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Deloitte Market Access Accelerator

The overall US health care ecosystem is evolving and a convergence of trends, led by health care reform, is accelerating the rate of change. These macro trends are contributing to the emergence of a new “normal” with evolved stakeholders that drive cost pressures and new requirements for Life Sciences companies. Macro trends are creating new customers as well as shifting relative influence at a national and state level. With scarce resources and continuing customer change, it is critical for Life Sciences companies to prioritize where and how to allocate resources against external stakeholder needs. Furthermore, Life Sciences companies run the risk of significant revenue losses if they do not proactively plan for the changes in the ecosystem. With systemic cost pressures and availability of substitutes, margins will be further compressed and some portions of the portfolio are more likely to be impacted than others.

Our Market Access Accelerator impact model provides a quantitative tool to track shifts in customers across major reimbursement channels and helps clients in their efforts to understand impacts to regional customer influences and Life Sciences revenues. Analysis include:

  • Projection of shifts in covered lives across major channels as current payors evolve and new payors emerge (e.g., Health Insurance Exchanges (HIX) 2010-2020)
  • Determination of regional differences in customer influences based on understanding of state specific drivers (e.g. HIX implementation dates, shifts in pharmacy Medicaid benefits)
  • Scenario analysis of differences in channels dynamically modeled through several levers such as “more employers drop coverage” vs. “expansive Medicaid expansion”
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Mini-Case Study

Business Problem
With provisions of Health Care Reform beginning to take effect and other ongoing industry trends, the client recognized that its managed markets strategy had to address new and evolving payor groups in order to:

  • Prevent erosion to existing revenue
  • Address distinct regional/local customer characteristics and needs
  • Capitalize on potential revenue from newly insured populations
  • Increase influence on structure and engagement models with emerging payor segments

Our Approach
Our team collaborated with the client to develop baseline assumptions, establish a set of select model variables and build out scenarios of interest. The model was built using client-specific data and aggregated analysis from interviews, Deloitte’s Actuarial practice, industry reports and studies. The client’s portfolio was overlaid on top of the evolving payor landscape to determine potential revenue impacts. In addition, workshops were conducted to identify major strategic imperatives for the client’s Managed Markets function based on insights from model.

Value Delivered
Our team delivered a highly dynamic quantitative model to track shifts in market access accelerator, structured specific to the client’s portfolio needs. We helped identify the impact of shifts in market access accelerator and other HCR related impacts such as increased Part D rebates, formulary restrictions, state controlled exchanges to the client’s biopharma portfolio. The analysis was used to identify and recommend major strategic imperatives for the client’s Managed Markets and Commercial functions.

Publications

The impact of health care reform on insurance coverage: Update 2012
In this report Deloitte Center for Health Solutions evaluates a range of possible reform-driven outcomes on insurance coverage, from how employers might respond to cost increases to how uninsured individuals.
Health insurance exchanges: A strategic perspective
This Issue Brief provides an overview of requirements for health insurance exchanges, including anticipated coverage and outlines implications for key stakeholders.
Moving targets
This article  focus on indirect impacts related to the changing nature of their relationships to other sectors and the choice and consumption of their products could be an even greater catalyst for transformation.
Life sciences and health reform: No going back
Tune into the latest episode of Deloitte Insights to learn more about the impact of health care reform on the life sciences industry.
Challenge Questions addressed
Local market decision-making
  • How are local markets evolving?
  • Who are the dominant stakeholders?
  • What are the levers of control?
Revenue impact
  • What is the level of impact due to shifts of lives between commercial and government reimbursement channels?
  • What should our contracting strategy be?
Capability requirements
  • What capabilities are required to face off against these new influencers?
  • How do LS organizations prioritize stakeholders and allocate resources to address evolving needs?

  

Our leadership team

Ralph Marcello
Principal, Deloitte Consulting LLP
Greg Szwartz
Director, Deloitte Consulting LLP
Terry Hisey
Principal, Deloitte Consulting LLP <br>Life Sciences Vice Chairman
Scott Evangelista
Principal, Deloitte Consulting LLP<br> Life Sciences Commercial Lead
Kevin Kenny
Principal, Deloitte Consulting LLP
Rob Jacoby
Senior Manager, Deloitte Consulting LLP

As used in this document, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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