Policy Analysis



Review of payer policies to identify impact on client portfolios

WHAT WE DO...
  • Define key business need(s)
  • Understand payer policy landscape, including commercial payers, Medicare & Medicaid
  • Develop a policy framework to identify risks and opportunities for key assets
  • Ensure alignment with client needs and priorities
WHAT TO EXPECT...
  • An evaluation of how key assets fit into current policy framework
  • Analysis of gaps in current policy environment
  • Workplan to close gaps in manner consistent with client goals and priorities
  • Development of collateral supporting advocacy efforts with payers

Case Study #2



THE SITUATION

GHC was engaged by a developer of a novel ophthalmic product to identify changes in reimbursement trends

THE ASK

The client wanted to understand if payers were currently covering, or were likely to cover their product

1
PAYER TREND REVIEW

• Inventoried commercial payer and state Medicaid program policies
• Identified high value states and commercial payers
• Reviewed current status of coverage in high value targets

2
COVERAGE PATHWAYS

• Based on review of existing coverage, identified pathways to expanded coverage and identified likelihood of success

Representative Deliverables