Easing Payer Pressure with Analytics

The 2016 Medical Marketing & Media (MM&M) Healthcare Marketers Trend Report produced two findings that, given the current state of the industry, are not all that surprising, but they are nevertheless intriguing. Payer/Managed Care Pressure was cited as the top challenge to healthcare marketers by the 181 director-level-and-above executives of pharma, biotech, device and diagnostics companies who were surveyed. On the other hand, Big Data topped the list of opportunities perceived by the executives of medium to large companies.

What’s interesting here is that, marrying the top opportunity to the top concern, data analytics – specifically healthcare network analytics – can provide marketers with an avenue to enhance their market access strategies and lighten some of that payer pressure.

Recent headlines have illuminated the challenge, including the widely publicized kerfuffle between pharma companies and managed care over the pricing of hepatitis C drugs and PCSK9 inhibitors, and a survey found that more than two-thirds of health plans use patient outcomes and efficacy data to support the reimbursement of the highest-priced medicines. Payer pressure is likely to continue as the dominant issue for healthcare marketers in this presidential election year, where drug pricing is already a hot political topic and payers are among the key stakeholders weighing in. America’s Health Insurance Plans (AHIP), the national trade association for payers, is seeking greater transparency of drug pricing, more market competition, and such reforms as alternative payment and incentive structures for new drugs, and earlier access to lower-cost specialty drugs and biosimilars.

Advanced analytics can give pharma marketers objective guidance through this complex landscape based on the real world behavior of clinicians. Here at 81qd, our Plexus™ solution uses disease-specific patient encounter data to help marketers build market access strategies. For example, Plexus can optimize targeting of co-pay resources by engaging local influence networks, and help determine what networks or geographies would best respond to a particular co-pay reimbursement strategy. Recently, one of our clients leveraged the platform to better understand the payer landscape across the U.S., which helped guide their market access strategy to launch a product for a rare neurologic condition.

While pricing pressure won’t go away anytime soon, the right analytics approach might be able to ease some of the pressure.