Dr. Jim Cross, president of Jim Cross MD Consulting and previous vice president and national medical director of national medical policy and operations for Aetna shares examples of why he enjoys working with Baker Tilly and why he would recommend our healthcare consulting team.
During the video testimonial, Dr. Jim Cross answers the following questions:
Read the full interview below.
My name is Dr. Jim Cross, and I’m the president of Jim Cross MD Consulting. My experience includes practicing medicine for 10 years, and for the last 30 years I have been in the insurance industry as a senior clinician. I was also vice president and national medical director of national medical policy and operations for Aetna. In that role, I was responsible for reimbursements and clinical policy nationally. After I left Aetna, I started my consulting firm where I began working with Baker Tilly Healthcare and their clients.
Companies trying to get coverage from insurance companies for their technology really do need outside help and expertise while working their way through the maze of insurance coverage. I think an outside consulting firm that has the industry experience such as Baker Tilly is critical for a company to know how to relate to a health plan and to get the results they want.
In my experience of working with companies that are trying to obtain positive coverage decisions from payers, it is unusual for them to have the internal expertise, know how the process works and understand what it takes to get a positive coverage decision. This is why I think it is universally important for a company to reach out to a third party company like Baker Tilly. A company who has the expertise and thoroughly understands the process of how positive coverage decisions are obtainable from a health plan. It takes a tremendous amount of data and information. It is also crucial to understand that the kind of information a health plan organization is looking for is not always what the investors are looking for and to rely on Baker Tilly to provide that information. They are one of the most outstanding companies to perform this kind of research.
I think the unique thing about Baker Tilly is their wide experience in various clinical settings and their clinical specialties in coverage decisions. Their internal staff is diverse and has a wide range of healthcare experience. Baker Tilly really does understand the process; they know the importance of clinical data. They know how other data helps with coverage decisions like economic information, meta-analysis, reaching out to societies and working with the provider community to make sure the health plan knows there is a demand for providers to provide quality care for their patients.
Everyone is focused on the cost of healthcare in America and the challenge of healthcare costs rising each year. Therefore, it is very important especially from a health plan perspective that organizations be able to manage costs. When looking at a new technology and coverage decisions, it is critical to weigh-in on the importance of the clinical improvement of that technology with its impact on medical costs. With that, an important piece of the equation that should be presented to a health plan is the economic impact. Clinical information, data, published literature and what is happening clinically with the technology will always be the number one importance to health plans, but the economic information is significant. If the economic information is not positive or reasonable then it will be harder to convince the health plan that this is something they should consider for coverage.
I have really enjoyed working with Baker Tilly and their clients. Baker Tilly helps their clients be on a path to receiving positive coverage decisions from health plans. It is unusual for a company to be able to do this on their own, and Baker Tilly makes it more understandable and easier for the client to get the end result which is positive coverage.
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