Reimbursement Landscape Assessments
Discovering payer market opportunities, obstacles, and the outcomes variables necessary to develop a value story for payers and other stakeholders.
Discovering Your Product’s Unique Value
Regulatory clearance or approval is not enough to ensure market access. Stakeholders including payers and regulators frequently require companies to demonstrate the distinctive value that new therapies including drugs, medical devices, diagnostics, biologics, and combination products deliver. In order to obtain appropriate reimbursement by payers and gain the support of professional societies and providers, our Value Discovery Landscape Assessment® work will identify payer market opportunities, obstacles, and help identify the elements necessary to develop a value story for payers and other stakeholders. Not conducting a Reimbursement Landscape Assessment for new medical technologies may delay access to payer markets – a specific billing code for a Product may be not available for several months after market launch which can result in provider concern about coverage and payment. Globally, individual countries may decide not to pay for the new medical technology because their specific requirements for coverage and payment are not met.
Our Value Discovery Landscape Assessment® work will identify payer market opportunities, obstacles, and help identify the elements necessary to develop a value story for payers and other stakeholders.
Our Value Discovery Process
Creating Value Based Reimbursement Strategies
Payers around the world are consolidating and the larger payers are demanding demonstration of value – for – money and proof of positive, real-world outcomes to justify reimbursement. The GIRS Value Discovery Landscape Assessment® Team includes a Technical Expert Panel (TEP) of current insurer medical directors and technology assessment experts. We work with payers and other decision makers, reimbursement specialists and clinical outcomes staff early in the stage of Product Development to develop value – based reimbursement strategies that meet the key stakeholder needs for coverage and payment of new medical technologies.
We assist our clients to partner with many stakeholders by communicating continuously in all phases of development and commercialization of pharmaceuticals, medical devices, diagnostics, biologics, and combination products.
Benefits/Deliverables of Reimbursement Landscape Assessments
- Effective integrated reimbursement strategies to overcome obstacles and optimize opportunities for market access in key payer markets;
- Payer desired study design, RCTs, real world outcomes, and Value Dossier for downstream Payer Advocacy work;
- Innovative payer payment, risk agreements, and other payer contracting strategies;
- Medicare Part D/ formulary strategies
- Medicare, Medicaid, commercial payers, Workers’ Compensation reimbursement criteria;
- Utilization controls and medical policies information;
- Payer feedback on pricing points;
- Development of value story.
- HCPCS/CPT, Revenue codes, ICD-10 Coding and Billing information;
- Future coverage and clinical and cost outcomes trends; and
- Coordination of reimbursement strategies with marketing, sales, regulatory, and clinical outcomes strategies.
Communicating continuously with key stakeholders in all phases of Product Development and Commercialization helps create a Value Team for our Clients.
Testimonials
“I worked with GIRS because they were the only firm that answered the phone immediately and gave me an original proposal that showed that they had knowledge of the DME reimbursement field. The Reimbursement Landscape Assessment for our physical therapy device helped us understand the key reason for the lack of reimbursement for our codes-our regulatory strategies. This helped us to plan future Company strategies to support the device.”
CEO, Medical Device Company
Corporate Office
Memphis, TN
(P) 901-834-9119
Maryland Office
6701 Democracy Blvd., Suite 300
Bethesda, Maryland, 20817
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