Market access stands at the cusp of a golden opportunity to help increase healthcare efficiency, improve outcomes, and transform the patient experience—but only if we’re brave enough to recalibrate our approach. For years, pharma’s engagement with payers has focused narrowly on securing access to treatments, with authorization and reimbursement our single-minded pursuit. It turns out we may have been missing the mark.
Payers play an important—if hidden—role at the center of the healthcare ecosystem. Often, the first ask in any healthcare setting isn’t “how can I help you?” it’s “what insurance do you have?” Why? Because what gets paid for, gets done. This underlines the power of the payer.
While patients’ connections are naturally with providers—sometimes spanning multiple stakeholders and multiple settings—payers’ presence hides in the background. But make no mistake, they’re the underlying backbone of the journey, driving decisions around authorization and reimbursement. Moreover, no matter where the patient goes on their journey, payers are the one stakeholder group that can connect all the other components. They’re the invisible glue of healthcare. It’s time we made the most of them.
If we can help payers play a more visible role in connecting the ecosystem quickly and effectively, we can truly galvanize the member experience—driving efficiencies, improving problem-solving, and expediting access to treatments. The benefits could be transformative—helping patients navigate the system and accelerating pathways to maximize outcomes. However, realizing these benefits requires a wholesale shift in market access approach.
In the new model, access teams must look beyond narrow payer value propositions and instead deliver education, services, and programs that drive connectivity across the ecosystem. The pharma companies that reimagine communications to give payers a 360° view of how their brands support providers, patients, and—of course—payers themselves, will likely enjoy significant competitive advantage. More importantly, they’ll reduce fragmentation, improve efficiency, and transform the healthcare experience for everyone.
So how do you do it? Here are five recommendations to ensure your market access strategy maximizes payer engagement to connect stakeholders, showcase value, and improve outcomes.
1. Incorporate Patient Experience Benefits into Your Payer Value Proposition
Enhancing the patient experience is a key pill of the Quadruple Aim—the framework developed by the Institute of Health Improvement as a means of achieving value-based care. However, the patient experience quadrant is sometimes overlooked, with payer value propositions predominantly focusing on things such as population health, resource utilization, cost reduction, or product efficacy. It’s a missed opportunity. Effective value propositions show how improvements in the patient experience enhance outcomes. Those are critical to the value story.
Improving the experience is about motivating and engaging patients in their care to improve outcomes. This can be particularly impactful in chronic diseases where patients often endure poor experiences. There are great examples of best practice in categories such as diabetes and COPD where empowering patients with education and support has made a real difference to patient engagement, experience, and outcomes. Initiatives like these should be front and center of your payer value proposition.
2. Embrace and Highlight Patient-Reported Outcome Measures
Patient-reported outcome measures (PROMs) are becoming a key component of product differentiation. As part of proving cost-effectiveness, healthcare providers are now required to provide evidence that they’ve delivered meaningful value for the patient—as reported by the patient. The most successful companies look for innovative ways to improve PROMs and use that data to show how their products are providing value for patients and improving their experience. Moreover, they’re able to demonstrate that the experience is connected to the outcome.
3. Adding Patient Experience to Value-Based Agreements with Payers
PROMs—and other measures like compliance or discontinuations—provide a good route for adding patient experience to value-based agreements with payers. If you can show an improved experience delivers meaningful benefits that translate into value and outcomes, payers are more likely to authorize/reauthorize your product. Payers not only need confidence that treatments are safe and effective, they want to know that the benefits support quality metrics and pay for performance. Warranties make sense here, creating a mechanism that ensures payers only pay for what works.
4. Connect Stakeholders to Drive Efficiency and Quality—and Invigorate the Healthcare Experience
Connectivity across the system is key to everything—it’s the antidote to the fragmentation that commonly holds up care. Pharma has a big opportunity to help payers become the connectors-in-chief that accelerate patients through the system. This can be approached in numerous ways—the scope for innovation is vast. Here are some top-line recommendations to get started. These may prove particularly useful in connecting patient support services and specialty pharmacy providers:
- Leverage technology to optimize member experiences—telehealth, electronic health records (EHRs), diagnostics, coordination of care, etc. This is especially important with chronic conditions such as asthma, diabetes, cardiovascular disease, etc.
- Improve coordination of care through routine outreach and follow-up with patients—ensuring “patient starts” and compliance by linking patient support and specialty pharmacy providers. If you can link it effectively, you’ll create a better-connected experience overall. In the process, you can ensure that patients:
- Are diagnosed and authorized appropriately
- Onboard and comply appropriately
- Are supported through reauthorization and other management issues
- Are monitored effectively (long-term safety and outcomes)
With smart use of tech it’s possible to create a framework that improves care co-ordination and enhances the patient experience right across the ecosystem. Better still, it does it seamlessly.
Don’t be afraid to innovate. For example, a payment EZ-Pass with the swipe of a card could be a massive upgrade on co-pay cards. It’s no different to Apple Pay, right? Perhaps we could bring it to healthcare.
5. Focus on EHRs to Improve the Patient Experience—In Both Chronic and Rare Disease
EHRs are the gateway to delivering more efficient care, providing a common language to help us better coordinate, deliver, and pay for healthcare. Oracle’s acquisition of Cerner earlier this year is a huge deal with a new bar to deliver more value. We need to make the most it. EHRs can help improve the patient experience by facilitating communication between patients and providers via online portals. Pharma can contribute to this not only by providing education and resources that support a better experience, but also by organizing the codes and business rules that help providers identify appropriate patients. This could be particularly valuable in rare disease.
EHRs have the potential to be an incredible tool for identifying suspect patients for rare disease. These are often difficult to diagnose. The challenge for providers is to examine the various touchpoints, connect them, and then re-assess to determine if something else is going on. This takes time; the average time to diagnose a rare disease is around four to five years. Effective use of EHR can short-circuit this.
Pharma has a big opportunity to work with payers and other organized customers to develop tools to identify patients with rare diseases—highlighting the patient journey, specific symptoms, and codes that enhance our ability to detect target patients. Organizations that grab the opportunity will significantly improve the patient experience.
Connecting Experiences
Market access is the fundamental entry point for effective and efficient healthcare experiences—because no matter how innovative a medicine or service is, it all counts for nothing if a patient cannot access or afford it. But success isn’t about securing access with payers, it’s all about focusing on the holistic experience. Today’s healthcare is fragmented. If we rewire our approach to focus on improving the experience for all stakeholders—through greater connectivity powered by a strong digital footprint—we have the opportunity to drive value, yielding better outcomes at a more efficient cost.
It’s a simple equation: a better experience = better outcomes = better value.
It’s time to connect.
