Payor Policy Analysis
The Service: Review of Payor Policies to Identify the Impact on Company or Product Portfolios
What We Do
- Define key business need(s)
- Understand payor policy landscape, including commercial payors, 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 the current policy framework
- Analysis of gaps in the current policy environment
- Workplan to close gaps in a manner consistent with client goals and priorities
- Development of collateral supporting advocacy efforts with payors
The Case Study: Payor Policy Analysis
The Situation
Gettysburg Healthcare Consulting was engaged by a developer of a novel ophthalmic product to identify changes in reimbursement trends
The Ask
Our client wanted to understand if payors were currently covering, or were likely to cover the company’s novel ophthalmic product
Our Actions
Payor Trend Review
- Inventoried commercial payor and state Medicaid program policies
- Identified high-value states and commercial payors
- Reviewed the current status of coverage in high-value targets
Coverage Pathways
Based on our review of the company’s existing coverage, we identified pathways to expanded coverage and identified the likelihood of success
Representative Deliverables: Payor Policy Analysis
Medicaid Analysis Phase 1
Summary of Findings
