PAYOR COVERAGE &
REIMBURSEMENT MANAGEMENT
We add the value of economics to the science of life.
The introduction of any new technology should proactively anticipate and define private health plan coverage and reimbursement parameters (see Economic Value Analysis). The success of a product’s market adoption can be severely hindered if this segment of the market is not managed effectively.
However, competing priorities and limited reimbursement resources within many new or existing technology companies make it difficult for these reimbursement parameters to be addressed in a timely basis. You can rely on the experienced professionals at Presscott Associates to uniquely assist Life Sciences companies in these instances in many distinct ways:
- Develop financial models to project the revenue associated with a new product or service based on the payor mix and anticipated delivery settings (see Revenue Chain Management)
- Define the benefits and challenges associated with securing positive coverage decisions and adequate payment levels from private health plans
- Benchmark private health plan coverage and reimbursement levels for similar technologies
- Recommend improvements in either the supporting data or coding mechanisms to facilitate positive coverage decisions, reimbursement levels and efficient Revenue Chain Management
- Assist Life Sciences companies in conducting post-market clinical and economic studies that may be required to facilitate market adoption and private health plan acceptance
- Develop a focused strategy for approaching private health plans in an effort to secure optimal private health plan coverage and reimbursement
- Profile key private health plan marketplaces in order to identify a manageable number of “priority plans”
- Assist Life Sciences companies in understanding the revenue cycles of hospitals and physicians to facilitate appropriate revenue capture for these important stakeholders
- Assist organizations with initiating, maintaining and improving relationships with key stakeholders (see Strategic Relationship Management) including:
Private Health Plans
The long-standing relationships Presscott Associates has developed with many of the private health plans offers Life Sciences companies the unique opportunity to access senior executives on a timely basis, creating opportunities for discussions regarding coverage and payment for new technologies.
“A New Paradigm: Development of Partnerships with Private Health Plans”
Hospitals/Institutional Providers
Presscott Associates’ comprehensive understanding of hospital financial operations can better position you to meet their needs, and gain a competitive edge for current and future initiatives that require hospital buy-in.
And, when in need of institutional partners for clinical studies or post-market initiatives, you can count on Presscott Associates to leverage its many senior-level relationships developed at prominent academic and community institutions.
“A Successful Case Study: Reengineering the Revenue Cycle to Improve Outpatient Operations”
Physicians
Improve physician receptivity to your product utilizing Presscott Associates’ thorough understanding of their income streams, office operations and status with private health plans.
Patients
If your strategy includes a “self-pay” option or a change in member benefit structures, you can rely on Presscott Associates to help gauge the anticipated demand for your product at the patient level utilizing a variety of research methodologies.
If you’re looking to develop an effective value proposition for your technology to optimize private health plan responsiveness and leverage your strategic relationships, call Presscott Associates today!
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