Improving Physician-Payer Interaction Create a conversation among the people who mean the most to your brand Gina Clark, Senior Vice President, Marketing & Business Development AmerisourceBergen Specialty Group ou’re a global pharmaceutical manufacturer with a collection of successful, physician-administered oncology products and one sizable issue: Continued use of your products may be threatened. Managed care companies may feel that your products are no longer cost-effective at their current reimbursement levels. Without adequate reimbursement, prescribing physicians may not be able to continue administering your products. Social media may be all the rage for marketing, but no amount of product promotion will overcome this issue. So what do you do? Play the part of mediator. Open a dialogue between physicians and payers to achieve common goals: cost-efficient treatment, equitable reimbursement, superior patient care. Call it marketing through diplomacy. Here’s how Specialty Group client Manufacturer X put it into action. Find the Right People For Manufacturer X’s program to be successful, the company needed to gather feedback from a host of key opinion leaders on both sides of the table. Manufacturer X looked for oncologists who would candidly discuss how clinical pathways could be improved — within their own practices, as well as nationwide. On the payer side, Manufacturer X searched for decision makers at national or large regional payers who understood that more dialogue with providers would lead to more informed coverage decisions. The program required strategic thinkers, effective communicators and collaborative workers who could commit on a long-term basis to find solutions validated by data. With help from the Specialty Group, Manufacturer X enlisted the help of physicians from 18 large oncology practices, encompassing 200 total physicians and more than 250,000 patients. Managed care representation came in the form of executives from 18 payers, who provide coverage for a combined 38.5 million Americans. Physician and payer participants provided feedback through live meetings and online surveys. The goal was to provide varied channels of interaction to let participants offer their thoughts frequently and organically. Representatives from the Specialty Group led all elements of the program to keep discussions on point and to ensure that Manufacturer X stayed neutral to the process. Create a Shared Vision of Improvement Physicians and payers who took part in Manufacturer X’s program all recognized that the current system for cancer care and reimbursement is unsustainable. They shared concern over the rising cost of cancer treatment. They all pointed to decreasing variability in cancer treatment as a key priority. Still, a large challenge remained — the fundamental lack of trust between payers and physicians. Physicians felt that some payers made reimbursement decisions without adequate clinical knowledge. Payers felt that financial considerations motivated treatment decisions among some physicians. To address this, program moderators from the Specialty Group encouraged participants to create a shared vision and common action items. Words like “sustainable and measurable" combined with “patient-centric" and “aligned incentives" to form the group’s vision. Action items focused on reducing variability of care, examining disease management to include end-of-life care and education for all stakeholders. Put Collaboration into Action Armed with these shared objectives, program participants then proposed pilot initiatives that would produce measurable results. One proposed pilot identifies clinical guideline adherence as a primary method for decreasing variability of care. In this pilot, a large oncology practice would focus on supportive care for patients with breast, lung and colorectal cancers. Metrics would include clinical guideline adherence, reduced emergency room and hospital utilization, as well as patient satisfaction. Incentives from participating payers could include bonus payments based on a percentage of calculated savings or offering a differential fee schedule. Though this pilot has yet to launch, the fact that it was proposed as a collaborative effort between physicians and payers speaks volumes about the level of trust among program participants. It also shows extraordinary promise for what can be accomplished when stakeholders put preconceived notions aside to work toward a common benefit. For Manufacturer X, sponsoring this program may not be as thrilling as seeing a channel with patient testimonials on YouTube. It may not be as cutting-edge as communicating directly to patients through Twitter. But it does affirm Manufacturer X’s position as a thought leader, an innovator, an organization dedicated to improving cancer care. More importantly, the program shows that manufacturers can facilitate solutions that address legitimate needs for stakeholders beyond those sitting in their own offices. n AmerisourceBergen Specialty Group provides the comprehensive resources needed to effectively launch, market, support and distribute specialty pharmaceuticals to providers and patients. For more information, visit www.absg.com.

Download PDF