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.
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Effective roster management has long been an overlooked topic in Pharma commercial operations. In fact, in our 2016 Commercial Excellence Survey, we found that 46% of Pharma organizations still don’t have integrated processes to manage their sales rep to territory mappings. At any point in time, it is critical for the Sales Operations business processes to have access to the latest and distinct set of sales personnel that will need to be accounted for.
Sales crediting and eligibility are two of the most common challenges that organizations face in managing their Incentive Compensation programs. Traditionally, these processes have relied on accurate alignment and roster data to determine the right individual to get sales credit, the absence of which causes incentive compensation & other downstream systems to wonder ‘what happened’ well after ‘it happened’.
People Placement constitutes the activities related to assignment of sales reps, following any major sales force territory alignment or change in the size and structure of sales force. Placing the best available rep into each territory is critical to the success of any sales force realignment effort.
Incentive Compensation (IC) today continues to be a critical function in sales operations, and is one of the key levers for driving field force effectiveness. An effective organization should be able to leverage incentive compensation as a strategic tool to drive performance and, as a result, increased revenues. With proliferation of data sources, technologies, selling models and cost pressures, priorities are changing rapidly. IC team leaders today need to be aware of best practices that drive high impact and keep sales organization aligned with corporate sales goals.
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.
