The Importance of Payer Relations: Collaboration, Evidenced-Based Treatment and Reimbursement in your Practice - A Panel Discussion (1 CME)
In the midst of an opioid epidemic and uncertainty with health care coverage, understanding the "how's" and "why's" payers function as they do is increasingly important. This topic is relevant to providers dedicated to evidenced-based treatment, participation in solutions, and improvement in patient outcomes. Panelists from ASAM's Payer Relations Committee will offer thoughts on the best ways to form working relationships with Managed Care Organizations, Health Plans, and Third-Party Payers. The purpose of this discussion is to conceptualize what payers do, to whom they are accountable, and the frameworks within which they must function. The ultimate goal is to provide perspective and emphasize the importance of building bridges, forming alliances, and collaborating with payers. Panelist would like provide participants a glimpse into the payer world which may have been unseen or unfamiliar to them in their practice. By shifting the current "Us vs. Them" to a collective "We" paradigm, panelist hope to lay a foundation for improved relationships that decrease burdens, improve access, and result in better experiences and outcome for patients.
Shawn A. Ryan
MD, MBA, FASAM
Shawn A. Ryan, MD, MBA is an Dual Board Certified Emergency Physician as well as Addiction Specialist. He is currently an assistant professor, Department of Emergency Medicine, University of Cincinnati, and President & CMO of BrightView Health. Dr. Ryan is currently practicing addiction medicine treatment in Cincinnati, is published on this issue, and also serves on many regional, state, and national committees addressing this complicated subject. Dr. Ryan is President of the Ohio Society of Addiction Medicine and the Chair of Payer-Relations for ASAM and he spends a significant amount of time working with large commercial payers and Medicaid administrators on current and future payment strategies.
Frank P. James
MD, JD, FASAM
Frank P. James, MD, JD, FASAM, FACLM
Dr. James earned a Bachelor of Arts in Premedical Studies and Japanese Language from the University of Notre Dame. He earned his Law and Medical Degrees at Southern Illinois University. Dr. James is a member of both the Ohio and Illinois Bar. Dr. James is a Veteran of the United States Army, having completed Residency in General Psychiatry at Walther Reed Army Medical Center. He then completed Fellowships in Child and Adolescent Psychiatry at The Children’s Hospital of Philadelphia and Forensic Psychiatry at the University of Cincinnati School of Medicine. He is Board Certified in General, Child and Adolescent and Forensic Psychiatry as well as Addiction Medicine.
Dr. James spent his clinical years providing inpatient and outpatient psychiatric services in underserved areas in the Ohio Valley. He developed specialty clinics in ADHD, Bipolar Disorder and Schizophrenia, and developed an Opioid Use Disorder (OUD) outpatient clinic focused on the integration of group therapy, psychotropic medication management, and Medication Assisted Treatment (MAT).
Dr. James has over five years of experience in managed care with expertise in OUD clinical program development, provider network expansion, and quality improvement measures. Through participation in peer case discussion, complex case coordination, fraud, waste and abuse investigation, and utilization management, Dr. James provides large behavioral health organizations guidance in drafting evidenced-based benefit guidelines and prior authorizations specific to OUD treatment and MAT. With an emphasis on understanding member needs, collaborating with providers, and improving payer relations his current passion is medical/behavioral integration and alternative payment models.
Dr. James is a member of ASAM’s Finance Committee, Vice Chair of ASAM’s Payer Relations Committee, and Alternate to ASAM’s Board of Directors for Region III.
Anne C. Fernandez
Anne Carroll Fernandez, MD, MS, MBA is the Medical Director for Behavioral Health with Capital District Physicians Health Plan (CDPHP), a regional not for profit, physician run health plan in Upstate New York. She joined CDPHP in December 2012. Prior to joining CDPHP, she practiced psychiatry in the greater Albany Capital District, including over 10 years of direct clinical experience treating patients throughout the rural Leatherstocking Region of New York as an Attending Psychiatrist with Bassett Health Care System in Cooperstown, NY and more recently, as a Staff Psychiatrist with St. Peter’s Addiction Recovery Center in Albany, New York where she worked in a variety of inpatient and outpatient settings.
Dr. Fernandez was awarded her MD from State University of New York at Stony Brook, Stony Brook, NY. She completed her medicine internship at the University of Virginia Hospital in Charlottesville, Virginia and, her Psychiatry Residency at Long Island Jewish Medical Center, in Glen Oaks, NY. She was awarded an M.B.A. in, Health Systems Administration from Union College, an M.S. in Science & Technology Studies from Rensselaer Polytechnic Institute and a B.A. in Biology from Vassar College.
Dr. Fernandez is licensed to practice Medicine in New York and is a Diplomate of the American Board of Psychiatry and Neurology and of the American Board of Addiction Medicine. She is a member of the APA and its Executive Committee for the NYS Capital District Branch. She currently serves on Governor Cuomo’s SUD Treatment and Insurance Workgroup. Dr. Fernandez is a member of ASAM and serves on its Payers Relations Workgroup
Prior to attending Medical School, Dr. Fernandez held increasingly responsible positions in healthcare administration and policy as a Senior Budget Examiner with the NYS Division of Budget, Mental Health and Substance Abuse Unit.