Payer 101: One size doesn’t fit all: Sample sizes for payer research

At MedSpan Research, we have over 17 years of payer research experience. In our Payer 101 series, we’re sharing our expertise with you. In our two previous posts in this series, we covered the basics of the U.S. payer landscape as well as the appropriate titles within these organizations to include in payer research projects. In this final post in the series, we’ll discuss how to determine the appropriate number of payers to include in your research study.

Continue Reading November 5, 2015 at 6:03 PM Leave a comment

High-Deductible Health Plans

At MedSpan Research, one of our key areas of focus is payer issues. Throughout my daily work, I hear about various trends within the healthcare industry. One trend that I continually come across, and have encountered personally, is the increase in the prevalence of high-deductible health insurance plans, including consumer-driven health plans. So, what is a high-deductible health plan?

Continue Reading November 1, 2015 at 10:48 PM Leave a comment

MedSpan Musings — Tips for better market research

MedSpan MusingWhen conducting market research with the hospital pharmacy department, ensure that the right section is informing your actions.

While some hospital pharmacies limit their scope of practice to their individual hospital, others are responsible for the purchasing and management of drug therapies throughout the integrated delivery system.

  • Pharmacy directors — Sets policy for operations, contracting, inventory management, and intra-delivery system distribution. The pharmacy director typical is a voting member of the P&T Committee, thereby influencing product selection.The pharmacy director tends to be the most knowledgeable among his or her staff regarding billing, coding and reimbursement for drug therapy. However, in our experience, the level of expertise in these areas varies between hospital pharmacy directors.

    Integrated delivery systems may have one pharmacy director for inpatient care and another for outpatient care. They report to a Vice President of Pharmacy. Standalone hospitals tend to have one pharmacy director.

  • Clinical pharmacists — Are often stationed throughout the hospital. Share drug insights with other clinicians. Develop drug monographs for the P&T Committee. Each clinical pharmacist specializes in one or more disease categories (e.g., cardiovascular disease) or hospital patient care unit (e.g., emergency medicine).
  • IV operations managers — Oversees compounding processes and clean rooms. IV operations managers are important respondents for studies involving IV therapies.
  • Pharmacy buyers — Work directly with wholesalers and drug companies to execute the delivery system’s day-to-day buying practices.

October 26, 2015 at 3:44 PM Leave a comment

MedSpan Musings — Tips for better payer market research

2015 08 25 rodin the thinker for MedSpan MusingsMedSpan Musings — Tips for better payer market research  

The benefit covering a drug is not always obvious
When discussing benefit coverage of drugs with payers, remember that some health plans at first cover drugs under the medical benefit and then transfer those costs each month to the pharmacy benefit. Be sure to probe for this approach and its implications for drugs administered in physicians’ offices and alternate sites of care.

October 12, 2015 at 5:51 PM Leave a comment

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.

Continue Reading October 12, 2015 at 4:02 PM 1 comment

Hospital Purchasing:  Value Analysis Committees

Since its inception nearly twenty years ago, MedSpan Research has developed extensive experience with the purchasing process at US hospitals.   Although purchasing processes vary by hospital, there are some common themes across the majority of hospitals regarding their purchasing.

In the past, getting physician support could be enough to get your product purchased.  However, with an increased focus on cost savings including reduced product costs in general as well as products that help reduce length of stay and reduced readmission rates, other members of the hospital have an increased responsibility in purchasing decisions.  As a result, various perspectives should be considered when selling a product to a hospital.

At many large hospitals, once there is interest in a new product, it is required to go through a value analysis committee (VAC) for review.  The exact composition of the VAC varies, but typically includes:

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During the VAC review, a variety of product attributes are examined, including:

  • Product cost: upfront cost and the total cost of ownership (such as cost of maintenance, disposables, etc.)
  • Potential for cost savings: reduction of procedure cost, reduced length of admission, reduced readmission rates, reduced infection rates
  • Quality: ability to achieve desired outcomes, improvement in outcomes compared to other products

The VAC then makes a decision whether to purchase, trial, or reject a product.

Each member of the VAC may place a different level of importance on each attribute and bring a different perception to the table.   Therefore, it is important for a manufacturer of a hospital-based product to take into account how their product can appeal to each of the VAC members.  Manufacturers could consider reviewing their sales strategy and potentially adjust it to target the various members of the VAC in order to better position their product for acceptance in the hospital.

October 5, 2015 at 5:39 PM 1 comment

Gene therapy — The price is right?

The introduction of the first gene therapy presents challenges for payers. These costly therapies will require new approaches in terms of pricing benchmarks and reimbursement methodologies.

Continue Reading October 2, 2015 at 4:32 PM 1 comment

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