Medical Reimbursement, Health Economics, and Market Access Mapping for Wound Care Dressings

January 17, 2017

Limitations of the Fee-for-Service (FFS) medical reimbursement model and arrival of Value-based Purchasing (VBP) pose a significant challenge for medical device manufacturers and service providers looking to enter the medical reimbursement market space.

Despite being an integral part of every nation’s well-being, rising costs are putting a strain on the healthcare system and threaten to restrict doctors from providing their patients with the best care possible. With high levels of national debt and rising geriatric population, governments from across the globe are well aware of the steps that have to be taken to reduce the rising cost of healthcare expenses while retaining and ameliorating the quality of patients’ care. Medical reimbursement is a big part of this picture and continues to alter the methods of care. Limitations of the FFS medical reimbursement model and the arrival of VBP medical reimbursement are some of the key challenges faced by professionals looking to enter the reimbursement market space. Furthermore, with the growing preference for Value-based Care among payers and providers, they will continue to navigate between new and old ways of providing high-quality patient care, while keeping an eye on cost.

Over the years, reimbursement for medical device segment has utilized a variety of payment mechanisms with varying degrees of effectiveness. However, whether these mechanisms are used individually or in combination, it is crucial that the resulting systems remunerate on the basis of complexity, quantity, and quality of care provided. Consequently, it becomes crucial for a medical device company to obtain coverage and attract risk-averse investors. Also, factors like whether a device is reimbursable or not and costs associated with reimbursement are key factors that determine a product’s demand and its commercial success.

At Infiniti, our “Healthcare Practice” team understands that reimbursement is an integral part of developing and marketing a medical device and is a key enabler for strategies adopted by companies looking to derive maximum returns from the success of their products in the market. Key components which our “healthcare analysts” cover include coverage, coding, and payment as those are considered pertinent for obtaining adequate reimbursement in today’s competitive healthcare market space.

The Business Challenge

To assess the dynamic medical reimbursement landscape and understand the costs associated with healthcare reimbursement, a world leading manufacturer of wound care and single-use surgical products engaged Infiniti for a study focused on understanding the wound care dressings reimbursement market in China and Japan.

The primary goal of this market opportunity assessment was to develop a comprehensive understanding of the wound care dressing reimbursement market structure, price caps, regulatory compliances, the impact of the regulatory compliances on product prices, and medical reimbursement figures for wound care dressing products across the target countries. Additionally, this client also wanted to obtain critical insights into medical device funding and reimbursement pathways for wound care dressings product in China and Japan.

Infiniti’s healthcare practice team tracked recent developments and innovations in the market through secondary journals and reached out to relevant stakeholders, including industry experts, KOLs, product users, and procurement experts, to understand their views on the market. Our healthcare research team also spoke to stakeholders responsible for the sales and distribution of these products to understand how the market would grow in short and long term and also to validate the market size and opportunity model developed for this segment.

Why Infiniti Research is the preferred partner for more than 55 Fortune 500 Companies


Solution Offered and Business Impact

By evaluating a wide array of published literature to develop an initial hypothesis, Infiniti’s healthcare intelligence team offered the client insights into the medical reimbursement market for their product, recent changes in reimbursement policies, and an analysis of regulations specific to the product’s reimbursement. The market opportunity assessment also helped the business understand the market structure, price caps, regulatory compliances, impact of the regulatory compliances on product prices, and reimbursement figures for its products across target regions.

In just nine weeks, our healthcare industry intelligence team helped the client understand reimbursement pathways for wound care dressings products and gain strategic insights for its wound care dressing products in China and Japan.

To assess the challenges specific to the medical reimbursement sector, Infiniti’s healthcare analysts have developed an extensive proprietary database consisting of information on more than two million industry experts, doctors, physicians, key opinion leaders, medical technicians, payers, end-users, and patients.

What do the clients appreciate about our approach?

In a relatively short period of time, just nine weeks, the client saw clear benefits from our relationship. The benefit was not only in terms of revenue impact or analytics turnaround time but also in terms of the experience we were staging for them by exposing them to a new way of problem-solving.

Here are some of the key points appreciated by our clients:

  • Dedicated Market Intelligence Portal. A centralized platform for the collection, storing, processing, reporting, and dissemination of information with the specific purpose of assisting the decision-making process and developing actionable insights. This portal includes comprehensive information on quantitative and qualitative aspects on target markets, competitors and end-users.
  • Collaborative learning. We leveraged experience of our healthcare team and our technical capabilities to enable report-sharing and other collaborative features appreciated by client teams.
  • Database Access. Access to a patient database containing information about 60+ medical diseases and conditions, such as patient undergoing treatment, untreated patients, and patients with chronic conditions.
  • Interactive Dashboard. Using our Portal based solution for healthcare professionals, we took a design-first approach to problem solving and helped break through previously held assertions.
  • Value for Money. Infiniti’s dedicated client management team customizes reports to suit business requirements and offers the best insights for every dollar spent.

A must-read case study for strategy experts and decision makers looking for effective market opportunity assessment for the healthcare reimbursement landscape.

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