3 Questions with Dr. Nierman of Tufts Health Plan

Posted by The Evidence Blog on February 27, 2017

doc interview_1200.jpgThis week, we were fortunate enough to have a conversation with Dr. Nierman of Tufts Health Plan, located in Watertown, MA. The Tufts Health Plan is a nonprofit organization, founded in 1979, that is nationally recognized for its commitment to providing innovative, high-quality healthcare coverage. The plan offers members and employers an array of health management programs, which support evidence-based approaches to health and wellness. Dr. Nierman has served as the Medical Director for Medical Policy for more than 18 years, and took the time to speak with us regarding why the plan made the decision to subscribe to Hayes for our unbiased evidence evaluations to better serve their health plan members.

When looking at Hayes, what was the challenge at Tufts that you were trying to solve?

scientific method_1200.jpgThe Tufts Health Plan has always prided itself as being an organization that looked to improve their processes in order to better serve their customers. It became clear to us that to do that, we needed to ground our coverage policies in evidence that was free of bias and performed with scientific rigor. Hayes demonstrated that they had a vision as to what health plans need. The breadth and depth of their reports, along with their product offerings, was obvious from the outset. They continued to evolve and adapt with changes in the healthcare marketplace, and despite significant competition in the marketplace, we made the decision to stick with Hayes. I refer to the Hayes Medical Technology Directory as our “primary source of truth” when it comes to health technology assessments. Even our expert MD consultants from major Boston academic centers are always impressed by the reports they review.

“I refer to the Hayes Medical Technology Directory as our ‘primary source of truth’ when it comes to health technology assessments.”

Download a sample report from the Medical Technology Directory.

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How do you incorporate Hayes into your internal processes?

genetic test evaluation_1200.jpgWe use the unbiased evidence evaluations from Hayes in the majority of our coverage policy determinations. The Hayes Rating is a terrific starting point in our health technology appraisal process, due to your rigid exclusion criteria when assessing what is quality research regarding the technology. The addition of the Genetic Test Evaluation (GTE) program has been crucial to our processes. We could not begin to tackle the expanse of available genetic tests without your program assessing them in such a timely and thorough fashion. Anything with a “D” rating is added to our non-covered investigational list, which in turn saves our members from participating in unnecessary testing. Scientists look at the science; the fact that Hayes is composed of scientists who do just that gives us the utmost confidence in using your evidence evaluations. It allows us to provide a service to our members by reducing excessive spending, effectively passing the savings on to them by keeping premium increases controlled.

“Scientists look at the science; the fact that Hayes is composed of scientists who do just that gives us the utmost confidence in using your evidence evaluations.”

Who uses Hayes within your system?

internal practices_1200.jpgHayes is deeply embedded into many of the departments within our organization, including:

  • Medical policy
  • Medical affairs
  • Utilization management
  • Claims
  • Reimbursement and appeals

It’s my opinion that we do as much or more utilization management as any health plan in the country. The quality of that program wouldn’t be possible without a subscription to Hayes services. Not only are your evidence assessments thorough and in-depth, but the customer service, support options, and communication are superb. It has been a true pleasure to work with Hayes and I’m confident we will continue to do so for a long time to come.

We’re appreciative of Dr. Nierman’s gracious feedback. Click below for a sample report to experience the breadth and depth of a Hayes report. Then schedule a demo to see how you can put Hayes to work for you.

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Topics: Health Technologies, Payers, Hayes Blog, Health Technology Assessments,

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