COMPREHENSIVE SUPPORT FOR LEADERS AND DECISION MAKERS IN A TIME OF UNCERTAINTY AND DYNAMIC CHANGE
INNOVATIVE SOLUTIONS THAT UNLEASH THE POWER OF MISSING INFORMATION, CROSS STAKEHOLDER EXPERTISE AND THINKING
MAXIMIZE PATIENT ACCESS TO TREATMENT
ENHANCE VALUE OF PRODUCTS, SERVICES & FINANCING
ENHANCE VALUE OF PRODUCTS, SERVICES & FINANCING
DRIVE
SOLUTIONS THAT DELIVER RESULTS
WHAT WE DO
SOLUTIONS THAT DELIVER RESULTS
PROVIDING CLARITY THROUGH TRANSPARENCY
MINDSET
External evaluation of the status providing neutral feedback
Clean slate thinking to develop approaches reconciling myriad business, consumer and political drivers
ASSETS
Introducing new, untapped information assets to address challenges
Fusing new information with existing data to deliver fresh, executable insights
EXPERTISE
Applying cross-industry expertise to derive actionable strategies that enable desired results
Identifying new policy and research approaches by combining public and private sector experience
MINDSET
- External evaluation of the status providing neutral feedback
- Clean slate thinking to develop approaches reconciling myriad business, consumer and political drivers
ASSETS
- Introducing new, untapped information assets to address challenges
- Fusing new information with existing data to deliver fresh, executable insights
EXPERTISE
- Applying cross-industry expertise to derive actionable strategies that enable desired results
- Identifying new policy and research approaches by combining public and private sector experience
COMPREHENSIVE SUPPORT FOR LEADERS AND DECISION MAKERS IN A TIME OF UNCERTAINTY AND DYNAMIC CHANGE
INNOVATIVE SOLUTIONS THAT UNLEASH THE POWER OF MISSING INFORMATION, CROSS STAKEHOLDER EXPERTISE AND THINKING
LINE OF SIGHT INTO CROSS-STAKEHOLDER THINKING,
UNTAPPED INFORMATION ASSETS AND NEW ACTIONABLE STRATEGIES
RANGE
ATTUNED TO YOUR CHALLENGES
CLIENT CHALLENGES
ATTUNED TO YOUR CHALLENGES
STRATEGY | ACCESS & CONTRACTING | FORECASTING & INVESTMENTS | SALES & MARKETING | HEALTH ECONOMICS
CHALLENGES
- Business / Commercial models implemented are delivering wildly inaccurate projections, even for blockbuster innovations
- Limited intel into business models and interactions between Patients, Pharma, Providers, Payers and Policy leave an incomplete and unclear picture of real market potential of product innovations and treatment options
- Pricing, purchasing, reimbursement and rebate approaches do not reflect increasing payer market segment variations in plan designs nor patient and consumer on-the-ground experience
- Diminishing effectiveness of Patient support programs to address affordability, adherence and disease management driven by lack of timely access to changing variables related to patient experience, coverage and requirements
- Formulary inclusion alone is not enough – real patient access can only be assessed through a holistic look at financing, coverage, treatment, access, and market segment distribution
ACCESS | COVERAGE INSIGHTS| AFFORDABILITY | ADHERENCE | ENGAGEMENT & SUPPORT
CHALLENGES
- Inability to reliably evaluate patient access to life altering drugs and services due to lack of centralized data and information about coverage, out of pocket expense, treatment, and restrictions
- Those with complex medical needs continue to have difficulty accessing appropriate treatment as well as understanding key coverage exclusions and out of pocket expenses
- More variations in coverage requirements and prerequisites are leading to ballooning patient financial “surprises”
- Increasing differences in benefit design among consumers on employment, geography and market segments
- Promise of “patient-centricity” has not yet been fulfilled – patients need additional support to become true partners in their care
COVERAGE BARRIERS | INFORMATION TRANSPARENCY | ADVOCACY STRATEGIES | MEMBER SUPPORT
CHALLENGES
- More than half the population’s coverage and benefit design details across market segments have not been easily accessible
- Patient advocates lack access to key data on coverage restrictions/exclusions, stratification of financial burdens across insurance market segments
- Too time consuming and resource intensive to identify and analyze information from disparate sources across state, federal and public sources in order to be proactive and drive desired advocacy efforts
- Tailored, innovative approaches and solutions are needed to enhance and expand the reach of member/consumer support services related to complex health insurance issues and decisions
- Lack of an integrated view of the socio-economic burdens of patients with complex and/or chronic conditions to drive cross-industry support and engagement strategies as well as program and policy reforms
POLICY ASSESSMENT | IMPACT ANALYSIS | STRATEGIC ADVISORY | RESEARCH | STATE AND FEDERAL
CHALLENGES
- Lack of access to detailed health coverage variations across market sub-segments to support and drive state and federal level policy efforts
- Need for comprehensive evidence of real distribution of affordability and access barriers to enrich legislative strategies and advance advocacy campaigns
- Increasing demand for supporting capabilities and intelligence along with data and information to address myriad legislative and regulatory challenges
- Demand for timely, practical and novel research that is actionable by policy makers and healthcare stakeholders
- Limited transparency and insight into private and public sector health care payors’ benefit design decisions, coverage policies, and requirements, contracting strategies, operational approaches and control over utilization of drugs and medical services by providers and patients
EDGE
TRANSFORMATIVE APPROACHES
WHAT WE DO
TRANSFORMATIVE APPROACHES
STRATEGY
Leveraging understanding of business and political drivers of cross-stakeholders by market and geography to pressure test existing and/or develop innovative approaches
Product commercialization strategy, planning and execution by market sub-segments
Comparison of potential impact of traditional and new launch approaches on market penetration for product, service and financing offerings
Tailored market approaches for products and services that are first in class, or in challenging or/and niche therapeutic areas
Addressing Market Opportunity ≠ Service Obtainable Market powered by new untapped information and cross-stakeholder business insights
Leveraging understanding of business and political drivers of cross-stakeholders by market and geography to pressure test existing and/or develop innovative approaches
Product commercialization strategy, planning and execution by market sub-segments
Comparison of potential impact of traditional and new launch approaches on market penetration for product, service and financing offerings
Tailored market approaches for products and services that are first in class, or in challenging or/and niche therapeutic areas
Addressing Market Opportunity ≠ Service Obtainable Market powered by new untapped information and cross-stakeholder business insights
PATIENT ACCESS & AFFORDABILITY
Model distribution of covered lives by market sub-segment, state and carrier with associated medical, drug and device benefit management
Evaluate different levels of access by patients to products and services by therapeutic area or disease state based on the source of their health care coverage
Affordability models based on current plan design attributes to show patient financial burden, payer medical expense and utilization for products and services by state, market segment, payer and plan benefit types (Deductible, MOOP, Co-Pay, Co-Insurance)
Assess impact of access requirements and restrictions by payers on specific products or/and services across geographies and market segments
Enhance patient support programs and tools to incorporate financial and coverage attributes specific to plan designs based on market segment
Model distribution of covered lives by market sub-segment, state and carrier with associated medical, drug and device benefit management
Evaluate different levels of access by patients to products and services by therapeutic area or disease state based on the source of their health care coverage
Affordability models based on current plan design attributes to show patient financial burden, payer medical expense and utilization for products and services by state, market segment, payer and plan benefit types (Deductible, MOOP, Co-Pay, Co-Insurance)
Assess impact of access requirements and restrictions by payers on specific products or/and services across geographies and market segments
Enhance patient support programs and tools to incorporate financial and coverage attributes specific to plan designs based on market segment
MARKET OPPORTUNITIES & INVESTMENTS
Identify global and regional market trends and opportunities by payer markets, drivers and business approaches
Intelligent segmentation with new insights on actual covered lives, plan and benefit design attributes, and geographic variations
Evaluating investments that incorporate access, coverage and reimbursement variations across market segments
Stress testing of current and planned investment strategies through cross-stakeholder drivers and return potential variables by market
External assessment of prospective joint ventures, mergers and acquisitions based on new data and insights on actual market potential, and ROI on commercialization
Identify global and regional market trends and opportunities by payer markets, drivers and business approaches
Intelligent segmentation with new insights on actual covered lives, plan and benefit design attributes, and geographic variations
Evaluating investments that incorporate access, coverage and reimbursement variations across market segments
Stress testing of current and planned investment strategies through cross-stakeholder drivers and return potential variables by market
External assessment of prospective joint ventures, mergers and acquisitions based on new data and insights on actual market potential, and ROI on commercialization
PATIENT SUPPORT & ENGAGEMENT
Development of tailored approaches and solutions to enhance and expand the reach of member/consumer support services related to complex health insurance issues and decisions
Disaggregation of product and service patient access across market segments to develop support and engagement strategies and options
Apply Leverage’s Comprehensive Patient Experience (CPE) Solution to establish an integrated view of the socio-economic burdens of patients with complex and/or chronic conditions using the insights to drive cross-industry support and engagement strategies as well as program and policy reforms
Provide tools to enhance consumer understanding and knowledge to effectively leverage and utilize the health care system
Build solutions and approaches to provide patients with necessary additional support to become true partners in maintaining and managing their health
Development of tailored approaches and solutions to enhance and expand the reach of member/consumer support services related to complex health insurance issues and decisions
Disaggregation of product and service patient access across market segments to develop support and engagement strategies and options
Apply Leverage’s Comprehensive Patient Experience (CPE) Solution to establish an integrated view of the socio-economic burdens of patients with complex and/or chronic conditions using the insights to drive cross-industry support and engagement strategies as well as program and policy reforms
Provide tools to enhance consumer understanding and knowledge to effectively leverage and utilize the health care system
Build solutions and approaches to provide patients with necessary additional support to become true partners in maintaining and managing their health
POLICY & ADVOCACY
LEGISLATIVE | REGULATORY
Predictive and Retrospective impact assessments on legislative and regulatory policy initiatives and industry trends at the state and federal levels
Comprehensive strategic support on the development, evaluation and execution of state and federal legislative and regulatory policy initiatives
Expert consulting and advisory support in response to potential regulatory and legislative risks
Provide recommendations to drive legislative and regulatory policies by leveraging plan design variations and access factors across market sub-segments and geography
Deploying comprehensive evidence of real distribution of affordability and access barriers to enrich advocacy campaigns and initiatives supporting patient and consumer groups
Predictive and Retrospective impact assessments on legislative and regulatory policy initiatives and industry trends at the state and federal levels
Comprehensive strategic support on the development, evaluation and execution of state and federal legislative and regulatory policy initiatives
Expert consulting and advisory support in response to potential regulatory and legislative risks
Provide recommendations to drive legislative and regulatory policies by leveraging plan design variations and access factors across market sub-segments and geography
Deploying comprehensive evidence of real distribution of affordability and access barriers to enrich advocacy campaigns and initiatives supporting patient and consumer groups
INNOVATIVE HEALTH ECONOMICS
PDEOR: Payer Desired Economics and Outcomes Research – by Market Segment by applying new untapped coverage attributes and insights to health economic models
Enhance value dossiers by determining effect of coverage, payer medical expense and patient affordability by risk pool using proprietary solutions
Provide retrospective analysis combining transactional data with on-the-ground access, design, usage and social determinant attributes
Support and develop pricing and reimbursement models by Payer sub-segments that include utilization factors and variables incorporating benefit variations, restrictions and requirements to bolster policy, regulatory and HTA submissions
Evaluate impact of different payer accumulator policies on Pricing, Rebates and Reimbursements
PDEOR: Payer Desired Economics and Outcomes Research – by Market Segment by applying new untapped coverage attributes and insights to health economic models
Enhance value dossiers by determining effect of coverage, payer medical expense and patient affordability by risk pool using proprietary solutions
Provide retrospective analysis combining transactional data with on-the-ground access, design, usage and social determinant attributes
Support and develop pricing and reimbursement models by Payer sub-segments that include utilization factors and variables incorporating benefit variations, restrictions and requirements to bolster policy, regulatory and HTA submissions
Evaluate impact of different payer accumulator policies on Pricing, Rebates and Reimbursements
LEGAL ADVISORY
LITIGATION | INVESTMENTS | CORPORATE
Application of private and public sector health care payors’ benefit design decisions, coverage policies, contracting strategies, operational approaches and control over utilization of drugs and medical services by providers and patients
Risk consultation on potential litigation in emerging public health crises and product commercialization strategies
Identification of applicable state and federal government functions, availability and dissemination of information, as well as regulatory and legislative levers that could be used to mitigate damages
Advisory consulting on joint ventures, mergers and acquisitions enabled by new data and insights on real market penetration, reimbursement potential and return on investments
Application of private and public sector health care payors’ benefit design decisions, coverage policies, contracting strategies, operational approaches and control over utilization of drugs and medical services by providers and patients
Risk consultation on potential litigation in emerging public health crises and product commercialization strategies
Identification of applicable state and federal government functions, availability and dissemination of information, as well as regulatory and legislative levers that could be used to mitigate damages
Advisory consulting on joint ventures, mergers and acquisitions enabled by new data and insights on real market penetration, reimbursement potential and return on investments
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STRATEGY
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PATIENT ACCESSS & AFFORDABILITY
PATIENT SUPPORT & ENGAGEMENT
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MARKET OPPORTUNITIES & INVESTMENTS
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POLICY & ADVOCACY
INNOVATIVE HEALTH ECONOMICS
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LEGAL ADVISORY
ASSETS
NOVEL CUSTOMIZABLE SOLUTIONS
INNOVATIVE SOLUTIONS
NOVEL CUSTOMIZABLE SOLUTIONS
MEDIA
UNDERSTANDING THE BIGGER PICTURE
HOW WE THINK
UNDERSTANDING THE BIGGER PICTURE
PAYER STRATEGIES
CASE STUDY |HC-LS-CS-D 6580
IDENTIFY TARGET OPPORTUNITIES, DEVELOP PAYER STRATEGIES AND COMMUNICATE DEVICE VALUE AND PRICING TO DIFFERENT STAKEHOLDERS
PAYER STRATEGIES
CASE STUDY |HC-LS-CS-D 6580
IDENTIFY TARGET OPPORTUNITIES, DEVELOP PAYER STRATEGIES AND COMMUNICATE DEVICE VALUE AND PRICING TO DIFFERENT STAKEHOLDERS
ACCESS TO DRUGS
CASE STUDY |HC-LC-CS-P 3321
DRIVING ACCESS TO DRUGS WHILE REDUCING OPERATIONAL EXPENSE IN THERAPEUTIC AREAS WITH NO PREPONDERANCE OF COVERAGE
IMPROVING ECONOMIC ACCESS
CASE STUDY |HC-LS-PH-COM-CS-P 3024
IMPROVING ECONOMIC ACCESS AND SHIFTING CASH PAY TO COMMERCIAL PAY FOR BRAND
IN THE NEWS
NEWS ARTICLE |HC-NA-168
A RHODE ISLAND RULE ON HEALTH ENROLLMENT OFFERS A CONSUMER EXPERIMENT
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UNFOLDING THE FUTURE TOGETHER
Client Partners are seeking supplemental information and unique perspectives to take advantage of changing business models, consumer needs and uncertain legislative and regulatory environments. They are exploring alternatives to enhance or/and shift traditional approaches that are not achieving desired levels of return on investment.
