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Highly organized and profit-oriented professional, I have over twenty years broad-based experience across different disciplines of healthcare economics, reimbursement, product/service line development, payers, health policy, government affairs, research, management, and sales in the industry augmented by undergraduate, graduate and advanced degrees encompassing healthcare strategy, policy, management and economics.An analytical thinker, I combine hands-on practical approach with the newest and most sophisticated clinical and economic rationale, demonstrating the ability to successfully position current and new technologies for positive coverage, the right coding, and justified payment levels while maximizing profitability in a rapidly changing, regulated, managed competitive environment. My forté has been to evaluate evolving health policy issues while proactively positioning clinical and economic safeguards for provider service lines and manufacturer products while ensuring coverage by all payers - US and OUS. Solutions are based on advanced managed economic applications, tempered with regulatory and market realities.Specialties: Healthcare EconomicsHealth Policy & StrategyMarket AccessReimbursement, Strategies and ImplementationGovernment AffairsMedical DeviceDiagnosticsImagingAdvocacy & Coalition DevelopmentRegulatory Review & Policy DevelopmentCorporate AccountsHealthcare ManagementHealthcare ConsultingRevenue CycleBusiness DevelopmentManaged Care ContractingM&A
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Principal ConsultantNov 2023 - PresentProvide executive level consulting for start-ups and mid-stage medical device, diagnostics, imaging, companion diagnostics and biotech companies for US and international markets. Emphasis is on providing key strategies supporting market access, reimbursement, coding and valuation, pricing, product/service line development, contracting, health policy and economics, and government affairs activities. This also includes assisting with regulatory filings specific to Breakthrough Device designation, submitting applications for new technology add on payment (NTAP) and transitional pass-through (TPT), and managing commercial launches for devices awarded NTPA and TPT status. Strategies are aligned with an organization’s Research & Development, Clinical, Marketing, and Sales objectives for purposes of effective market product placement. Portfolio of clients include companies in Gastroenterology, Cardiology, Surgery, Imaging, Ear/Nose/Throat, and Oncology, including respective AI applications.
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Vice President, Market Access & ReimbursementVertos Medical Feb 2020 - Nov 2023Aliso Viejo, Ca, Us -
Vice President, Healthcare Economics, Policy & ReimbursementEndogastric Solutions Dec 2014 - Feb 2020Redmond, Wa, UsPricing strategy, reimbursement accomplishments that also include successfully gaining higher reimbursement levels by CMS (e.g., 93% increase for hospital outpatient payment), numerous coverage and market access accomplishments with national and regional payers (over 130M covered lives gained, including 100% Medicare MAC coverage), provider and payer economic modeling, new technology lifecycle management (pre/post-market). Health policy influencing, including CMS (national/MACs), medical societies and advocacy groups. Procedure coding and coding application expertise with AMA CPT categories I and III. Acquisition due diligence proficiencies: coding, coverage, payment per type of modality, delivery setting(s) and market acceptance. -
Vice President, Healthcare Economics & ReimbursementGiven Imaging (Medtronic) Apr 2013 - Apr 2014Minneapolis, Mn, UsSteward leadership of all healthcare economics, health policy and reimbursement strategies specific to all products and their franchise for all regions, globally. Focus was heavily driven by joint strategic planning and goal-setting with each franchise, facilitated by overseeing proactive implementation of required clinical and economic endpoints for purposes of market access opportunities, both in the US and OUS. Other responsibilities included new product development review, Phase 0 to IV, for optimum market launch opportunities with various country-specific payers and providers; acquiring from the AMA a Category III HCPCS code for measurement purposes, healthcare economic modeling development, including cost opportunity assessments for various delivery settings/countries; provider C-suite support bound by all regulatory compliance parameters; and M&A business plan due diligence. Leadership position was eliminated due to acquisition of company. -
Sr. Director, Healthcare Economics & ReimbursementSiemens Healthcare Fz Llc Apr 2012 - Apr 2013Baltimore, Maryland , UsProvided leadership on Siemens’ business issues related to movements by public and private payer environments, health policy developments at federal and state levels, and international guidance where market access approaches are required. This involved independently reviewing and developing healthcare economic and reimbursement strategies associated with current and proposed legislative, regulatory and private sector market changes. Product responsibilities covered imaging and laboratory diagnostic businesses ($4.7B/€3,6B revenues). -
Sr. Manager (Below Partner)Kurt Salmon, Part Of Accenture Strategy Aug 2010 - Mar 2012New York, Ny, UsResponsible for initiating a Healthcare Economics practice for firm. This practice assisted hospitals in addressing health reform requirements, specifically cost-effectiveness strategies. Also responsible for providing strategic guidance for providers in the areas of service line planning and management; physician alignment; M&A; and governance and organizational structuring. -
Sr. Director, Healthcare EconomicsAbbott Apr 2004 - May 2010Abbott Park, Illinois, UsResponsible for providing support to internal and external customers with respect to healthcare economics, coverage and reimbursement, prevalence/operational modeling, and public and private policy impact analyses associated with products as aligned with customer margins. Additionally, assisted with annual five year strategic planning per product division; M&A due diligence; new technology development reviews; product/provider financial modeling; international reimbursement and healthcare economics support, including justifying products for cost-effectiveness and/or budget neutral impacts for country states; and pre/post-marketing clinical/economic data development that supported providers' interest in capitalizing on value-based purchasing arrangements. -
Sr. Manager, Reimbursement And Government AffairsBayer Diagnostics May 1998 - Apr 2004Responsible for safeguarding the global diagnostic business while concentrating efforts on better product placement and coding/coverage/payment strategies of respective Bayer portfolio primarily with CMS, state Medicaid programs, private payer groups and the American College of Pathology. Secured from AMA a Category I CPT code from AMA. Successful in gaining coverage for the code by papers by implementing and managing multi-site studies to help with such efforts. AdvaMed liaison for Bayer, including Hill and state house affairs work through out US. Earlier role including Corporate Accounts responsibilities.
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Director, Disease Management And New Product InnovationHca Feb 1997 - Nov 1997Nashville, Tn, UsResponsible for projects specific to clinical improvements: lower costs and enhanced economic and clinical outcomes by means of care algorithms, managed care applications and educational initiatives. Active collaboration involved HCA medical advisory boards, pharmaceutical and diagnostic organizations. External Consultant: pharmaceutical and diagnostic delivery engineering for R&D products. Internal Consultant: Diabetic Task Force; Data Warehouse; Competitive Reconnaissance. Project unrelated to position: market analysis for Planning department centered on development of an acquisition process for leasing or purchasing Academic Medical Centers. Position and half of corporate were eliminated due to Department of Justice's action on HCA for improper upcoding.
Philip Macdonald Skills
Philip Macdonald Education Details
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University Of La VerneHealthcare Management & Economics -
The University Of MemphisHealth Services Administration
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The University Of MemphisHistory; Political Science
Frequently Asked Questions about Philip Macdonald
What is Philip Macdonald's role at the current company?
Philip Macdonald's current role is Market Access, Reimbursement, Health Policy & Economics.
What is Philip Macdonald's email address?
Philip Macdonald's email address is pm****@****ons.com
What is Philip Macdonald's direct phone number?
Philip Macdonald's direct phone number is +142530*****
What schools did Philip Macdonald attend?
Philip Macdonald attended University Of La Verne, The University Of Memphis, The University Of Memphis.
What skills is Philip Macdonald known for?
Philip Macdonald has skills like Medical Devices, Managed Care, Health Economics, Hospitals, Market Access, Market Development, Strategy, Healthcare, Capital Equipment, Cardiology, Cross Functional Team Leadership, Strategic Planning.
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