Edward Black spent 13 years consulting with medical technology companies around the world advising them on reimbursement, market access and health economics in the highly complex U.S. market. Mr. Black offers a strong understanding of payer perspectives in health policy and excels in translating government and private payer policies into successful reimbursement planning. He founded his own consulting company in 2008 (Reimbursement Strategies, LLC) which was acquired by NAMSA in 2018.
Prior to medtech consulting, Mr. Black worked for over 25 years in medical management and hospital and physician relations within the Blue Cross Blue Shield system and served on two national advisory boards responsible for driving consistency in medical, benefit, and payment policy across the Blue Cross system. During this time, he served as the executive director of three managed care business partnerships with large multispecialty clinics for which he was awarded the 1995 Outstanding Contribution to the Healthcare Industry citation by the Medical Alley Association.
Mr. Black has an MBA and has been involved in several global medical technology initiatives. He has been a frequent international lecturer in Canada, Ireland, the UK, Denmark, Norway, Sweden, Germany, Australia, Japan and China. Mr. Black is an adjunct faculty member in the University of Minnesota Master of Science in Medical Device Innovation Program and Reimbursement Advisor to the University of Minnesota Office for Technology Commercialization and the National University of Ireland-Galway BioExel and BioInnovate medical technology accelerators.
Special Skills and Experience:
- Reimbursement Landscape Assessment: A research-based report that identifies possible reimbursement barriers to the successful introduction of a new device. It includes a review of current coding, coverage and payment circumstances affecting the technology. An assessment will always precede development of a strategy.
- Reimbursement Strategy: Development of a specific strategy of goals and objectives with a budget targeted toward reimbursement barriers that would otherwise limit broad market adoption of emerging medical technology including the use of clinical and health economics evidence to secure coverage.
- Stakeholder Analysis: An examination of who benefits or is disadvantaged (clinically or economically) by the introduction of a new technology. This helps in development of a Reimbursement Strategy.
- Reimbursement Due Diligence: An assessment designed for early and late-stage potential investors to assess market risk prior to investment.
- Coding Analysis and New Code Applications: HCPCS (Healthcare Common Procedure Code System) and CPT (Current Procedure Terminology)
- Medical Policy Research: Secondary research to determine current coverage status for similar technologies among Medicare and commercial insurance companies.
- Payment Analysis: An examination of the methodology and payment amounts, if any, for a new technology based on the anticipated setting of service.
- Note: The same service is paid differently whether it is performed as a hospital inpatient, outpatient, ambulatory surgery center or office-based procedure. Government and commercial insurance payments also vary.
- Preparation of Materials for Payers to Support Adoption: Reimbursement Guides, FAQs, Draft Appeal Letters.
- Coverage During IDE Clinical Studies: Preparation of application and other materials to secure coverage from the federal Medicare program for either a Category A (Experimental) or Category B (Investigative) medical device during the course of a study.
- Health Economic Analyses:
- Cost Effectiveness Analyses (used to evaluate the relative cost of new technologies or treatments – important to payers when new treatments are more expensive, but also more effective)
- Cost Minimization Analysis (used when new treatment is less expensive and at least as effective)
- Budget Impact Models (a comprehensive study of third party payer payments, technology costs and savings that will result from the adoption of the proposed technology)