BLURRING THE LINES BETWEEN PAYERS & PROVIDERS
1
WE ARE READY TO SUPPORT YOU PLEASE CONTACT US FOR ADDITIONAL INFORMATION CONTACT@JUPITERLS.COM 1.833.JUPLIFE (587.5433) JUPITER LIFE SCIENCE CONSULTING IDNs Explained What do you get when you cross a payer with a provider? Some have coined this union as “payviders”. 1 Others call them integrated delivery networks or IDNs. Everyone is talking about them. Specifically, an IDN is a formal system of providers and sites of care that provides both health care services and a health insurance plan to patients in a particular geographic area. The goal for IDNs are to come together for more efficient use of resources, provide better quality of patient care and achieve homogeneity in guidelines and formularies within the network of physicians. This coordinated care is to ensure that patients and populations get the right care, at the right time and without harm, while avoiding care that has no proven benefit or represents an unnecessary duplication of services. This may sound familiar, like an ACO, right? IDNs can be part of an ACO. INTEGRATED DELIVERY NETWORK PROVIDERS & PATIENTS IDNS PAYERS Why Should I Care? • Providers are aligning with IDNs to capture patient volume, adjust to decreasing payer reimbursement, optimize revenue, and reduce financial risk • IDNs are impacting patient care, and the data and evidence required for uptake within these systems CENTRALIZING CARE MANAGEMENT • Treatment decisions moving to administrators and non- prescribers • IDN mechanisms for utilization management can impact physician prescribing decisions, e.g., centralized physician order entry (CPOE), centralized drug formularies and pathways to direct oncologists toward preferred therapies LEVERAGING SIZE TO NEGOTIATE PRICE • IDNs are taking on risk in the form of bundled payments and population health management, also coordinating with commercial payers and developing models for specific populations and sub-populations • Focus on novel reimbursement is highly disruptive to traditional fee-for-service reimbursement models INCREASING PATIENT INVOLVEMENT • Patient affordability issues are at the forefront in treatment decisions, with IDN physicians often looking to less costly drug alternatives Are You Ready? Jupiter Can Help You Develop an Actionable IDN Strategy PAYER SEGMENTATION Know your customer, Identify which integrated health systems are important and which individuals to approach within them COMMUNCIATION STRATEGY Deliver the right message with the right evidence, shape value and evidence to position for population health goals ALTERNATIVE PRICING OPTIONS Evaluate risk-based alternative approaches, focusing on pricing, contracting and market access relative to patient populations goals STRATEGIC CHOICES Develop scenarios and execution plan for your product and portfolio SOURCES: 1. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-managed-care-trends-watch- 2017?page=0%2C5 INTEGRATED DELIVERY NETWORKS BLURRING THE LINES BETWEEN PAYERS & PROVIDERS ?
Transcript of BLURRING THE LINES BETWEEN PAYERS & PROVIDERS
WEAREREADYTOSUPPORTYOUPLEASECONTACTUSFORADDITIONALINFORMATION
[email protected](587.5433)
JUPITERLIFE SCIENCE CONSULTING
IDNsExplained
Whatdoyougetwhenyoucrossapayerwithaprovider?Somehavecoinedthisunionas“payviders”.1 Otherscallthemintegrated
deliverynetworksorIDNs.Everyoneistalkingaboutthem.Specifically,anIDNisa formalsystemofprovidersandsitesofcarethatprovidesbothhealthcareservicesandahealthinsuranceplan
topatientsinaparticulargeographicarea.
ThegoalforIDNsaretocometogetherformoreefficientuseofresources,providebetterqualityofpatientcareandachievehomogeneityinguidelinesandformularieswithinthenetworkofphysicians.Thiscoordinatedcareistoensurethatpatientsandpopulationsgettherightcare,attherighttimeandwithoutharm,whileavoidingcarethathasnoprovenbenefitorrepresentsanunnecessaryduplicationofservices.Thismaysoundfamiliar,likeanACO,right?IDNscanbepartofanACO.
INTEGRATEDDELIVERY NETWORKPROVIDERS & PATIENTS
IDNSPAYERS
WhyShouldICare?
• ProvidersarealigningwithIDNstocapturepatientvolume,adjusttodecreasingpayerreimbursement,optimizerevenue,andreducefinancialrisk
• IDNsareimpactingpatientcare,andthedataandevidencerequiredforuptakewithinthesesystems
CENTRALIZINGCAREMANAGEMENT
• Treatmentdecisionsmovingtoadministratorsandnon-prescribers
• IDNmechanismsforutilizationmanagementcanimpactphysicianprescribingdecisions,e.g.,centralizedphysicianorderentry(CPOE),centralizeddrugformulariesandpathwaystodirectoncologiststowardpreferredtherapies
LEVERAGINGSIZE TONEGOTIATEPRICE
• IDNsaretakingonriskintheformofbundledpaymentsandpopulationhealthmanagement,alsocoordinatingwithcommercialpayersanddevelopingmodelsforspecificpopulationsandsub-populations
• Focusonnovelreimbursementishighlydisruptivetotraditionalfee-for-servicereimbursementmodels
INCREASINGPATIENTINVOLVEMENT
• Patientaffordabilityissuesareattheforefrontintreatmentdecisions,withIDNphysiciansoftenlookingtolesscostlydrugalternatives
AreYouReady?
JupiterCanHelpYouDevelopanActionableIDNStrategy
PAYERSEGMENTATIONKnowyourcustomer,Identifywhichintegratedhealthsystemsareimportantandwhichindividualstoapproachwithinthem
COMMUNCIATIONSTRATEGY
Delivertherightmessagewiththerightevidence,shapevalueandevidencetopositionforpopulationhealthgoals
ALTERNATIVEPRICINGOPTIONS
Evaluaterisk-basedalternativeapproaches,focusingonpricing,contractingandmarketaccessrelativetopatientpopulationsgoals
STRATEGICCHOICES Developscenariosandexecutionplanforyourproductandportfolio
SOURCES:1. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-managed-care-trends-watch-
2017?page=0%2C5
INTEGRATEDDELIVERYNETWORKSBLURRINGTHELINESBETWEENPAYERS&PROVIDERS
?
