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 Planning and Implementation

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

Our goal is to identify those payer(s) with established reimbursement pathways which meet the company's business objectives. There are instances when the reimbursement pathways need to be changed. We assist the companies, and if necessary staff our companies, to research, prepare, publish and present the evidence to justify the company's request for coding, coverage and reimbursement changes to the American Medical Association, the ICD10 Coding and Maintenance Committee and the Medical Directors for Medicare, Medicaid and commercial plans. 

 


 



Monetization and Health Economics Planning and Execution

 

In the absence of traditional reimbursement, we identify alternative monetization pathways for our clients' medical technologies. Reimbursement, a type of monetization mechanism, is increasingly becoming more challenging for medical and digital health technologies because of structural changes being made by the payers to their policies, rules and regulations. However, these same structural changes are also establishing other monetization pathways to traditional reimbursement. It is our objective to identify the pathways and demonstrate how they (the pathways) can result in incremental operating revenue for our clients' customers.

 


 


Market and Clinical Analysis using Payer Data

 

We use cost, dispersion, care patterns, reference pathways and utilization databases from Medicare, Medicaid and the commercial payers, to help our clients solve strategic and operational decisions. The (empirical) data we utilize is; 1) actual, not forecasted, 2) current with up to 10 years of historical trending, 3) high specificity, that is to the patient episodic level and 3) derived from well-respected sources, the payers.  Combining payer data with our analysis skills we help our clients solve their operational questions like Who is the beachhead payer? What are the potential market entry points in terms of procedures, re-admissions and referral patterns? Should the firm invest in a company? Who are the hospital clinical sites where we can expedite patient enrollment? How can we optimize our sales channels based on payers’ policies?

 


 


Payer Guidance for Reimbursement, Market, and Product Development Purposes

We encourage our clients to meet with the coding and payer decision makers. We will recruit the appropriate payer decision makers and lay the groundwork to help ensure the meetings' objectives for the client and the payer are meet.  We will accompany our clients to payer meetings or serve as an envoy on the behalf of our clients. Our objective is to help establish a professional relationship between our clients and the payers and in doing so create opportunities for both parties to collaborate on coding, coverage and reimbursement for medical technologies.

 


 


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 order to assist our investor clients with their financial decision-making processes.