ACR Insurance Subcommittee Chair Encourages Member Engagement

The ACR advocates for rheumatology on many levels, and Rebecca Shepherd, MD, MBA, FACR, FACP, new chair of the Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC), has a special interest in the advocacy between ACR member practices and both private and government payers.

Dr. Shepherd

“We are practicing in an exciting time, when new medications and treatment options for complex diseases are now available to rheumatologists and their patients, but this is only possible if a patient’s insurance company approves access to these important treatments,” Dr. Shepherd notes. “For better or for worse, healthcare in the U.S. depends on a third-party payer system; however, this system is not necessarily designed for patients and providers, and that’s where the ISC comes in.”

As an interface between rheumatology practices and insurance companies, the ISC plays an important role in following changes in insurance policies and advocating for rheumatology practice perspectives—and often, it’s practices that bring insurance concerns to light. For example, practices routinely contact the ISC when a payer tries to force stable patients to switch treatments or require practices to obtain medications through a specialty pharmacy. The ISC continues to work closely with ACR staff and other organizations to share such concerns, which has led to successful changes with this issue and many other payer policies.

“We are here to support the relationship between payers and practices and make it work for our members, to help them provide the best care available for their patients,” Dr. Shepherd says.

Driven to Advance Patient Care

Dr. Shepherd brings a perspective to rheumatology care and practice advocacy that is both global and local. Born in Scotland, she moved to Texas and grew up shuttling back and forth between Scotland and Texas before attending medical school at Vanderbilt University School of Medicine in Nashville, Tenn. Here, she chose rheumatology as a third-year medical student after seeing a young patient in emergency care for multi-system organ disease that had not been diagnosed. “This young man was very ill, and it was amazing to see how the rheumatology team swooped in, diagnosed lupus and quickly helped him regain health,” she explains. “Seeing this inspired me to pursue my own rheumatology practice.”

After completing her internal medicine residency and rheumatology fellowship at Washington University in St. Louis, she landed her first job in rheumatology care at Lancaster General Health, Pa., where she has built her career. Currently she is chief of rheumatology and director of the hospital’s Osteoporosis Service Line.

Dr. Shepherd came to the ISC chair position through several previous ACR volunteer roles with CORC and the Government Affairs Committee. Her close proximity to Washington, D.C., helped her participate in on-site ACR government affairs work, including insurance advocacy efforts.

Connecting Practices with Needed Insurance Support

Many ACR members are unaware of the support they can seek from the ISC to solve insurance practice challenges. Dr. Shepherd aims to change this, while also continuing successful ongoing ISC advocacy efforts.  In coordination with ISC members and ACR staff, she has laid out four goals for the year ahead:

Improve ACR member access to ISC support and resources. “We want to make sure we are accessible to our membership,” she stresses. Through the ACR’s upcoming website redesign, the ISC will be contributing ideas to provide members easier access to insurance support and related resources.

Continue work with Medicare Administrative Contractors (MACs). These efforts have been ongoing for several years, and the ISC will continue to advocate for recognition of the complexity of the medications administered by rheumatologists. “We aim to assist the contractors in understanding how powerful our drugs can be and how carefully we prepare and monitor them,” Dr. Shepherd shares.

Advocate for provider perspectives with insurance companies and PBMs. The ACR has taken an active role in speaking out against practices such as restricted formularies and white bagging, and the ISC will lend support to ensure this advocacy continues.

Work to streamline prior authorizations. The ISC will advocate for streamlined approaches to prior authorization to reduce delayed patient access to care, Dr. Shepherd says. “Too often, the process to get prior authorization approval is extremely cumbersome and doesn’t serve its intended purpose to patients or providers.”

When not giving her time to her rheumatology patients and ACR volunteer work, Dr. Shepherd balances her time between her husband, two teenagers and her 10-acre farm. Married to a musculoskeletal radiologist, she says family dinner conversation often centers around work talk, which she admits drives her teens crazy. When she and her family can leave the farm, they enjoy world travel and are planning their next trip to Iceland.

Dr. Shepherd encourages members to connect with the ISC directly for help with practice insurance issues by sending an email to [email protected].

Carina Stanton is a freelance science journalist based in Denver.