Reimbursement Intelligence Translates Insights into Actions
RI leverages the right information, at the product lifecycle moment, for the best solution:
- Rx Scorecard™ - Quantitative assessment of drug value, relative to competitors, from a payer’s point-of-view.
- HUB Excellence™ - Measure the impact of each HUB program element to design the most cost-effective support program using best-in-class and competitor practices.
- RiQ™ - Customer-based, measurable assessment of field force reimbursement and access performance with a metric-based improvement program.
- Foundational to Advanced eLearning - Managed markets training for field and internal teams, including implications of healthcare reform on your specific business area.
- Pathway Tracker™ - Measure drivers of oncology product adoption on pathways to prioritize brand-specific strategies and tactics.
- Value Driver Management for Market Access™ - Systematically measure market performance in a therapeutic category against what’s most important to payers; gain strategic and tactical alignment across your marketing, market access, and commercial operations.
- Custom Research and Tailored Training Programs - Leverage RI’s 2,000+ member Reimbursement Intelligence Network (RIN) to capture business insights from decision-makers in the ACO, PCMH, IDN, Payer, and Provider settings to refine your customer intelligence and to use up-to-date customer input to successfully engage all customer types.
Optimizing Product Use in Pathways
Pathways are a growing patient management strategy that payers and providers use to improve care quality while reducing costs. It is critical for pharma companies to understand the overall design and structure of pathways and the key drivers for product access at various treatment points.
There are multiple treatment points in a clinical pathway where decisions are made about the use of drugs. Pathway Tracker identifies and tracks the critical drivers that influence use of branded drugs at each of these points. RI uses the Pathway Tracker to develop brand-specific recommendations and tactics to improve or maintain access for your products.
Pathway Tracker is based on our extensive network of pathway designers, our deep experience in oncology and other therapeutic areas that use pathways, and multiple sources of primary and secondary research.
For more detailed information on our Pathway Tracker, please click here.
Driving Formulary Access and Placement
The VDM: Market Access solution is specifically designed to help executives prioritize activities which optimize formulary access and position. The solution identifies unique market by market opportunities and delivers a holistic view of each market that includes both approved and developmental competitive products.
It’s about Action
Align your team around reliable global indicators that predict formulary access and placement in each of the top established markets.
- Identify the specific factors driving access and formulary position in each market
- Monitor individual brand performance across your most important markets
- Gain reliable competitive intelligence on market leading and developmental products
For more detailed information on our Pathway Tracker, please click here.
Building high-impact customer engagement in today’s payer environment
How can you ensure your organization consistently delivers best-in-class service to current and emerging customers?
Your customers are changing like never before. Decisions about your entire portfolio are more frequently being made at the institutional level (ie, payers, Accountable Care Organizations), requiring your company to seriously rethink the way you engage key customers. Even pharmaceutical, biotech and device manufacturers who have historically been top performers will require critical adjustments around who they target, what they say, and how they deliver services in order to sustain success.
RiQ helps you build teams that have the expertise, skills and flexibility to meet your customers’ quickly evolving needs. Your organization will receive a seamless training program that allows you to measure your organization’s proficiency on key performance indicators (Diagnosis), develop a path for driving better customer penetration (Design), and accelerate performance on the exact dimensions where there is the greatest ROI (Treatment).
For more information on our RiQ™, please click here.
Putting the formula for market access in your hands
How do payers value a drug vs. its competitors? What would change their assessments?
Rx Scorecard™ is the first and only tool that assesses the value of drugs from a payer’s perspective—objectively,transparently, systematically.
Using our proprietary algorithm, in-depth analysis of publicly available data, and years of experience working in the P&T decision-making process at major payers, our team of pharmacists, statisticians and physicians “score” all the drugs in an indication on the 19 efficacy, safety, practicalities of use, and economic elements which define value to payers. Each element of the score is linked to the original research source—which means the results are completely, transparently supported.
In short, Rx Scorecard™ puts in your hands the intelligence, logic and necessary back-up to create productive discussions with payers—in their language, based on their concerns—not to mention providing a roadmap for the follow-on studies that will make a meaningful difference to your product’s market access.
Rx Scorecard™ is:
- Web-delivered, interactive
- Updated monthly
- Fact-based; all data sources fully document
- Customizable; can test/save scenarios
- Objective and transparent
For more detailed information on our Rx Scorecard™, please click here.
Managed Markets Communication Tools
RI partners with our clients to deliver customer communications that inform, motivate, and integrate with provider and patient messaging platforms.
Full Service Communications Capabilities
RI offers full service customer communications with our team of writers and designers focused in the managed markets area. Our capabilities include traditional print as well as the latest digital technologies to increase customer participation and engagement, such as iPad tools and interactive video. Recent customer fulfillments include:
- Branded and unbranded slide presentations (Product Value Propositions; Health Economics Outcomes Research (HEOR); Disease Management)
- Clinical monographs
- White papers (Impact of Medicare Part D, Value-based Insurance Design)
- E-print carriers
Optimize Patient Support to Maximize Access
What will differentiate your services and improve brand performance?
Reimbursement assistance is critical to the commercial success of current and new therapies, especially expensive specialty products. Decisions regarding prescription fulfillment are often financially driven and have less to do with performance of a particular therapy. As a result, all life science companies have assembled patient and provider support programs (HUBs) that help patients and prescribers navigate and reduce barriers to access and reimbursement. Manufacturers must identify the program elements, channels and design that meet customer needs and differentiate their HUB services from the competition.
RI has developed HUB Excellence, an assessment tool to help brands optimize key services relative to the competition. HUB Excellence provides a view of customer needs and expectations for HUB services, creates a comparative view of service offerings, prioritizes and measures program performance for relevant branded drugs based on customer input, and provides regular market updates as competitor programs evolve. To act on these findings, RI offers a suite of programs including sales and call center messaging, field training, impactful communications, and eLearning modules. No matter where you are in patient support program development, RI uses HUB Excellence to form a fact-base for action to support all aspects of planning.
For more detailed information on our HUB Excellence, please click here.
Winston Wong, PharmD, is the President of the W-Squared Group. The W-Squared Group is committed to assist healthcare innovators to launch their technology in the government and commercial marketplace. He is known for his clinical innovations throughout his 30-year career. Among his accomplishments are participating as a member of the APhA STAT committee first addressing the value of MTM services, implementation of a provider network Pay-for-Quality program in Oncology and Rheumatology, and incorporating MTM services into the overall Medical Management Strategy in a health plan.
He earned his PharmD degree in 1981 from the University of the Pacific in Stockton California, and completed a General Residency at the University of Nebraska Hospital and Clinics in Omaha, Nebraska. Since earning his degree, he has held numerous staff, clinical, and leadership positions in hospital, GPO, and managed care settings.
Susan is Co-President at Reimbursement Intelligence. In 2008, Susan built our managed markets training solutions division. She developed a landmark training solution – RiQ™ (Reimbursement IQ), a new model for reimbursement sales force effectiveness. She works with small and large pharmaceutical companies to develop custom, targeted, and strategic training programs. As an expert reimbursement trainer, she is able to create programs that will not only identify and target gaps, but also create sustainable and scalable training programs for our pharmaceutical and biotech clients. Susan’s passion and energy will ensure that the RiQ™ becomes an integral part of your organization’s sales force effectiveness initiative. Her clients value her insights and unparalleled customer service. Susan began her career as a financial analyst for Prudential, eventually managing a division responsible for individual insurance financial analysis and projections. Susan holds a BS in Finance from Seton Hall, from which she was graduated summa cum laude.
“Don’t Let Benefit Design Complexity Silence Your Salesforce”
What do your customers really want from your Key Account Managers?
Learn what defines success, directly from the payer’s perspective
Guest Speaker: Winston Wong, PharmD, President, W-Squared Group
Susan Raiola, Co-President, Reimbursement Intelligence
Date: Tuesday, March 4, 2014
Your Key Account Teams are smart. They are creative. And they are experienced. So why isn’t your organization meeting all of its goals?
Healthcare is more dynamic and complex than ever before; as a result, your customer-facing teams need sharp business acumen. Whether a result of the Affordable Care Act (ACA), provider and payer integration, or the rising specter of cost burden, your customers’ needs are growing exponentially. It can be overwhelming, even for the most experienced Key Account Manager (KAM).
Fortunately, the solution is in your organization’s hands. Your KAMs have the ability to significantly shift your product’s adoption if you follow three simple steps. Join Reimbursement Intelligence with guest speaker Winston Wong, Pharm.D. to understand what your KAMs need to do in 2014 to surpass your organization’s business goals. Mr. Wong is a 30-year industry veteran, and has held numerous staff, clinical, and leadership positions in hospital, GPO, and managed care settings.
Key Webinar Benefits:
- Understand why companies who adopt a Key Account Model now are the only ones who will flourish in the next few years
- Identify if your current Key Account Model is keeping pace with the changing healthcare landscape
- Target Key Account Manager dimensions that are most critical to success
- Reinforce the Key Account Manager behaviors that will generate optimal product access
Maximize sales force reimbursement effectiveness
Our changing reimbursement landscape is demanding greater attention, with economics playing an increasing role in provider decision-making. Training on reimbursement issues is now a critical component for a sales force to remain effective in our value-driven healthcare marketplace.
Equip your Sales Force
Knowledge – Ensure your representative demonstrate understanding of the current and future reimbursement landscape, and respond appropriately to customer questions
Messaging – Deliver consistent and on-message information about reimbursement and access
Assistance – Act as liaison for providers and staff when implementing your own reimbursement assistance program
Resources – Become a go-to resource for providers and staff on reimbursement and access issues
Our Approach to Reimbursement Training
At Reimbursement Intelligence (RI), we take an integrated approach to reimbursement training. Working with your existing sales program, we can provide add-on training components or, when needed, build a program from the ground up. Each ensures our clients have targeted reimbursement tools for their specific needs. General information categories our clients often look for include:
- Drug Distribution
- Patient Assistance Programs
- Reimbursement in government programs
- Managed Care Basics
- Billing and Coding
Dynamic Training Vehicles
Our capabilities at RI include the latest technology platforms as well as more traditional training vehicles, including:
- iPad apps
- Live Workshops
- e-learning Training Guides
- Train-the-Trainers Programs
Managed Markets Research and Analytics
Reimbursement Intelligence (RI) supports its clients through customized research and development of targeted reimbursement strategies across a product’s life cycle.
Recent custom research topics include:
- Value Proposition Messaging and Positioning
- Health Outcomes Research
- Employer Coverage Decision Making
- Customer Segmentation Research
- Pricing and Contracting
From early development through commercialization, RI helps clients identify critical challenges and opportunities in today’s managed markets environment.
Download may take a few minutes.
Chief Executive Officer
Norman C. Selby is CEO of Reimbursement Intelligence and has been active in the healthcare world for over 30 years in a variety of operating, investment, consulting, and Board roles. In addition to his role as CEO, he is also serving as Executive Chairman of Real Endpoints llc., an innovative healthcare information business focused on the changing US reimbursement landscape.
Mr. Selby is also on the Board of three healthcare product companies: Infinity Pharmaceuticals, a leading public (INFI) oncology biotech company, Metamark Genetics, a start-up oncology diagnostics company, and Merz Group GmbH, a global specialty pharma company based in Frankfurt, Germany. He has previously served on the Boards of Millennium Pharmaceuticals (MLNM) and several other private healthcare companies.
During the past decade Mr. Selby led the growth and development of three healthcare companies, all of which had successful exits to larger strategic enterprises: Physicians Interactive Inc, which he built as Executive Chairman through 4 acquisitions from 2008 – 2012, and sold in 2013 to Merck GHIF; Windhover Information, which he invested in and became Executive Chairman of in 2004, and which was acquired by Reed Elsevier in 2008; and TransForm Pharmaceuticals, where he was CEO and President from 2001 – 2004, and which was acquired by Johnson & Johnson.
Mr. Selby spent the bulk of his career (1978 – 1997) at McKinsey & Company where he was Director (Senior Partner) in the firm’s New York office. He held several leadership roles at McKinsey, including head of the firm’s Global Pharmaceuticals and Medical Products Practice. From 1987-1989, Mr. Selby took a leave of absence from McKinsey to serve as Chief Operating Officer of the New York Blood Center, the largest community blood organization in the country, where he led its financial and operational turnaround. After McKinsey he went to Citicorp/Citigroup where he was an Executive Vice President.
Mr. Selby serves on the Board of Trustees of the Central Park Conservancy, the Memorial Sloan-Kettering Cancer Center and the Ralph Lauren Center for Cancer Care and Prevention, all based in New York City. He is also a member of the advisory board of the Harvard Business School’s Healthcare Initiative, and a Board member of the National Parks Conservation Association in Washington D.C.
Mr. Selby holds a B.A. in Architecture from Yale College and an M.B.A. with Distinction from the Harvard Graduate School of Business Administration.
John Hennessy is Vice President, operations for the Midwest Oncology Division of Sarah Cannon, the global cancer enterprise of Hospital Corporation of America (HCA). His focus areas at Sarah Cannon are medical oncology, survivorship, and palliative care.
Mr. Hennessy has held several leadership positions in oncology for more than a dozen years, including his role as the executive director of the Kansas City Cancer Center. Through this leadership, he has led the adoption and implementation of cancer care pathways, in addition to other innovative programs. Having served in the health care industry for more than 25 years, he has experience in physician practice, hospitals, and managed care and health plans. Hennessy received his Bachelor of Arts in English from Colorado College, and a Master in Business Administration degree from the Fuqua School of Business at Duke University.
He serves on the Board of Trustees of the Association of Community Cancer Centers (ACCC), and on several committees for the American Society for Clinical Oncology (ASCO), including the Clinical Practice Committee. Hennessy has been a speaker in the oncology field for many years including ASCO, ACCC, Society for Gynecologic Oncology, Medical Group Management Association, and a number of state and local healthcare meetings from Boston to Hawaii.
John Whang is a board-certified cardiologist with experience in both clinical and corporate environments. Prior to joining RI as COO, John was a senior consultant at McKinsey&Company in its Health Care Practice. He led and conducted multiple studies with pharmaceutical, medical device, payor, and provider clients; he also led due diligences on behalf of private equity and venture capital firms in their assessment of potential targets. While at McKinsey, John established McKinsey’s first Advisory Board of world KOLs in cardiovascular diseases that equipped them with resources to offer as an additional competency to raise its profile of unique consulting services.
Before McKinsey, John was Director of Non-Invasive Cardiovascular Services at Morristown Medical Center in Morristown, NJ, which is the second largest cardiac program in the Northeast. John managed all aspects of inpatient and outpatient cardiovascular services while actively practicing cardiology. He led the introduction of cutting-edge technologies such as intra-cardiac echo (ICE) to enable the growth of innovative catheter-based programs including PFO closure and transcatheter valve.
John received his MD from the College of Physicians and Surgeons, Columbia University and an AB in evolutionary biology from Harvard College.