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Our Strategic Reimbursement/Economic Marketing Solutions include:
New Product In-Licensing Analysis – A new drug or device that your company is considering for in-licensing may have clear clinical merits. But, do you understand the current reimbursement “space” in which the technology will be marketed? We take steps to help you gain a perspective on the challenges and opportunities that would affect ongoing product development and ultimate commercialization.
Clinical Trial Design and Assessment – Published clinical trials drive payer decision making for coverage, coding, and payment. We help design clinical trials with endpoints that will answer payers’ clinical and economic questions.
Reimbursement Market Analysis – The reimbursement environment continues to change across payer types and treatment settings. Our analyses are specific to your market, your products, and your technologies. Therefore, we can develop a starting benchmark by which to measure change in the market. Periodic additional analyses lend perspective on new challenges and opportunities related to product positioning and patient access.
Stakeholder Marketing Research – Our company has associations with numerous stakeholders in healthcare, including payers, providers, employers, and national organizations (e.g., Bridges to Excellence, National Quality Forum, American Medical Association). These relationships help us maintain a comprehensive understanding of the nuances of care for those stakeholders. We obtain perspectives, provide a tailored view of how stakeholders may affect an intended strategy, and provide actionable recommendations on our findings.
Corporate Reimbursement Training Programs – To keep your company on the cutting edge of the healthcare marketplace, internal education on the changing reimbursement environment is important. We develop training programs for all levels within your company, from field sales staff to executives. The training sessions build core competencies and demonstrate the importance of appropriate reimbursement for market success.
Drug and Procedure Coding Applications – The reimbursement process for new pharmaceuticals and technologies entering the market involves three components: coverage, coding, and payment. As one of the components, coding requires a clear plan of action regarding whether a HCPCS, ICD-9, or CPT code is required. Each coding application comes with distinctly different requirements and timelines. We successfully execute the application steps to significantly streamline provider reimbursement for drugs, biologics, devices, and services.
Payer Announcements and New Drug Applications – Upon FDA approval, an effective launch strategy can include sending clinical and economic information to payers to aid in the development of coverage decisions. We maintain a current database of target payers for mailing, including Medicare, Medicaid, and key commercial payer organizations.
Select payers may require a formal new drug application process before any coverage decision can be implemented. We have experience submitting the necessary information and working with payers to expedite the drug review process.
Competitive Reimbursement Assessment – Understanding your product’s environment is vital to successful marketing. Competition for your product could come in the form of drugs or devices in a similar category, alternative drugs or devices, surgeries, or no intervention.
Customer Reimbursement Resource Design – Our company has demonstrated expertise in creating content and designing format for a variety of resource materials including billing and reimbursement guides, train-the-trainer educational programs, or customized programs such as:
- Inpatient documentation resource
- CAC Representative educational overview
- Patient access insurance verification analysis
- Commercial payer collaboration action plan to establish consistent coverage policies
Continuing Education Program Design and Implementation – DK Pierce & Associates has developed program content and facilitated a variety of continuing education programs for oncology, nephrology, and other specialties. Our programs partner clinical case study profiles with reimbursement education and have been implemented via interactive web conferences or online study programs. We have received positive feedback on our programs from office practices and hospital staff across the U.S.
Payer and Provider Notifications – Using our database of targeted payer and provider contacts, DK Pierce designs and implements communication with payers when line extensions, new product indications, or coding changes prompt the need to educate payers and providers. We integrate a variety of notification instruments such as fax blasts, distribution emails, teleconferences, and web conferences to increase payer and provider awareness of news and updates.
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. |
