Reimbursement experts who spoke to Market Pathways agree that medtech firms tend to be on less sure footing when it comes to dealing with Medicaid compared to other payors. “Truly, I hear it all the time,” says Kip Piper, an independent consultant who used to run Wisconsin’s Medicaid office.
On one hand, it’s understandable, Piper says, considering that “Medicaid is the most complicated social program ever created,” he says.
On the other hand, the U.S. healthcare payment system is, by nature, diverse, and there is no reason why Medicaid is necessarily more challenging than the varied array of other commercial and public payors. It’s just different, experts say, and it is natural for each type of payor to have its own needs and priorities.
Short of a single-payor system, “there will always be a disparate playing field,” says Kuo Tong, a managing director at Guidehouse. “From Medicaid, from a managed care plan, from a Kaiser HMO to Medicare fee-for-service and Medicare MAC contractors, they’re all different,” Tong says, “but they all have their own behaviors, and what people need to do is just analyze those behaviors and historical fact patterns to figure out what the message is.”