Managed Care Plan Payer Hierarchy Management
By:
fundae
Pharmaceutical companies often face significant challenges in aligning internal revenue data with external market data due to multiple, inconsistent plan payer hierarchies. This misalignment leads to inefficient negotiations, delayed market access, suboptimal pricing strategies, inadequate coverage, poor compliance management, and challenges in performance and contract optimization. fundae addresses these issues by mapping internal plan payer hierarchies with syndicated data, ensuring comprehensive integration and enriched analysis. This unified approach enhances contract effectiveness, strategy success, term feasibility, optimal pricing, and market access.
Overview
Pharmaceutical companies frequently encounter significant challenges when trying to align their internal revenue data with external market data. One of the core issues is the presence of multiple, inconsistent plan payer hierarchies (PPH) from various sources such as Revenue Management Platforms, Syndicated Data Sources, and Master Data Management Systems (MDM), which do not seamlessly integrate. This fragmentation leads to a cascade of problems, including inefficient payer engagement, uncoordinated and ineffective negotiations, delayed market access, and suboptimal pricing strategies. Additionally, companies struggle with inadequate coverage and reimbursement rates, compliance management issues, and challenges in tracking and optimizing contract performance.
To address these challenges, fundae employs a comprehensive process that begins with extracting the plan payer hierarchy from Revenue Management Systems and Processes. fundae's advanced algorithms then match and blend this hierarchy with syndicated PPH from MMIT or DRG and MDM PPH. This crucial step ensures that all versions of the hierarchy are considered and integrated effectively. The process is further enriched by incorporating Formulary Status and Formulary Lives, providing a holistic view of the market landscape.
fundae's secret sauce lies in its sophisticated algorithms and data integration capabilities, which allow for seamless mapping and analysis of complex data sets. By bridging the gap between internal and external data, fundae provides pharmaceutical companies with enriched insights and a unified view of their market access landscape.
The output of this process includes enhanced market share analysis based on claims or prescriptions, accurate rebate tracking, and the ability to assess the effectiveness of rebate strategies. Companies can also better understand the feasibility of proposed contract terms, leading to more effective negotiations and optimal pricing strategies. Overall, fundae's solution results in improved market access, better compliance management, and more strategic decision-making, ultimately driving greater revenue and operational efficiency.
| Sold by | fundae |
| Categories | |
| Fulfillment method | Professional Services |
Pricing Information
This service is priced based on the scope of your request. Please contact seller for pricing details.
Support
fundae offers a comprehensive managed service for creating, maintaining, and updating the Plan Payer Hierarchy (PPH). This service starts with the initial creation of the hierarchy, designed to meet the specific needs of the pharmaceutical company. By using advanced algorithms and integration techniques, fundae ensures that hierarchies from various sources, such as Revenue Management Platforms, Syndicated Data Sources, and Master Data Management Systems (MDM), are seamlessly blended to provide an accurate representation.
Following the initial creation, fundae provides regular updates on a monthly or quarterly basis, based on customer needs. These updates keep the PPH current with the latest market data and internal changes, allowing companies to stay responsive and agile.
Complete white glove support is a cornerstone of fundae's service. This includes addressing all customer questions and resolving issues promptly with a mix of onsite and offshore resources. Support is available during 8/5 business hours, aligned with customer work hours (excluding holidays).
In addition to maintaining and managing the hierarchy, fundae's support includes liaising with external vendors and internal IT teams to ensure data integrity and consistency. Consulting services are also provided for integrating the PPH with transactional data sources like LAAD Claims and Model N Rebates.
However, fundae's support does not cover derivative works of the PPH, such as building custom reports or integrating the hierarchy into a data warehouse. This clear delineation ensures that fundae focuses on creating, maintaining, and updating the PPH, providing the highest level of service and expertise in these areas.