1. Integrated Research Methodology
Integrating Primary, Formulary, and Utilization Data to Assess Stakeholder Influence
Dmitry Goldenberg, JD
Global Consulting Services, Decision Resources Group
Why Read This Poster?
Key Trends Impacting Prescribing Decisions
Key Questions Requiring Integrated Data Analysis
Provider Trends
Acquisition and consolidation of providers groups
Standardization of product utilization and use of clinical treatment pathways
Decreasing payer reimbursement
Payer Trends
Shift from fee for service to fee for value
Increasing management of high- cost categories which have direct product competition
Increasing emphasis on quality care for patient populations
Stakeholder Influence Re-Evaluation: The transformation and consolidation of the US healthcare system is causing traditional prescribing dynamics to change and biopharmaceutical companies to re-evaluate their stakeholder engagement strategies and tactics.
Evolution of Research Methodologies: Traditional primary market research methodologies are no longer sufficient to evaluate the full ramifications of market trends on product sales. New research methodologies using payer formulary data and provider utilization should be used to obtain a 360 degree assessment of the factors that may influence product utilization and market share.
Matching Reported and Historical Actions: The use of formulary and provider utilization data is essential to ensure that the reported behavior of stakeholders through qualitative and quantitative market research, matches their actual market behavior and biopharmaceutical engagement efforts translate to a positive return on investment (ROI).
Does payer access that a biopharmaceutical company obtains through payer rebates translate to increased product utilization?
What influence does payer management have on product utilization at an individual physician and provider group level?
How can payers be segmented based on their ability to influence provider utilization of products?
How can providers be segmented based on their ability to counteract payer management actions?
Payers
Prescribing Decision
Market Trends
Providers
Patients
Patient Trends
Shift of costs to patients through increased out-of-pocket co-pays and co-insurances
Consumerization of healthcare and patient empowerment to evaluate potential product choices
Increased direct-to-consumer advertising which may dictate product choice
Key Data Sets for Integrated Data Analysis
Environmental Trends
Vertical and horizontal consolidation of stakeholders
Expansion of non-traditional prescribing stakeholders influence
Increased emphasis on healthcare costs, including drug pricing
Environment
Payer formulary data
Product utilization and claims data
Provider and provider-group affiliation/roll-up data
Regional MSA relationship and market share maps of payers and providers 3
Analyze Provider Utilization 4
Examine Management vs. Utilization 1
Set Up Analysis Architecture 2
Analyze Payer Management
Identify product category and key products for the analysis
A basket of products should be used with comparable clinical data, used along the same line of therapy, and being actively managed by US managed care organizations
Identify regions across the United States for analysis based on business relevance (e.g., top states by product revenue, regions with the most covered lives, or other factors)
Analyze payer and provider linear relationships within identified regions to identify target providers and payers for analysis
Analyze payer management of target payers to create management archetypes based on common utilization management levers
Segment payers based on the level of differential management exhibited by payers
Analyze provider utilization and identify preferred products across individual physicians and provider groups
Roll-up individual provider utilization to provider groups and institutions
Match provider utilization to key regional payers to enable linear analysis of payer management and actual utilization patterns
Overlay the utilization management of payers with provider product utilization
Assess whether payer product preference through utilization management policies translates to higher utilization of preferred products by providers
Conduct primary research to evaluate factors that may impact provider treatment decisions
Analyze return on investment of payer access rebates for preferred access vs. actual product utilization
Archetypes
Management Detail 1
Preference of 2 products through double step therapy 2
Preference of 2 products through single step therapy and differential co-pay 3
No product preference and parity access
Integrated Research Methodology
Individual Provider TRx/NRx
Rolled-Up Provider Group
TRx/NRx
Mapping Provider Utilization to Regional Payers
Actual Product Provider Utilization vs. Product Payer Preference
Group 1
High
70% market share for Brand X
Payer 1
Good ROI on payer access rebates; translates to higher provider product utilization
Relationship Analysis
50% of HCP 1 patients are from payer 1, and 50% from payer 2
100% of HCP 2 patients are from payer 2
High Adherence to Group Preference
High Adherence to Payer UM
Actual Product Provider Utilization
HCP 3
HCP 1
HCP 2
Payer 2
Payer 1
Group 2
30% market share for Brand X
50% market share for Brand Y
Payer 1
No Product Preference
Low Adherence to Payer UM
Bad ROI on payer access rebates; does not translate to higher product utilization
High
Payer 2 1 2
Low
Level of Management
Low
High
Payer Preference Through Utilization Management (UM) 3 4
Low 0M 5M
10M+
# of Covered Lives