Talk about famous last words. When we last left this topic, I was wrapping up coffee with my colleague, Rick, with the ominous, “Once we get your data organized …”
After I posted my hypothesis that Managed Markets analytics and operational teams were simultaneously more over-whelmed and under-resourced (Blog Series), I had a number of good exchanges with my colleagues, both digitally and IRL.
Launching a new product in today’s Pharmaceuticals marketplace can be very challenging. The dynamics of the market are shifting at an unprecedented pace, with an ever-increasing number of factors influencing the prescribing behavior of Healthcare Professionals. This is evident in the expansion and control of integrated health systems, the conversion of FFS Medicaid to Managed Medicaid, impacts of Healthcare Reform (including Accountable Care Organizations and Healthcare Exchanges), etc. Further, the need to control healthcare costs is having a direct impact on Pharma, where physical access for sales reps is being limited, quality-based initiatives are being driven, and branded products are being restricted.
While my colleague posts that bio-pharmaceutical sales operations staff are working too hard, I think managed markets operations and analytics staff members are simultaneously more over-whelmed and under-resourced. For too long, too many bio-pharmaceutical firms have under-invested in analytics and operational infrastructure to support their managed markets organizations.
An Accountable Care Organization (ACO) is a group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. The goal of the ACO is to deliver coordinated and efficient care. ACOs that achieve quality and cost targets (determined by Medicare) will receive a financial bonus based on selected “Risk Sharing Model”, and under some approaches, those that fail will be subject to a financial penalty.
Integrated Healthcare Groups can be segmented (targeted) based on several criteria/factors such as size, # of hospitals, # of admissions, # of employed HCPs (hospital and community-based), etc. When analyzing IHGs it is also important to assess their true level of integration. Several large IHGs (i.e. Carolinas HS and Novant) have grown rapidly through acquisition however they do not have common systems in place across their network, therefore the level of “integration” is somewhat weak. Conversely IHGs with more established systems (i.e. Kaiser, Geisinger, etc.) have infrastructures in place that position them to drive a high level of control and track, measure and reward performance.
Many factors influence deal performance and it benefits a Pharma manufacturer to thoroughly gather and analyze as much data as possible in order to make the most informed decision. Pre-deal analytics are certainly a critical step in the process, however a comprehensive evaluation of all drivers that influence performance is required to truly evaluate a deal. Developing tools that assist in looking back at previous deals provides an organization with a clearer understanding of a payer, the effectiveness of their internal resources and positions leadership to pursue new opportunities with greater confidence