Market Access – Payer Contracting
Our Situation
Our client was working with payers to review contract terms and conditions. But they did not have the internal infrastructure or the resources to support contract offer development activities and contract review. Despite their lack of experience, they wanted the ability to track offers and share progress with leadership and investors.
Our Approach
Initially, We reviewed the market and competitive landscape to give our client strategic options to gain broad market access without having to significantly discount the price. This included a review of preferred, non-preferred, tiered formulary positions. We then developed strategic options for achieving reimbursement, evaluated drivers of payer decisions, and correlated them with strategic options. After we estimated the market potential of each strategy, we recommended the best one to move forward with.
We then developed a customer proposal template that our client could use with payers. We supported them with recommendations to be included in their proposal, including contract position and pricing. We also reviewed customer agreements, and highlighted areas our client should be concerned about from a business perspective.
Finally, we developed a contract tracker for the client account management team with data fields that let them report on key metrics for success.
THE RESULT
Mind Machine was able to craft a highly effective value proposition with focused messaging to promote differentiation in the product category, to allow for a stronger negotiation position for our client. We also developed a standard process to provide proposals to payers that has been accepted successfully. They can now review redlines internally with business partners, saving contracted legal team billing time. For each contract offer made, they can now capture data and easily share key information with leadership every month. This payer-centric approach led to the product being reimbursed by multiple plans, totaling over 95 million lives in the U.S.
