Services

Strategic planning to implementation. Our work covers the entire commercialization spectrum from concept and development  through the clinical trial phase and into product launch and sales.

 

Reimbursement and Coverage Planning and Implementation

Reimbursement is the ideal monetization option for new medical technologies. We start with understanding our client's regulatory, clinical, marketing and sales plans for the technology to help us identify the beachhead payer(s). The beachhead payer(s) can include commercial and public U.S. based payers.  

Our goal is to identify beachhead payer(s) with established reimbursement pathways that meet the company's business objectives.   There are instances when the reimbursement pathways need to be changed.  In those cases, it is necessary for us to pursue new or modify current coding and payer reimbursement amounts and policies.  We assist our clients with preparing and presenting the evidence and coalescing the medical community's support to justify the requested changes to the American Medical Association, the ICD10 Coding and Maintenance Committee and the Medical Directors for Medicare and the Commercial plans.

Monetization and Health Economics Planning and Execution

In the absence of traditional reimbursement, we identify alternative monetization solutions for our client’s medical technologies. Reimbursement, a type of monetization mechanism, is increasingly becoming more challenging because of structural changes to payers’ policies such the use of bundled payment methodologies.  However, these same structural changes are also establishing other monetization pathways to reimbursement. It is our objective to identify those pathways and to demonstrate how they can result in incremental operating revenue for our client's customers.

Market and Clinical Analysis using Payer and Reimbursement Data

Using cost, dispersion, care patterns, and utilization databases from reputable sources, such as Medicare and U.S. commercial payers, we provide our clients with empirical data for their key business decisions and operations. The empirical data we provide is 1) Actual, not forecasted, 2) Timely and current with up to 10 years of historical trending, and 3) Derived from well-respected sources.   Our analysis using payer and reimbursement data helps our clients solve their operational questions such as; Who is the Target Payer?  What are the potential markets for us to enter? Should the firm invest in a company? Who are the clinical sites where we can expedite patient enrollment? How can we optimize our sales channels?

Payer Guidance for Reimbursement, Market, and Product Development Purposes

We encourage our clients to meet with the coding and payer decision makers. We lay the groundwork to help ensure the meeting objectives for the client and the payer are meet. We help establish a professional relationship between our clients and the payer and in doing so create opportunities for both parties to collaborate in the future. We will accompany our clients to payer meetings or serve as an envoy on the behalf of our clients.

Investor Services to Support Financial Decisions

Before making an investment in a medical technology company, our financial clients want to know if and how the company’s technology can be reimbursed or if other monetization pathways are available. Our work for investors is focused on helping them make financial decisions using primary and/ or secondary research methodologies. Our primary research can include selecting the payers and preparing them for interviews or meetings with our clients in a private, one-on-one setting.   Our secondary research methodologies often include the use Medicare, Medicaid and U.S. commercial payer data identified and analyzed using mathematical and statistical methodologies in roder to assist our investor clients with their financial decision making processes.