Patient Access Task Force Mtg 9/27/00

[Guest guest]

Hi everyone,

As I had mentioned several weeks ago, what had been a

subcommittee under Tx Administrators has recently been elevated by

the UNOS Board of Directors into a Task Force to look into non-

clinical issues which might impact a pt's access to tx services & I,

along w/Art (chair of TAC) had been asked to serve on the

Task Force. (It was in the subcommittee that the TFC survey was done

& the by-laws change initated). The Task Force met this past

Wednesday in Dallas & this listserv has an opportunity to participate

in one of the early projects of the Task Force.

Multiple members of the Task Force brought up the difficulty

many pt's have in knowing exactly what their coverage is when they

start down the long & winding road towards a tx. Diane Pelman, who

started the tx unit @ Guardian Insurance, outlined for the group the

very thorough benefits description she provides for Guardian members

& their TFC's when they are starting the tx approval process, right

down to an itemization of individual drugs covered under the benefit

plan. It was suggested that, using Guardian as an example &

enlisting the aid of this group, as well as case mgrs/tx coordinators

from some of the larger payers nationwide, to at least investigate

the possibility of developing some standardization of information

exchanged between TFC's & the payers. (Similar to what TAC has been

working on w/many of the larger payers for the past couple of years

to develop a standardized RFP). The flip side of this would be

development of some standardization of the information we provide to

them! (Hey, that's only fair, right?)

So, it would be a great start if everyone ( & I mean EVERYONE!!!)

could take a few minutes & think of the top 10-15 'benefits' related

questions you need answers to when a patient is being evaluated or

listed. (If you've got more than that & want to list them all,

that's great, too-go for it!) If there are issues or concerns you

have problems getting answers to on a regular basis (i.e., organ

acquisiton charges covered, home health services, etc.) please list

those as well. Also, as we all know, it can take some digging to

find the person @ the payer who 'speaks' transplant-tell me what your

usual process is for finding these people, assuming it's a payer

you've never dealt w/before. If you have any horror stories you want

to share, feel free. Finally, if you know of any " exemplary " ins

case mgrs/coordinators who might be willing to help w/such a project,

please include their name, company, & phone#'s. Don't worry-we're

not asking for a major committment on behalf of the individual or

their companies, just some names to use as a starting point. Again,

to be fair, if there are any companies or case mgrs/coordinators who

are, shall we say, less than exemplary, feel free to include those as

well. Maybe we can " guilt " them into seeing the error of their

ways :-)

As always, any questions or confusion re: this, let me know.

Ok, now that everyone has their homework assignment for the

weekend...class dismissed! :-)

Thanks everyone!

J. Aguiar

Beth Israel Deaconess, Boston