Starting With Market Access

Offering Market Access, Messaging, and Engagement Services

Reimbursement IQ designs, implements, and oversees next-generation Market Access, Market Messaging, and Market Engagement strategies for U.S. healthcare’s volume-to-value (V2V) transition.

We start with Market Access and promote value-based/outcomes-based coverage, coding, payment, contracting, and compensation for healthcare breakthroughs and best practices that contribute to a better functioning society.

Count on us to…

• identify high-cost, high-impact diseases—and other adverse health conditions—that have a disproportionate effect on the well-being, productive capacity, and socioeconomic status of individuals, organizations, and communities;

• research and summarize value-assessment frameworks relevant to products, services, and solutions that target these conditions;

• document points of leverage in reducing the incidence, prevalence, and cost of disease including social determinants of health (SDoHs); disease progression, comorbidities, and complications; the patient journey; and stakeholder incentives;

• research breakthroughs and best practices in condition prevention, diagnosis, treatment, management, mitigation, or palliation;

• evaluate products, product portfolios, and product pipelines to ensure they’re superior to current standards of care—and that they enable 360-degree performance accountability, outcomes accountability, and impact accountability;

• compile health economics, outcomes research, and comparative-effectiveness research (HEOR/CER) studies to build the evidence base for coverage, coding, reimbursement, real-world data (RWD) and real-world evidence (RWE) sharing, value-based contracting (VBC), and outcomes-based compensation (OBC); 

• source, collect, and analyze real-world data (RWD) to build real-world evidence (RWE) of differentially favorable economic, clinical, and humanistic outcomes (ECHOs);

• conduct specialized industry, market, and competitive assessments—including value-focused SWOT (strengths, weaknesses, opportunities, threats), Ansoff Matrix (old/new product vs. old/new market), and Porter’s Five Forces analyses (rivals, buyers, suppliers, substitutes, and new entrants) —to identify healthcare financing implications and imperatives;

• weigh-in on HEOR/CER considerations for clinical trial design (e.g., in double-blind, randomized controlled trials [RCTs]) to build the case (pre-launch) for value-based/outcomes-based coverage, coding, reimbursement, real-world data/evidence (RWD/RWE) collaborations, contracting, and risk-bearing compensation;

• design legislative, regulatory, and payer advocacy programs to secure appropriate coverage, coding, reimbursement, contracting, and risk-bearing compensation policies (e.g., based on product contributions toward the Triple/Quadruple/Quintuple Aim of reduced per capita costs, improved population health, and enhanced patient/provider experiences, and boosted health equity);

• implement code-acquisition, coverage precedent-setting, and payment-optimization campaigns (e.g., presenting the case for coding, coverage, reimbursement, real-world data/evidence [RWD/RWE] collaborations, value-based contracts [VBC], and outcomes-based compensation [OBC]);

• develop value-communicating content that facilitates health plan purchaser, third-party payer, and capitated provider payment (e.g., illustrative prior-authorization checklists, statements of medical necessity [SMNs], step therapy guidelines, prior authorization [PA] and predetermination [PD] scripts, appeal letters, and more);

• design and manage patient and provider support programs, including health plan navigation helplines, Plain Language and health literacy helplines, community care referral helplines (e.g., 211 and FindHelp), patient registries, patient assistance programs [PAPs], real-world data/evidence [RWD/RWE] collection programs, and other hands-on longitudinal services);

• educate executives, professionals, and clinical teams on next-generation medical affairs, HEOR/Value, market access, commercialization, and alliance development topics (e.g., two-hour executive briefings on “Impact Analytics” that focus on the extreme visibility data science is bringing to the U.S. healthcare market; and

• provide just-in-time training on other value-focused topics that are critical to success in an era of performance-, outcomes-, and impact-accountability.