Healthcare System Changes and Pharmaceuticals Payments

on May 2, 2019 at 4:30 am

Healthcare System Changes and Pharmaceuticals Payments

The U.S. healthcare system is in transition to a value-based approach, and this will change the way pharmaceuticals manufacturers and their clients manage contracts, payments, and rebates.
The goal is to provide the healthcare system with more accountability, better outcomes, lower costs and to provide wider access to care.
This movement has brought changes to the way pharmaceuticals are priced and paid for, and it will bring more changes.

Nearly half of all Americans (49 percent) have at least one prescription drug, and 12 percent of the population has five or more, according to the Centers for Drug Control and Prevention (CDC). In 2016, $329 billion was spent on prescription drugs—an increase of nearly 30 percent from 2010, according to Deloitte’s most recent report.

But the market for pharmaceuticals has widened to include much more.
“The stakeholders for pharmaceuticals manufacturing have proliferated,” writes ZS Associates. “Where once we could focus marketing efforts primarily on healthcare practitioners, consumers and caregivers, our reach has expanded by necessity to include institutional stakeholders, advocacy groups, policymakers and influencers, payers and more. During this same time, pharma continues to expand the ways it provides value to its broad stakeholder network, moving from care efficiency and patient management to include innovations in, among other arenas, non-traditional pharma domains such as reimbursement, policy-shaping, financial analysis and risk-sharing.”

Until recently, commercial success for a prescription drug involved two factors: Getting the drug on payer formulary and driving sales force efforts with physicians. But now, public concerns over drug pricing, and a gradual shift from fee-for-service to value-based payment models are transforming the pharmaceuticals market.

Data Analytics enables adaptive change at pharmaceuticals manufacturers

With all these changes in the market, and in the structure of marketing and sales, pharmaceuticals firms must employ technology to get closer to market trends and to control the sales process. The large group of stakeholders involved in making decisions about product adoptions means that data analytics must provide product targeting and pricing accuracy.

“Often, disparate data sources, huge volumes of external and internal data, disjointed processes and budgetary constraints pose challenges toward accurate and comprehensive measurement and monitoring of commercial performance within the pharmaceutical industry. Companies today seek an analytics solution to gain a comprehensive view of their customers to make more informed decisions,” comments ZS Associates’ Pratap Khedkar.

Oddly enough, many pharmaceuticals manufacturers don’t make use of contracting and rebates data as they should, because contracts and rebates admin sits in a much different place in the organization than marketing—it practically sits in finance. The data source could be easily leveraged, but very few of the companies are putting two plus two together. Pharmaceuticals marketing should be thinking about joining this data with other types of data from other sources, to get better analytics results. It shouldn’t just be for contracting and rebates, it should work for marketing in a whole variety of ways. This is particularly important as US healthcare transitions to value based contracting where manufacturers will be claiming rebates based on the success of the drug. A whole new level of leveraging data will be required once this transition is completed -- it is currently at 34 percent according to some experts.

Companies that can use all of this data efficiently across the enterprise will really be in a great situation to improve rebate admin, marketing, everything. It’s almost as if there’s an unseen opportunity right under their noses.

Analytics is the key. “Pharmaceuticals companies in the US pay billions of dollars in rebates to third-party payers and provider organizations,” continues ZS Associates. These firms can save significant amounts of money and increase profit by building discipline in their contract management function. To do so, pharmaceuticals companies must improve in five areas: Using thoughtful analytics processes to guide contract decisions; maximizing the sales opportunity unlocked by contracting investments; assessing contract value through retrospective assessments; developing business processes that leverage analytics effectively; and maintaining the data required to support business decisions effectively.”

There was also concern about errors in the data. But in the last five years, lots of third-party data sources have come into being and matured. Now pharmaceuticals firms are in a position to double-check data with a high level of accuracy.

To achieve results with contracting and rebates data, it is no longer necessary to spend a lot of money on computers, software and expertise. Today, companies can take advantage of high quality and secure third-party outsourcing, obtaining expert results without a substantial outlay.

PointData is your partner for contracts, rebates and consulting

PointData provides proactive and robust monitoring and updating of IDN/GPO rosters and rebate management. We offer pharmaceuticals companies peace of mind -- rosters are continually updated in real time so that accuracy is assured.

Accurate data is critical to pharmaceuticals companies if they are to get the full benefit of working with GPOs and IDNs. But, currently, each pharmaceuticals company tries to maintain its own roster, with revisions and updating only made when errors in the roster are discovered. The burden of adding new locations or expanding the customer list is too imposing for pharmaceuticals firms to support -- they lack the tools for these operations.

PointData fills this gap for these companies. Using our services, GPO and IDN rosters are updated almost in real time -- this reduces error rates and provides accurate data that saves time and money.

No other company offers Data-as-a-Service format to manage these rosters. PointData was founded by a team of seasoned IT professionals, all with years of experience in the healthcare industry. We believe the roster management processes and rebate processes for pharmaceuticals/biotech firms is in dire need of an update. As a result, our focus is on helping organizations to make their entire contracting process more efficient and to drive down the cost of services, freeing up resources to focus on activities that add greater value. Today, PointData is improving efficiency at pharmaceuticals firms, offering them our Data-as-a-Service platform and providing consulting services to integrate cutting-edge solutions.

Servicing Rebates

The rebate validation process and the associated support activities are proving too labor-intensive and costly for pharmaceuticals firms. Yet managing these rebating processes efficiently is critical to pharmaceuticals firms’ success. Rebates are, of course, necessary to obtain formulary and tier placement. But rebates have to be negotiated with all the stakeholders in the pharmaceutical value chain every year, and then tracking how they are to be paid has become an overburdened complex process for pharmaceutical companies.

Using our data-as-a-service platform, and our proprietary software solutions to manage rebates, we can cut down on the time-intensive and error-producing process used by most pharmaceuticals firms. And firms can easily track every aspect of the rebate support process in real time. And we can track them. PointData can cut rebate processing costs and increase value obtained from rebates.

API Connection aligns business and IT

Every pharmaceuticals company has unique rules for determining its roster. Thanks to PointData’s unique API which connects rapidly and effectively with these companies, it is easy to quickly modify which GPOs, IDNs and even which websites are accepted by a given partner. Yet all this data can be modified in real time by PointData right in the customer’s data portal, rapidly and easily, via our API. Customers are also updated in real time, and so can be alerted about and/or accept any new sites before for roster data-set population.

All of our updates to the rosters are logged and shared with our partners. This enables prompt resolution of historical issues.

Aligning the business product roadmap to IT

Because not every pharmaceuticals firm has the technology to partner with us, PointData offers a full-scale consulting package that will enable partnering with us.

We can help pharmaceuticals firms to reorganize the internal workings of the team, review pre-existing practices to streamline the roster management process and enable us to provide cutting-edge services.

We can address processing challenges and drive continuous improvement, ensuring that all contracting and rebates processes are clearly defined, providing a clear picture to stakeholders of all interactions and dependencies (for example, providing Process Maps and RACI matrices).