Payer 101: The respondents you need for your payer market research study

At MedSpan Research, we’re proud of the expertise we’ve gained over the past 17 years in an important but not well understood sector of the healthcare industry: payers. Today, we’ll continue with the Payer 101 series that we started in September by covering the key types of payer respondents to include in your next payer market research study.

To recap, the term ‘payer’ is broadly defined as any entity that reimburses the use of healthcare services or products.  The term commonly refers to health insurance companies (otherwise known as health plans) as a whole, or to a key decision-maker at a health plan, such as a medical director. In the first post in our Payer 101 series, we focused on the former definition. In this second part of our series, we’ll go into more detail about the latter.

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The two most common payer executives included in payer market research are medical directors and pharmacy directors. In this post, we’ll briefly explain the responsibilities of each job title as well as how they relate to market research study objectives. We hope that this will be helpful to you in determining the ideal target for your next payer market research study.

Medical Directors

Health plan medical directors are board-certified physicians. While some spend 100% of their time in the Medical Director role, others are also active care providers. Although their responsibilities can vary widely based on their geography, which lines of business (i.e., commercial, Medicare or Medicaid) they are responsible for, and their seniority level within their organization, there are a few key responsibilities that most share.

The figure below illustrates medical directors’ job responsibilities and how these relate to payer market research objectives.

Screening criteria for health plan medical directors will vary by the type of market research study you’re conducting.

• For studies focused on product evaluation, medical directors should be knowledgeable about coverage of current treatments in that therapeutic area.
• For studies focused on new provider evaluation, the medical director should be a decision-maker in the decision whether or not to include provider in the network, as well as provide input into benefit design.

 Health plan medical directors are not the only payer respondents that could be included in a payer market research study. For example, a market research study that aims to understand payers’ willingness to work with a care provider should also include directors of network development.

 Pharmacy Directors

Health plan pharmacy directors are registered pharmacists (RPh), and many are Doctors of Pharmacy (PharmD). Like medical directors, pharmacy directors’ job responsibilities may vary depending on which lines of business they are responsible for and their seniority in their organization. However, their key job responsibility is determining the drug benefit design for their health plan.

The figure below shows pharmacy directors’ key job responsibilities and how they relate to payer market research objectives:

For studies that focus on product evaluation, pharmacy directors should be familiar with coverage and formulary placement of current treatments in that therapeutic area. They should also be a standing member, or provide input into, the Pharmacy & Therapeutics (P&T) committee.

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As you can see, health plan medical directors and pharmacy directors are key targets for market research that is focused on product evaluation and provider evaluation. Though the information above is not inclusive of all payer research respondents, we believe it is the most important for your understanding of payer market research and what makes it successful.

In the next part of our Payer 101 series, we’ll take a look at typical sample sizes for payer market research studies. Stay tuned!

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