Greater Bremen Area
Holistic expert in Market Access / Provider Reimbursement / Health Economics / Technology Assessment in Europe (mainly Germany / Austria / Switzerland): 25 years of strategic guidance & tactical execution at local, regional, national & supranational level in implantable Medical Devices for Hospitals & and Office-based Physicians. Achievements: - 1 coverage with clinical evidence development (CED) study by federal joint committee (GBA) in Germany. - 487 entitlements (NUB) for applying hospitals to negotiate NUB supplementary fees with health insurance companies for inpatient procedures in Germany. - 152 additional procedure codes (OPS) for inpatient procedures in Germany. - 6 additional diagnosis codes (ICD) for inpatient procedures in Germany. - 1 additional diagnosis-related group fees (DRG) for inpatient procedures in Germany. - 17 additional supplementary fees (ZE) for inpatient procedures in Germany. - 12 additional procedure codes (EBM) for outpatient procedures in Germany. - 12 additional procedure codes (AOP) for outpatient surgical procedures in Germany. Product Sales / Customer & Referral Acquisition / Technical Consultancy: 6 years of successful operations in Medical Devices (Implantables) for Hospitals & Office-based Physicians in- & outpatiently in Germany.
Boutique Consultancy for Market Access / Provider Reimbursement / Health Economics / Cost-Effective Product Pricing / Health Technology Assessment / Outcomes Research on Medical Devices in Germany / Austria / Switzerland
• KEY ACHIEVEMENT Successful evidence dossier-based application to the German Federal Joint Committee (GBA) for temporary coverage while generating randomised clinical evidence funded by health insurance companies (coverage with clinical evidence development; CED) – capitalised value of €1.75m –. The CED study is currently prepared by an independent scientific research institute on behalf of the GBA and should start to enrol patients by mid of 2026. • Leading the development of innovation funding (NUB) requests through German hospitals to Institute for calculation of inpatient hospital reimbursement (InEK). • Leading the development of reimbursement dossier incl. Budget-Impact-Analysis (BIA) on ultrasound-guided endoscopic injection implantation of ³²P-labelled microparticles combined with systemic chemotherapy in treatment of primarily unresectable locally advanced pancreatic tumours and submission to Belgian HTA agency NIHDI. • Exploring the French CED "forfait innovation" scheme in collaboration with KOLs and relevant medical societies for submission to HTA agency HAS. • Leading the preparation of interventional procedure guidance application to English HTA agency NICE. • Exploring the HTA & CEA-based public health insurance market access scheme conducted by Dutch ZIN Agency with particular consideration of the CED "potentially promising care" scheme as well as the diagnosis-related groups (DRG) based hospital reimbursement in the Netherlands. • Supporting the development of a reimbursement dossier to be submitted to the Greek Ministry of Health (MoH) through a local distributor. • Supporting the development of a reimbursement dossier incl. BIA to be submitted to the Israelian MoH through a local distributor.
• KEY ACHIEVEMENT The revenue decline was stopped – capitalised value €12.5m – by guiding treating physicians and medical controllers of customer hospitals to select suitable patients and document the treatment decision properly in proactive action to avoid retrospective funding denials by Statutory Health Insurances (SHI) based on expert opinions by medical review boards (MDK) in reimbursement roadshows in close collaboration with the sales colleagues to prevent hospital administrations to order the stop of Transarterial Radioembolisation (TARE) at all and secure justifiable treatment utilisations and corresponding revenue. • Consulting customer hospital solicitors in payment claims against SHIs at local, regional and national social courts in retrospective funding denial cases of TARE treatments. • Developing a Profit-/Loss-Calculator from German Hospital Perspective on TARE versus Transarterial Chemoembolisation (TACE) in Hepatocellular Carcinoma (HCC) Barcelona Clinic Liver Cancer (BCLC) Stage B/C. • Development of therapy / product related grouping simulations & revenue calculations as well as economical pathways based on analysis of diagnois (ICD) & procedure (OPS) coding catalogue as well as case (DRG) & supplementary (ZE) fee-based tariff. • Representing the company in access / reimbursement working groups of German medical device trade association (BVMed).
• KEY ACHIEVEMENT Developing and maintaining Individual Funding Requests (IFR) for applications to health insurance companies for coverage of biological tissue reinforcements for both the lower pole of implant-based breast reconstructions and hernia repairs for individual patients by hospital physicians – capitalised value €2m –. • Development of Budget-Impact Analysis (BIA) utilising claims data from German Public Health Insurance Perspective on implant-based breast reconstruction utilising a biological tissue for lower pole reinforcement versus various other methods of breast reconstruction after mastectomy. • Development of BIA utilising claims data from German public health insurance perspective of abdominal wall reconstruction utilising a biological tissue versus other reinforcement methods of abdominal wall reconstruction. • Training the sales, marketing, clinical and medical colleagues on requirements of Health Technology Assessment based incremental clinical / medical patient-relevant benefit assessments and Provider Reimbursement based hospital funding system and the corresponding consequences for commercialisation and product pricing. • Representing the company in access / reimbursement working groups of German medical device trade association (BVMed).
• Neuromodulation (Spinal Cord Stimulation [SCS], Intrathecal Baclofen [ITB], Deep Brain Stimulation [DBS]). • Chronic Pain, Movement Disorder (Morbus Parkinson, Dystonia, essential Tremor). • Product Sales / Customer & Referral Acquisition / Technical Consultancy. • Hospitals & Office-based Physicians in- & out-patiently. • The well-developed reimbursement situation for providers attracted several competitors, which required the strengthening of the technical consultancy, user and referral acquisition as well as the product sales positions (Reimbursement services were provided as well occasionally). This led to an organisational restructuring and resulted in the termination of the Senior Reimbursement Specialist role ultimately.
• KEY ACHIEVEMENT Successful transformation of the former per-diem hospital funding into the case and supplementary fee based hospital funding introduced 2003 in Germany for neuromodulation interventions, which generated the foundation for prosperous commercialisation in Germany – capitalised value €30m –. KEY ACHIEVEMENT Accessing outpatient neuromodulation procedures in hospitals (AOP) to overcome budget restrictions imposed on inpatient services by developing tools for convincing hospital administrators - capitalized value €6m -. - 6 new diagnosis codes (ICD) for neuromodulation interventions - 151 new procedure codes (OPS) for neuromodulation interventions - 30 new case (DRG) and supplementary (ZE) fees including innovation funding (NUB) for inpatient services - 24 new reimbursement codes in Uniform Value Scale (EBM) for outpatient services. • Time-driven, activity-based, bottom-up, micro-costing collection and calculation of neuromodulation interventions to inform customer hospitals for appropriate DRG & ZE & NUB fee negotiations with the statutory health insurances during the annual budget negotiations. • Co-Development of Cost-Effectiveness-Model from German Public Health Insurance Perspective on Intrathecal Baclofen Therapy (ITB) versus Best Medical Treatment (BMT) excluding ITB in Patients with severe generalised Spasticity. • Co-Development of Budget-Impact-Model from German Public Health Insurance Perspective on Deep Brain Stimulation (DBS) versus BMT excluding DBS in Patients with advanced Parkinson’s Disease. • Collection of outstanding debts (>€2m) from SHIs resulting from outpatient neuromodulation interventions. • Training the sales, marketing, clinical and medical colleagues on DRG & ZE fee-based hospital reimbursement system and corresponding consequences for commercialisation and product pricing. • Representing the company in access / reimbursement working groups of the German medical device trade association (BVMed).
• Neuromodulation (Spinal Cord Stimulation [SCS], Intrathecal Baclofen [ITB], Deep Brain Stimulation [DBS]). • Chronic Pain, Movement Disorder (Morbus Parkinson, Dystonia, essential Tremor). • Product Sales / Customer & Referral Acquisition / Technical Consultancy. • Hospitals & Office-based Physicians in- & out-patiently. • Annual Revenue Responsibility: €2m.