In Part 1 of this two-part series, we learned about what managed care analytics means for pharma brand success and the factors that pharma companies need to keep in mind while planning their managed care strategy. In this part, we will explore how pharma account managers can leverage managed care analytics, in their constant endeavor of optimized contract performance, better formulary positions, and improved patient access and health outcomes.
Operating in the managed care system in the US healthcare market is challenging due to the complex environment. It is incredibly volatile and fragmented, with stakeholders ranging across various categories:
- Healthcare delivery systems like Integrated Delivery Networks (IDNs) and Preferred Provider Organizations (PPOs).
- Care systems like the Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs), and Health Maintenance Organizations (HMOs).
- Governmental Point of Service (PoS) systems like Medicare and Medicaid.
As part of Axtria’s exciting presentation lineup, David Wood, Senior Principal, and Shubham Lahoti, Associate Director, will be presenting on the topic of “Measuring Direct and Indirect Influence of Account Managers”.
Numerous publications, blogs, etc. have reported how quickly the pharmaceutical industry is changing and how manufacturers need to modify their approaches and structures to survive the competition. The pace of change necessitates that Pharma companies undergo a transformation; with organizations expanding the capabilities of their commercial models through smarter experimentation, scalable measurement, faster learning, and dynamic decision making regarding their commercial models.
Prescribing decisions in the institutional setting differ considerably from the retail setting. As noted in the figure below, HCPs are influenced by several parties, both internal and external. While the health of the patient and safety of medications continue to be of paramount importance, over the past several years, financial considerations have increased attention on quality of care. No longer is a hospital’s survival dependent on the “hotel model” (where higher occupancy equals greater profitability), rather insurance companies, in an effort to control costs, are incentivizing institutions (IDNs) to keep patients healthy, reduce the length and frequency of hospitals visits, etc. Further, as new information systems and technologies are implemented (many driven by requirements outlined in the Affordable Care Act) the ability of key payers to manage costs and processes will improve. This will continue to drive the behaviors of healthcare professionals and their employers.