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

United States maps showing 5 Medicaid targeted pediatric hospitals for treatment of more than 32 million Medicaid beneficiaries with 24 million Medicaid Managed Care Organizations

Summary of Findings

Summary Table of findings showing the number of lives impacted in five states for Medicaid and Medicaid Managed Care Organizations