PRIA Healthcare: Making Emerging Medical Innovations Accessible to Patients

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PRIA Healthcare

Stephanie Dumont, Senior VP of Operations and Clay Schwabe, VP of Business Development, PRIA HealthcareStephanie Dumont, Senior VP of Operations and Clay Schwabe, VP of Business Development
The adoption of innovative medical devices has skyrocketed due to recent technological advancements in the healthcare marketplace. With this meteoric growth, new challenges have emerged in the form of complex payment barriers and unpredictable payer coverage determinations, substantiating the disconnect between a technology's medical necessity for a patient and the clinical value to the payer. In today's payer-focused healthcare environment, device manufacturers must develop a well-designed reimbursement strategy early, integrate the needs of key stakeholders, and focus on the value of the technology to both the payer and the patient.

The past decade has witnessed the "Payer" emerge as the key decision maker for patient healthcare services and, along with this, an increased level of evidence required to establish medical necessity and patient access to emerging technologies. This payer-required evidence is in addition to the rigorous FDA-required clinical data supporting safety and efficacy for commercialization. Without evidence of sustained clinical benefits, many emerging technologies are deemed "experimental/investigational" by the payer, disallowing patients access to new technologies due to the payer's lack of coverage and payment.

Enter PRIA Healthcare, a company that leverages clinical data, real-world utilization, and a centralized communication platform to assist medical device manufacturers in improving patient access to new procedures and technologies. PRIA delivers on this promise by utilizing an integrated approach, combining the expertise of its critical strategic teams of experts across a wide array of reimbursement-related functional roles.

Transforming the Commercialization of Innovative Medical Devices

PRIA's experienced team of reimbursement and market access experts collaborate with medical device manufacturers to remove adoption barriers by assisting them in navigating the complex reimbursement process. PRIA's expertise has supported various clients, from pre-funded medical technology start-ups to large enterprise partners. PRIAs unique, dedicated case-by-case client engagement approach magnifies the patient's clinical needs, guaranteeing that insurers recognize the importance of medical innovations to improve the lives of their patients.

"Our experienced strategic reimbursement team, which includes veteran consultants and industry experts, assists companies to identify and develop the critical components of a well-defined reimbursement strategy including coverage, coding, and payment initiatives," states Stephanie Dumont, Senior VP of Operations with PRIA.

Alleviating Reimbursement Challenges in the Domain

"Historically, PRIA has offered individual one-off solutions to address the unique needs of our clients. With the recent addition of several new Patient Access program services and the expansion of our strategic service offerings we are now able to provide a 360° comprehensive solution for our clients," said Kelli Hallas, PRIA Vice President.

Since its initial founding in 2012, PRIA's service offerings have grown in response to increasing client demands. Although they remain focused on patient access, the increasing use of its proprietary network has allowed for the collection of real-world, real-time utilization data to support new client initiatives to satisfy requirements for establishing new CPT® and ICD-10-CM codes. In addition, this data can be leveraged to support a patient-based appeal process demonstrating clinical demand and procedure approvals, ultimately establishing positive coverage.
Recently the company expanded its services to provide payment support to facilities, including hospitals and ambulatory surgery centers, on behalf of its clients. They continue to evolve and evaluate client needs and respond in real-time with new programs to support those needs.

  • One of the best things about PRIA in terms of patient access is our dedicated strategic team, which has personnel with specific expertise across all facets of a medical device manufacturer


PRIA's unmatched core competencies have ignited numerous successful client collaborations since its inception, specifically securing coverage and payment for emerging technologies represented by Category III CPT® codes.

Historically these codes garner "disapproval" from insurance companies, as they are deemed "experimental and investigational" due to perceived minimal levels of clinical evidence. PRIA has implemented several successful programs that have secured at least 75 percent positive coverage approval for Category III device codes, resulting in provider payment and increased device adoption.

A Distinctive Approach

PRIA's in-depth expertise and proven success in providing patients with quick and assured access to medical innovations has helped numerous companies build a stable and robust business foundation. Following a tenet that highlights the needs of the four critical healthcare pillars: Patients, Payers, Physicians, and Device Manufacturers, PRIA is on a trajectory for continued service expansion to ensure that more patients have access to life-changing technologies.

CPT is a Registered Trademark of American Medical Association 2021. All Rights Reserved.

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