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Our Payer and Stakeholder Services Include:
Payer Advisory Boards and Stakeholder Summits – What are payers thinking about your product, or the overall treatment of your product’s target disease? Are they planning to apply utilization management techniques such as prior authorization, increased patient cost share, or even non-coverage parameters? What about the role of employers, especially self-insured employers who make their own health benefit decisions? Are the various stakeholder positions in alignment or do they conflict? Our services can link clients with the right mix of influential decision makers to help guide development of clinical trials, market messages and product positioning within payers. Whether via interactive web conferences, or live meetings, we develop the right forum to get clients the needed input.
Provider Advocacy Programs – There is no question that the best outcomes with payers can be achieved from “peer-to-peer” discussions. However, clinical thought leaders in a given disease area or medical specialty aren’t always prepared to deliver information to payers regarding the acceptance of a technology. Physicians may be more comfortable focusing on patient care, rather than discussing payer policy development. We work with individual physicians to help them understand what is important to share with payers and how to request an outcome, whether it is initial coverage, expanded coverage, or clarification of patient access.
Provider Education Programs – How will reimbursement trends at commercial payers affect the oncology environment? What steps can providers take to work positively with payers to demonstrate quality care? What changes in Medicare will affect how hospital outpatient billing staff must document utilization of drugs and biologics? These are just a few of the questions that can be answered through provider education programs developed by our company. Using a variety of forums, including teleconferences, web conferences, interactive CDs, interactive web-based programs or live meetings, we tailor the program to clients’ needs and budgets.
Proactive Payer Coverage and Coding Positioning – Is your company preparing for a new drug launch, or the expansion of current FDA indications? Have new codes been issued to describe your technology or service? Is your technology more expensive than the standard of care? These types of circumstances may require direct intervention with payers to ensure appropriate coverage and coding clarification. Our expertise in working directly with Medicare, Medicaid and commercial payers across the U.S. qualifies us to provide services to meet your needs, precluding the need to hire additional field-based personnel. Based on our access to a variety of payers, we can quickly request the change and monitor the payer’s actions to affect change.
Payer Policy Resolution – Inconsistent coverage issues can mean problems for providers, and create negative perspectives about a client’s product. With our team’s access to Medicare medical policy management, Medicaid pharmacy and physician drug staff, commercial payer pharmacy, and medical benefit decision makers, we can help identify the problem and implement a tactical plan of action to achieve resolution.
Payer Specific Strategy Development – In the reimbursement world, each payer may implement a different mechanism to manage utilization of drugs, biologics, medical devices and services. Many factors affect how a payer will approach coverage and ongoing utilization oversight, such as:
- The category/class of the drug, biologic, device or service
- Mode of administration or use
- The payer system itself (commercial, government)
- Geographic exposure (national plan vs. local plan)
- Technology price
- Benefit design objectives
- Regulatory mandates
- Employer interface and expectations
Integrating consideration of these and other factors, we develop tailored strategies to effectively position your product, technology or service among different payers. This includes a possible national strategy to identify your objectives and goals with payers in a general sense, as well as local implementation strategies and pull-through tactics to address the nuances of local healthcare delivery. |
