The current state of the U.S healthcare market is characterized by continuous flux and uncertainty. When compared to the overall healthcare costs, the drug costs have grown at a slower rate. Companies in the U.S. healthcare system are now exploring ways to combat these challenges and survive the mounting healthcare market access pressure.
Healthcare market access assists the right patients to get timely and easy access to medical services and products at an affordable price. Accessibility, availability, affordability, adoption, and willingness to pay (reimbursement) should be achieved while ensuring equity and quality at each level. Furthermore, multiple challenges and inefficiencies, and uncertainty in healthcare systems lead to unnecessary delays in access to innovative technologies, slow adoption of new and effective technologies, and inequalities in guaranteeing that patients receive the best-in-class treatment.
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Challenges in successful healthcare market access
Uncertain impact of reforms
The prevailing financial crisis is leading to reform across the board in healthcare systems. However, the key challenge remains in predicting how these reforms will really impact the pharma and healthcare market. Beyond price cuts, these reforms include the demand for real-world evidence that can be put to use either to alter price over time or to re-position the use of a product in the treatment pathway.
Technological research and developments often exceed the pace at which regulations are updated. New products are designed continuously to fulfill the unmet needs and the existing products are regularly optimized and improved. This rapid evolution of technology is a major healthcare market access challenge as companies often find it difficult to keep up with these constant changes.
Lack of resources
Governments and the payer systems have been expressing constant concern over the sky-rocketing healthcare costs. For better healthcare market access and financial sustainability of healthcare systems call for more effective and strategic public spending on health. However, this has raised concerns that even in strong, comprehensive health systems, austerity measures and cuts in public spending may endanger people’s healthcare market access and affordable care. The economic crisis has been blamed as the major cause for the drastic rationing and reductions in resources of the healthcare system. Often, the need for effectiveness may be misinterpreted to mean budget cuts.
Building an effective healthcare market access strategy
There is undoubtedly plenty of noise around healthcare market access right now. Given all the turmoil in the current healthcare system, especially around access-related issues, it behooves the providers of access programs to get rid of such challenges. Infiniti Research has pooled a host of their healthcare market access experts and has identified some of the most successful healthcare market access programs that follow these commandments:
This is one of the aspects that is often overlooked in multifaceted programs. It is essential not to position a product in one light to a provider and another to a payer. A healthcare market access program must represent appropriate use across the board. Marketers in the healthcare market must also consider that everyone involved in the supply chain is focused on value-based care and outcomes. As recently as a decade ago, the main themes in healthcare market access programs were efficacy, outcome, and cost.
Identify the focus
Access programs can’t go light on sending out messages about which stakeholders (such as physicians) care the most. The patient’s focus should extend beyond cost and condition. They are often overwhelmed when dealing with a diagnosis or in the case of an escalation of a condition. Healthcare providers have got to understand how patients feel emotionally about their diagnosis and it is vital to address that too.
Use social media
A highly effective healthcare market access strategy to disseminate information and create demand is by doubling down on social media. In fact, a popular company in the healthcare market used Facebook, home to numerous patient communities, to promote a recent co-pay program. The patients were given the opportunity to sign up and get a co-pay card. This healthcare market access strategy worked really well for the company.
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Bring teams together
A perfect healthcare market access strategy takes a lot of planning and work, and much of that work is still completed in silos. Consequently, healthcare programs that are isolated which lead to suboptimal results for patients, payers, and providers alike. When healthcare market access programs are planned across audiences and at the same time, their messaging are more likely to come across more authoritatively. A digital platform that works in conjunction with EHRs should be used to perform this process and can be embedded into provider and payer workflow.
Patients who are diagnosed tend to get calls from their HCPs, pharmacy access managers, specialty pharmacy staffers, and insurance providers. It often happens that the avalanche of information can result in problems down the road, given that patients might not be able to take in all the data presented to them or the question asked to them. It becomes much more effective when a single point of contact is provided – it could either be one rep from the hub or one person from the healthcare company.
Healthcare market access vs patient access
Healthcare market access has become a buzzword as access to markets is as significant a hurdle to product used as the registration itself. Although, earlier a topic for pharmaceutical companies concerned mostly about volume, it now affects all aspects of healthcare. Industry experts at Infiniti Research believe that the current understanding of healthcare market access will undergo a fundamental shift of perspective away from a company-centered towards a patient-centered view of the problem. There are several forces that challenge the current understanding of healthcare market access and lobby for a patient-centered, comprehensive approach that aims to address the needs of all stakeholders, but primarily create value for patients through a patient access model. Some of the key reasons why the current approach is doomed to fail include:
- The term ‘healthcare market access’ is primarily of a self-centered mindset, which is one of the reasons that could result in a paradigm change. Healthcare companies who want access to markets, revenues, and profits aim to persuade those that control access to let them in. But the market access framework often does not address the needs and goals of all the parties involved. Healthcare market access looks at the world from the perspective of companies with the ultimate goal of improving reach for their products and also of their attention focused on convincing payers of the value of its products.
- Market access is considered a remedy to address the pricing pressures the healthcare industry is facing. As policy-makers and payers are tirelessly looking for ways to control cost without compromising on care, the failure to communicate a convincing value proposition to the stakeholders results in increased price competition. The rising use of tenders as a means of cost containment should be interpreted as a failure to communicate the value of medication.
- Healthcare market access is based on a one-size-fits-all, product-driven marketing model. Patients have similar needs and the existing healthcare systems go about pursuing the same common goal which is improving public health – differently. A one-size-fits-all approach proves to be ineffective in addressing the different needs in each market. That being said, managing market-by-market is not realistic either. In this case, it is vital to define market archetypes and address the needs of each archetype effectively while leveraging limited resources efficiently.
- Traditional marketers focus on lagging metrics such as the number of patients diagnosed and a number of patients receiving treatment. However, they often fail to understand and appreciate the patient and payer journey. Marketers need to focus on understanding the ‘why’ instead of the ‘what’ in the healthcare system.
- Patient access focuses on actual product usage. Although market access is often tasked with obtaining strong pricing and favorable reimbursement status, this mindset ignores real product uptake.
How to move from healthcare market access to patient access model?
- Companies must be aligned with researching, developing, and delivering products that improve people’s lives. They have to recognize that its goal is to demonstrate the value proposition.
- Create a formal framework that identifies the impact of decisions on patient access. Get prior payer input and advice.
- Develop a deep understanding of all the stakeholder’s goals and key performance indicators. Map the complete patient journey. Understand the payer flow.
The way forward
The Affordable Care Act currently remains a core part of the U.S. healthcare framework. Will it eventually be replaced in whole or part by another reform? This is something that we are to wait and watch. In the interim, there are core trends such as higher out-of-pocket payments and more value-based models that will define how to engage in today and tomorrow’s healthcare market. Leaders in the healthcare market need to understand the long-term implications of the evolving landscape and undertake proactive actions to secure their companies’ future. This means looking beyond the immediate landscape in the healthcare system and adapting to change healthcare programs in the years to come.
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