MedTech + Mindset Newsletter #018

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This week we're making a request for feedback, Medtech+Mindset Moment Rankings, and digging into the most popular one.

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2. Medtech+Mindset Moment Recap

Insight from Matt Tucker

Below are the most recent Medtech+Mindset Moments ranked in order of views. If you missed any of them, hop in and take a look!

Perfectionism

Just one slide?

Too much learning?

Digestible Bites

Take a beat

Take to the oars

3. Secrets of Medical Policy

Insight from Matt Tucker

I hear a lot of manufacturers talk about how surprised they are that payers don’t get excited about the innovations they are bringing to market. Payers are faced with so many different vendors all saying the same thing. To payers, manufacturers have some sort of ulterior motive or agenda. 

So it’s important when communicating with them to make sure you are connecting with them on an emotional level that is centered on improving patient care and helping patients manage their pocketbooks. This focus during your conversations can help you cultivate a positive relationship. 

But eventually, you’ll have to face medical policy.

Medical policy is designed to establish just three things. Those things are medical necessity, efficacy, and the safety of a product. 

Medical policy professionals consider four key areas which help them validate the effectiveness, usability, and economics of a product. What I’ve noticed however is that most manufacturers overly focus on the evidence category when giving payers information, which limits their chances of adoption. It’s very important for everyone to know is that while clinical evidence is a very important piece of the puzzle, is not the only piece of the puzzle. 

When the medical policies staff goes to evaluate a product there really focused on what problem it solves, what improvement it makes, and then use this framework to make the best decision they can. The first thing they do is to look at what other national or regional payers are doing with regards to a new technology. They will benchmark whether it’s covered by other payers. In the case of a Blue Cross Blue Shield affiliate, they will look to the blues Association as a reference. 

Going to clinicians in academic centers is very common. While plans don’t want to be overly risky, they do want to understand and be part of the adoption of valid innovations that can help improve clinical care, radically change the economics of care delivery, or would be a marketable technology that makes them look good to prospective patients. 

The last category is off everyone’s radar. Payers evaluate the current treatment pathway and how a new product changes that pathway. They want to understand if it is significantly changing how providers are delivering care, if it changes ways of working or how the provider’s office may function. They are very sensitive to clinician disruption. 

You have to be cautious how you discuss your offer when you are significantly challenging the status quo by suggesting the replacement of one category of products for different one. If the product category is entrenched and ingrained in the workflow of the clinician’s office or treatment algorithm, sometimes it can be viewed as so disruptive the clinical or economic benefits don’t outweigh the ‘provider abrasion’ the payer will have to manage. 

If you aren’t thoughtful in how you structure and plan your conversations, you can find yourself in an uphill battle against both providers and payers as they face the challenges of changing practice habits and behaviors that have been ingrained in doctors for decades. 

Their goal is to figure out how excepted your product is in the market and whether they would be doing something different than the norm if they covered your product. This is where you can really get hurt if you are a newer technology or if you are truly disruptive. You can be seen as an unknown or as something that is too risky. 

If the payer doesn’t find evidence that your product has been covered by other payers, they will balance the information they are collecting by talking to clinician key opinion leaders. This could be at a local level, within the health systems most associated with their plan, or could be at a national level and using thought leaders at other health systems that are more nationally known. 

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