improve patient access talk about that, like what's that experience like, the legislation experience, your conversations, where are the policymakers getting it right, where could they improve, and then what can we do together to needle them a little bit.
Christine Mann: So this was my second trip to the Hill. And it's really, it's incredible. It's amazing. There's so much going on in the nation's Capitol and they're responsible for so many things. So it helped me understand that it [00:19:00] takes a lot of us to help move some of these policies or to help people understand some of these policies.
So you've got people in the Senate and the Congress voting on certain bills. Sometimes they don't really know the downstream effect. And so when we have the opportunity to sit with their staff and explain some of maybe the unintended consequences or things, how their constituents or how patients are affected by some of the healthcare bills that are swirling and waiting for approval and waiting for vote.
It's great to have people who represent , like myself, represent from the practice. I see patients on a day to day basis. I see patients in our clinic. I see the patients that come in for infusion and I live and breathe it every day. So to bring those experiences to people who are making decisions on these policies has been really incredible.
And we had a great run last week, we had my group specifically had eight meetings throughout the day. We walked over 13, 000 steps. We [00:20:00] were pretty busy. But it's really an experience to be able to tell that side of the story because sometimes they don't understand what they're voting on, or they don't understand the implications that it might have to people that live in their districts , or all of us collectively.
Kip Theno: Well kudos for tracking your steps, you know, remote patient monitoring. It's pretty cool technology these days. Do they does it seem when you're there that they're listening that the lawmakers get it or do you see that there's a disconnect.What's your feeling?
Christine Mann:Sometimes there is a disconnect.
So when we talked about infusion therapy, there were people that thought that was reserved for cancer centers and chemotherapy. And we dial it back and say, you know, you have people that have multiple sclerosis, you have people that might have rheumatoid arthritis, ulcerative colitis, Crohn's disease.
We're treating, we're giving those medications in our offices too, to those patients and they could be in their 20s, 30s, 40s, you know, it's not just cancer patients. It goes [00:21:00] so far beyond that. And these are professional people that are going to work and taking care of families like you and I Kip or we now have Alzheimer's drugs that we're offering to our senior population.
So it encompasses a lot of different people. And I don't know that sometimes that's understood when you talk about infusion therapy. So we did a lot of educating around that, a lot of educating about certain bills ,and how we might be affected more importantly, how patients are affected, right? You don't want to be, you have to stop therapy for anybody, but specifically somebody young that has a family to take care of. They're trying to keep their job. So we'd like to have evening hours. We'd like to have Saturday hours, but we also need to make sure that we're getting paid adequately to do that. So those conversations were real and very well received.
I thought. The people that we met with were educated in what we were discussing, they were engaged. They took a lot of notes. So I hope it makes a difference. I really do.
Kip Theno: Well, thank you [00:22:00] for doing that. It takes a village. You've got the manufacturers, you've got the payers, you've got organizations like SamaCare.
You've got thought leaders like yourself. How do you get other people engaged and involved in that? I'm, not sure everybody knows how to do it and you've been up to the hill twice. What advice can you give to some of our listeners?
Christine Mann: I think anybody could have the opportunity to go I am fortunate enough to sit on the board of the National Infusion Center Association (NICA), and as a board, we're invited. NICA puts this day on for us. They work with an organization called Heart Health Strategies in Washington that arranges all of these meetings. And I think through trade associations and groups like that, people get in front of the right people and are able to deliver the right messages. So that's how this particular Hill Day got put together.
But I'm sure there's other ways that people could get together and do some advocacy for patients. There's a lot of great, like the Alzheimer's association, the MS association.
Kip Theno: We've got a newswire that goes out [00:23:00] every month. We're doing these podcasts, anything else you can suggest to us, to the listeners, I know they'd appreciate it.
And you know, you haven't stopped there. Christine said, we talked about technology. We talked about technology partners, legislation, and thinking about bettering patient care. Tell us a little bit about CareNet. What is that?
Christine Mann: SoCare Net is a brand new organization that we put together to follow the model of Neuronet.
Neuronet has been so successful in getting neurology practices across the country together, not only for some buying power, but for sharing such intellect and information to better patient care. Move to CareNet is really looking at the behavioral health sector. We here at DENT, we have a behavioral health clinic.
We have 15 providers in that clinic and we're still booking out months. There's a lot of patients in our communities across the country that need help in the behavioral health sector. We're working with Janssen on an [00:24:00] amazing product called Spravato. It's nota new product, but it's a new product for behavioral health and psychiatrists to actually be able to deliver in their office.
So we've spent the last couple of years trying to help educate other practices on how to bring this medication to their practice and to their patients. One of the things that Janssen had said to us back a few months ago was only 2% of the patient population with severe depression are able to access this medication.
Oh, wow. What a better way to try to do more educating and advocating for this patient population, then to start something like CareNet.CareNet is clinical access, reaching everyone in a network of people that are understanding and learning how to be able to prescribe the medication and give the medication within their practices Kip.
We're just about to launch. We're ready to go on all fronts. We are partnering with [00:25:00] Cencora on this, and we're really excited to be able to help bring our knowledge to the collective community and psychiatry and help people understand how to get their patients in and get them on therapy.
This is just the first of, I'm sure, many, but to get that healthcare sector ready is really exciting, and we're hoping that's whatCareNet comes together to do
Kip Theno: Wow. Well, my potato math, you know, 2% leaves 98% on the table. So anything SamaCare can do to partner with you on that, you know, we're all in Christine. Part of the genesis of SamaCare was almost 5 out of 10 patients don't get on the right therapy at the right time because of the process.
Christine Mann: I certainly appreciate it. And I'm counting on it.
Kip Theno: Well, here's the final jeopardy question, the $20,000 question, right? The future of healthcare, where do you see it going? Open forum, Christine, what's the future of healthcare and prior auths.
I wish I had a magic ball to see what it looks like. I do know that there's [00:26:00] a lot of new therapies in the pipeline. A lot of those therapies will get approved and bedelivered within a provider setting, whether it's an injection or an infusion and I'll inhale that product.
However you give that product, it'll be done in the confines of, a prescribing provider. So we need to be ready for that. We need to make sure that we have the capacity to do that and the understanding of how to bring those in. Having said that, we're getting so much better at diagnosing patients earlier.
So quicker start to get on these therapies. The therapies are not inexpensive. So that's where I talked about in the beginning, how we really got to partner with our payers to understand what they're thinking, what their policies might look like and what we could bring to the table so that we can continue to evolve those therapies and bring them to the patients that need them.
But it's exciting. There's a lot of robust things and there's biomarkers that will tell us if somebody's on the right [00:27:00] therapy, if it is working for them, some testing before somebody initiates therapy while they're on it, maybe helping them get off of it at some point. So it's an exciting time to be in medicine, but it's also, like I said, it's very expensive.
It's a 3 trillion part of healthcare, and we all have to be good stewards of that and make sure that we're all partnering and working together because it could be anybody that needs any of these things.
Kip Theno: You know, our tagline for the podcast is together, we can make things right.
And we'd love being on the journey with you, Christine. How can folks out there contact you or Neuronet?
Christine Mann: We're actually launching our brand new website in the next couple of days.
So it's Neuronet.com. DENT Neurologic Institute also has a website that I'm on with an email address and a cell phone number. I'm onLinkedIn as well. Feel free to reach out. I'd love to hear from people.
The more we band together and help one another the stronger we'll be and the more patients [00:28:00] that we'll be able to help
Kip Theno: Thank you Christine for joining The Road to Care podcast.
Christine Mann:Thanks Kip.
Kip Theno: Thank you for joining the Road to Care podcast hosted by SamaCare, the leader in prior authorization technology and services. We're through a script to therapy operating system. We enable connectivity with clinics, payers, and manufacturers focused on optimizing patient care. Tune in next time as together we can make things right.
Enjoy the music written, produced and recorded by Jamestown.
Together, we can make healthcare right. Here are some of the outstanding
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