Reimbursement Consulting



Analysis of payor trends in reimbursement and projections of future payor rates.

WHAT WE DO...
  • Define key business need(s)
  • Conduct primary and secondary research
      • We can design and conduct 1-on-1 or group interviews with industry leaders
      • We also research publicly available information and reports
    • Develop value messaging for products reflecting key business needs and market trends


WHAT TO EXPECT...
  • A comprehensive analysis of current
      • Payer coverage dynamics
      • Coding strategy
      • Pricing pressures
  • A workplan designed to secure payer acceptance of your Reimbursement modeling
  • Development of collateral supporting advocacy efforts with payers

Case Study #1

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 how enrollment growth in different payer plans (e.g., Medicare Advantage) was trending and what those changes could mean to their product

The Action

1
PAYER TREND REVIEW

Reviewed and performed primary and secondary research to identify enrollment and spending trends in different payers

2
COVERAGE PATHWAYS

Identified trends and determined possible implications of payer growth in different markets on client’s product

Representative Deliverables