Developing Effective Payment and Reimbursement Models

*Funding for this project was made possible in part by 1R13HS026821-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Participant Bios:

Erin Trish, PhD, (Moderator) is associate director of the USC Schaeffer Center and an assistant professor of pharmaceutical and health economics at the USC School of Pharmacy. In addition, she is a nonresident fellow in Economic Studies at the Brookings Institution and a scholar with the USC-Brookings Schaeffer Initiative for Health Policy.

Her research focuses on the intersection of public policy and health care markets, with recent projects focused on surprise medical bills, prescription drug spending, health care market concentration, and health care reform. Her research has been funded by grants from the Robert Wood Johnson Foundation and the Laura and John Arnold Foundation and published in leading health policy, health economics, and medical journals. She has testified in the California State Assembly and presented her research at numerous federal agencies, including the Congressional Budget Office, Federal Trade Commission, Office of the Assistant Secretary for Planning and Evaluation, and the Center for Consumer Information and Insurance Oversight. In 2018 she received the Seema Sonnad Emerging Leader in Managed Care Research Award.

Trish completed a postdoctoral fellowship at the USC Schaeffer Center and the Fielding School of Public Health at the University of California, Los Angeles. She received her PhD in Health Policy and Economics from the Johns Hopkins Bloomberg School of Public Health and her BS in Biomedical Engineering from Johns Hopkins University.

Kathryn A. Phillips, PhD, is Professor of Health Economics and Health Services Research, Department of Clinical Pharmacy, University of California San Francisco. She founded and leads the UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), which focuses on developing objective evidence on how to implement precision/personalized medicine into health care so that it is effective, efficient, and equitable. Kathryn has published over 150 peer-reviewed articles in major journals including JAMA, New England Journal of Medicine, Science, and Health Affairs. She has had continuous funding from NIH as a Principal Investigator for over 25 years and was recently awarded a 5-year, $6M NIH grant to examine payer coverage and economic value for emerging genomic technologies (cell-free DNA tests and tests based on polygenic risk scores). Kathryn serves on the editorial boards for Health Affairs, Value in Health, JAMA Internal Medicine, Genetics in Medicine; is a member of the National Academy of Medicine Roundtable on Genomics and Precision Health; and has served on the governing Board of Directors for GenomeCanada and as an advisor to the FDA, CDC, and the President’s Council of Advisors on Science and Technology. She has also served as an advisor to many diagnostics, sequencing, and pharmaceutical companies. Kathryn is Chair of the Global Economics and Evaluation of Clinical Sequencing Working Group, and a member of an evidence review committee for the Institute for Clinical and Economic Review (ICER).

Michael Sherman, MD, is Executive vice president and chief medical officer for Point32Health, a leading not-for-profit health plan insuring 1.2 million members in Massachusetts, New Hampshire, Maine, and Connecticut. Widely recognized as a pioneer in the development of outcomes-based payment agreements, Dr. Sherman is credited with cementing Harvard Pilgrim’s position as a leader among insurers in crafting agreements with pharmaceutical companies that tie payments for a drug to its performance. In 2018, he received Xconomy’s “Contrarian Award” for his contributions, which include having signed the nation’s first such payment model for a gene therapy, helping pave the way for the development of innovative financing models.

Dr. Sherman serves as chair of the Board of Managers of the Harvard Pilgrim Health Care Institute, which encompasses the Department of Population Medicine at Harvard Medical School and on the Advisory Board of the Institute for Clinical and Economic Review (ICER). He also sits on the board of directors for the Personalized Medicine Coalition.

Prior to joining Harvard Pilgrim, Dr. Sherman held leadership roles at Humana, UnitedHealth Group, and Thomson Medstat (now IBM Truven). He holds a B.A. and an M.S. in biomedical anthropology from the University of Pennsylvania and received his M.D. from Yale and M.B.A. from the Harvard Business School.