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Business Forecasting

Health Economics and the Reimbursement Landscape in Healthcare

The uncertainty in the United States healthcare market has made it rather imperative for the medical practitioners and service providers to understand the nitty gritty of the evolving reimbursement landscape. While traditionally the focus of manufacturers remains on getting regulatory approval to push their products in the market, the scenario has changed hugely in the past five years. Today with an increase in patient access, it is not just the physicians but other stakeholders like health care organizations as well as the insurers who decide the future of drugs and medical devices.

Influence of the latest trends in the healthcare landscape

The emergence of bundled payments, tiered narrow networks, along with high demand for price transparency from the patients’ end are some of the major trends which the healthcare sector is witnessing now. These trends are sure to impact reimbursement programs like ASC (Ambulatory Surgical Center) Payments. It is therefore critical for ASCs to optimize their payment strategies to protect their financial footing.

Similarly, patients are no longer just a group of end-consumers in the healthcare industry. Rather the patient community has emerged as a financial class which demands transparency in pricing and are forming pressure groups to prevent surprise billing. Only last September, the California Health, and Safety Code was approved which mandates the providers of out-of-network at in-network facilities to treat patients as if they are part of the network itself.

Another critical element which is changing the face of the reimbursement landscape is the bundled payments system. According to one of the latest studies conducted by ORC International, by the year 2021, 17 percent of reimbursements will take place in the form of outsourced bundled payments system. This means that reimburses like ASC must collaborate with the third-party providers of the payments system to stay relevant in the competition.

Infiniti’s take: Health Economics to the rescue

The basic premise on which health economics works is improving the overall delivery of the healthcare services without any major spike in the health care costs. One of the best ways in which this can be attained is by integrating the healthcare services and the reimbursement process seamlessly. The therapies, be it traditional or innovative ones, should be aptly targeted to improve the clinical outcomes as well as optimize the healthcare costs.

Experts in health economics believe that changes in the commercialization strategy by integration of new therapies is sure to improve the overall reimbursement landscape. This can be possible only if there is a nuanced understanding of the clinical conditions, related treatments, and the most appropriate healthcare delivery model.

Understanding the Health Economics Behind Medical Devices

Traditionally, health economics studies the manner in which limited resources are allocated to provide better health care services. It also takes into consideration how medical services can be better distributed among individuals and groups. Currently, the healthcare industry is becoming more cost-conscious, which is why medical devices manufacturers are looking for the best solutions that would bring down the cost of production without compromising on quality.

The two key focus areas for every medical device company, regardless of their size, are:

  1. Better access to the market
  2. Increase in reimbursement

Often small-sized organizations, adopt health economics to boost the sale of their tools and gain higher acceptability for their diagnostics. The major players, on the other hand, adopt health economics initiatives to reach the best value – for both medical devices as well as patient outcomes. Our health plan market intelligence studies show that manufacturers are sure to benefit if health economics is put into play right at the initial stages of product development. This strategy helps companies to commercialize their products in a better manner and thereby disrupt the market to their advantage.

Benefits of health economic analysis in the medical devices market

Health economics analysis (HEA) enables the manufacturers to gain a clear understanding of the direct as well as indirect costs of medical intervention. Different models are adopted to understand how a particular medical device would get a better access to the market as well as meet the manufacturer’s reimbursement goals. HEA provides a clear picture on the sustainability of the business strategy of any medical device company. It does this by examining:

  1. Cost-functionality: By taking technology costs and utility outcomes of the medical devices into consideration, HEA indicates how functional is the product for the patient. Cost-functionality also brings into perspective if the patient is keen to pay for high-cost devices without guaranteed high clinical benefits.
  2. Cost-minimization: Health economics is all about finding the best viable alternative medical solution at the least possible cost. For instance, if a low cost technology can provide the same benefit as an existing high-cost one – it is beneficial for both the patient and the manufacturer.
  3. Cost-effectiveness: Here the clinical outcome of the alternate technologies is examined in a detailed manner. While the cost of technology is measured in monetary terms, an increase in life expectancy determines the overall health benefits of the product.

The focus of healthcare systems across the globe is on reducing the cost of health services per person. Advances in medical technology and higher dependency on medical devices has made it imperative for those in the medical devices industry to take health economics into serious consideration.

Infiniti Research are leading providers of life sciences and health economics solutions

 

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Market Intelligence Study on Health Economics Helps Bridge the Gap Between Demand-supply of Resources

The recent market intelligence study by Infiniti Research on health economics data helps a leading laboratory diagnostics company derive health economics data with country-specific operational, clinical, and financial data sets.

Health economics, market access, and reimbursement policies

Health economics helps analyze the size of the contribution of the healthcare sector to the overall economy and identifies the several health issues that have a substantial economic element. The theory analyses consumer, producer, and social choice to understand the behavior of public and private organizations, healthcare providers, governments, and individuals in the decision-making process. Health economics and market access have close applications as one method help develop statistical models of disease recognition and treatment areas and the other designs salesforce models to boost the sales of related drugs and therapeutics in the market. Market access and health economics are gaining immense popularity in the market as it helps bridge the gap between demand-supply of limited resources in the healthcare sector. The market intelligence team at Infiniti provides detailed insights in terms of allocating resources to bridge the gap effectively.

The data analysis gained through health economics helps regulatory bodies understand the price valuations and cost-effectiveness of various drugs and therapeutics that are available in the market. These analytics helps the government formulate pricing and reimbursement policies in the global market. The increasing cost of healthcare is one of the primary challenges that is tackled through health economics and market access evaluations.

Resource optimization at a global level

Developing health economic database with country-specific operational, clinical, and financial data sets on COF business areas, ROI calculators, and COF Wiki KPI’s will help companies gain a holistic overview of the healthcare industry. Furthermore, designing country-specific models will help pharmaceutical companies understand the market landscape of the target region and optimize new product launches. The new models offer information on cost-saving opportunities and resource allocation techniques that will fuel the growth of affordable healthcare products in the global market.

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Emergence of personalized medicines

Data analysis through health economics is increasing the availability of personalized medicines in the market. The data collected analyze the genomic information and suggests different methods of drug delivery that will increase patient satisfaction. The application of these data points is valuable in the drug development process and to increase efficiency and effectiveness of health care delivery.

Solutions and recommendations

The market intelligence team at Infiniti Research provide solutions on health economics optimization, helping stakeholders to apprehend product value and its potential in the healthcare sector. Some of the solutions are listed below:

  • Create a database that shows clinical statistics on the incidence rates of disease such as lung cancer, breast cancer, coronary artery disease, prostate cancer, structural heart disease, and stroke
  • Provide insights on the average reimbursement rate for each procedure/diagnostic test through robust insurance practices such as statutory health insurance (outpatient), statutory health insurance (inpatient), and private health insurance
  • Validate the existing demand-supply gap and allocate the resources according to the specific requirements
  • Deliver a reasonable understanding of the demand-supply gap analysis and find measures to curb the gap

Read our comprehensive case study on how we helped a leading laboratory diagnostics company derive health economics data

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Other case studies you might be interested in:

For any queries, reach us at – hello@infinitiresearch.com

Market Intelligence

Market Intelligence Study on Health Economics Data Helps Medical Devices Sector Explore New Opportunities

The recent market intelligence study by Infiniti Research on analyzing health economics data from existing data sets examines information from country-specific clinical, operational, and financial data to help companies in the medical devices sector to maximize ROI.

Health economics – applications and effectiveness

With the increasing demand for affordable healthcare services and growing requirement for innovative medical devices, it becomes pertinent to employ a team of researchers to analyze data sets that affect the healthcare industry. Leading pharmaceutical manufacturers and healthcare professionals are relying heavily on health economics data analysis to explore future growth opportunities and maximize ROIs. Limited resources and increasing investment for better healthcare services are encouraging healthcare industries to adopt this analytics solution. The market intelligence team at Infiniti Research helps companies understand that the scarcity of healthcare resources, therapeutic, diagnostic, and preventive procedures should not be evaluated only on their efficacy but also on their cost-effectiveness – the ratio between the resources used and the related effects.

Health economics helps medical device manufacturers to introduce cost-effective tools for lower income countries. Relevant data models are prepared using economic analytical tools that help vendors introduce new support vaccines in these areas. Some of the vaccinations include pneumococcal, rotavirus, and human papillomavirus vaccines. These cost-effective tools will help the government make policies that will improve the healthcare sector in these countries and help offer affordable services to everyone.

Developing effective health economics database

Developing an effective health economics database with country-specific clinical, operational, and financial data sets will help companies explore and identify future growth opportunities. The database will help manufacturers analyze information gathered to create new ROI calculations and business cases for their product offerings. Data collected through these tools offer information on COF Business Cases, ROI Calculators, and COF Wiki KPI’s, which will help the companies validate the market size and current competitive scenario.

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Most of the medical device companies, when they try to showcase the importance of a new product, should utilize health economics and increase the capacity of their products in two primary areas: medical reimbursement and market access. Since different customer needs a different kind of approach, it is important to understand the needs of the customer base. Market access helps companies package data in the right process and deliver it to the target customer at a short time-to-market period.

Solutions and recommendations

The market intelligence team at Infiniti Research offers various solutions for the decision-making process and develop actionable insights that helped the client increase their ROI. Some of the solutions offered include:

  • Offer information collected from various sources and calculate KPIs from ROI calculators across regions like the US, China, Brazil, and Japan
  • Analysis of the COF wiki KPI’s to understand the clinical statistics pertaining to the incidence and prevalence rates of diseases like breast cancer, prostate cancer, structural heart diseases, stroke, and traumatic brain injury
  • Provide strategic insights into the dynamic demand-supply analysis specific to the market
  • Develop 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
  • Design new analytical model that offers a new way of problem-solving and helps the company generate revenues

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Read our comprehensive case study that offers market intelligence study on health economics data from existing data sets

Other case studies you might be interested in:

For any queries, reach us at – hello@infinitiresearch.com

IPTV Service

Immunization and Health Economics– Best Friends in the Making

Health is not just the absence of illness– rather it is the ability to grow and develop to one’s full potential. Several elements go into the making of a healthy workforce– and it is health economics which closely analyses the connection between health and resources. Resources are not just about money; it also covers materials, time, and the people involved in making the process of healthy living easier. Especially in the case of developing countries, the debate often spirals on how to make a lasting impact with the limited availability of resources.

Relation between health and economic growth

According to noted American economist Robert Fogel, a good part of England’s economic growth in the past 200 years is the result of improvements in the population’s food consumption. Thus, the relation between health and economic growth is a rather strong one. Improved productivity and less burden of illnesses is in fact the direct effect of health on economic growth. At the same time, health also has an indirect impact on economic growth. For instance, a generation of healthy children are sure to raise the future income potential of any country – and this is the indirect and long term impact of health on the economic progress of a country.

Another report published by David Bloom and colleagues outlines how the labor productivity of a nation can improve by 4% just by increasing the life expectancy of its citizens by one year. All this shows how health and economics are deeply connected to one another – any change in one aspect is sure to influence the other.

Better immunization, greater economic gains?

Adopting the right vaccines is one of the major agendas of those involved in public-health decision making. Often there is a lot of brainstorming done on if it makes economic sense to promote and use expensive vaccines in a low-income country. The debate gets an even more serious angle when traditional cost-effective solutions are taken into consideration. But the fact remains that despite being expensive, these vaccines have broader benefits which often goes unrecorded in the traditional calculation formats. For instance, most traditional methods fail to consider the fact that lessening child mortality rate results in families having fewer children that enables the parents to spend more on their children and take better care of them.

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Lately, due to immense research and field studies, it has finally been accepted that immunization is the stepping stone to building a healthy family, vibrant community, and a strong nation.

For a better understanding of health economics and immunization : Request a Proposal
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Health Economics for Medical Device Developers

The medical device industry is driven by optimistic device companies in the U.S., Europe, and Asia that seek innovation. With new innovations, the key stakeholders in the medical device market will keep funding research and new ideologies to bring about product differentiation. From the demand for self-medication to in-home healthcare services, the medical device industry is witnessing a change in preferences. Currently, the industry is going through a huge strategic change with respect to the development and launch of new products. And our health economists are here to help decode the trends for all the medical device developers.

Health economics plays a vital role in demonstrating the value of new products launched by medical device manufacturers. In general, there are two main areas to focus – Medical Device Reimbursement and Market Access. Involving health economics early in the process will help businesses assess product development opportunities. At Infiniti Research, our experts will leave you with compelling reasons to choose health economics for the medical device industry.

Let Data Do the Talking

Create a comprehensive reimbursement plan for medical devices with the help of health economics analysis from a payers’ perspective. A detailed health economics analysis will give you insights on providing quality care for more people by reducing costs. This will help decision makers to conclude how effective the proposed medical device is over the existing ones and its value for money. This will also prevent the development of technologies and devices that have doubtful value in the future.

Make Well-informed Decisions

Expenditure in the medical device industry is substantially growing. There is an extensive government intervention when it comes to norms and regulations to promote the efficient use of medical devices. This is where an economic evaluation of medical devices will keep every medical device manufacturer informed about the pricing and reimbursement plans. Not just that, it will demonstrate the cost-effectiveness of new and emerging medical devices to make sound decisions.

Rethink Reimbursement

Cost-effectiveness of medical devices plays a huge role when it comes to reimbursement. If there exists therapy A and a new therapy B and they both seem to have similar clinical outcomes, preference will be given to the therapy that is more cost efficient. However, this choice of treatment can be debated if therapy B is much more effective than A. As a medical device manufacturer, you can save time and money when you rethink reimbursement.

As a medical device manufacturer, it is a wise choice to analyze the health economics for the newly developed medical device. Right from assessing the commercial viability of the device to avoiding frugal innovations, the device will have its reimbursement strategies explored. Other than that, a developer can make a better, informed product design ruling out unpromising technologies.

Whether you’re a strategy expert or a decision maker, here is our case study.

Medical Reimbursement, Health Economics, and Market Access Mapping for Wound Care Dressings.
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Market Intelligence Study on Health Economics Data from Existing Data Sets

Effective analysis of health economics data to help companies in the medical devices sector explore future growth opportunities and maximize ROIs.

 

What is the exact value of a human life? This is one of the most fraught questions in public policy as governments across the globe struggle with rising healthcare costs from aging populations. The answer matters not only to patients, taxpayers, and insurers but also to the pharmaceutical manufacturers seeking rewards for the medical advances that have helped double life expectancy globally in the past century. In view of this conundrum, healthcare companies across the globe have started focusing more on health economics data analysis to explore future growth opportunities and maximize ROIs.

Health economics is the connection between health and the resources needed to promote or safeguard it. Bycapture resources, we just don’t mean money, but also people, materials and time, which could have been used in other ways. Though our healthcare needs as a population are unlimited, it must be noted that the resources required to satisfy them are not. As a result, healthcare choices have to be made about which needs are the most important and how to manage healthcare requirements with the limited resources.

At Infiniti, our “Healthcare Economics” team understands that the recent scarcity of healthcare resources, therapeutic, diagnostic, and preventive procedures must no longer be analyzed purely in terms of their efficacy but also regarding their cost-effectiveness – the ratio between the resources used and the related effects. This is done with the help of effective health economics data evaluation studies. If health economics data evaluations are to serve as a direct aid in decision-making, prerequisites like the implementation of an effective methodology and transparency will become extremely necessary in the near future.

The Business Challenge

With an eye on exploring future growth opportunities, a leading global company in human diagnostic imaging andcapture2 laboratory diagnostics approached Infiniti to develop an effective health economics database with country-specific clinical, operational, and financial data sets. The development of such a database would help the client leverage the information gathered to create new ROI calculations and business cases for their product offerings.

The primary objective of this engagement was to offer the client country-specific clinical, operational, and financial data on COF Business Cases, ROI Calculators, and COF Wiki KPI’s. Infiniti’s health economics data evaluation 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 health economics team also spoke to prominent 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

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Solution Offered and Business Impact

By evaluating country-specific clinical, operational, and financial data on COF business cases, ROI calculators, and COF wiki KPI’s, Infiniti’s health economics data evaluation team helped the client leverage the information gathered to create new ROI calculations and business cases for their products. The market intelligence study also focused on calculating KPIs from ROI calculators across regions like the US, China, Brazil, and Japan. Additionally, an analysis of the COF wiki KPI’s to understand the clinical statistics pertaining to the incidence and prevalence rates of diseases like breast cancer, prostate cancer, structural heart diseases, stroke, traumatic brain injury, etc. was also carried out to help the client gain strategic insights into the dynamic demand-supply analysis specific to the market.

In just eight weeks, the client – a leading global company in human diagnostic imaging and laboratory diagnostics – was able to leverage the information gathered for COF business cases, ROI calculators, and COF wiki KPI’s to understand the acceptance of their products across the US, China, Brazil, and Japan.

To assess challenges specific to healthcare data economics, Infiniti’s healthcare research team 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 eight 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 insights on health economics data analytics.

Request your free proposal now

 

Related reports:

 

HEALTH ECONOMICS DATA FROM EXISTING DATA SETS

To read more about health economics and its importance to medical device manufacturers, click here.

Market Intelligence

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

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 withcapture 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 thecapture2 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

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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.

 

Request your free proposal now

 

Related reports:

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