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The Aequitas Group Capabilities Overview Q409
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The Aequitas Group Capabilities Overview Q409



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  • 1. The Aequitas Group Advantage
    Capabilities Presentation
  • 2. 2
    The Aequitas Group Specializes in the Development of Solutions Used to Define and Communicate a Product’s Value. We Deliver These Offerings in a Disciplined, Evidence-Driven Environment.
    The Aequitas Group Who We Are
    • Boutique strategic healthcareadvisory firm
    • 3. Established December 1999
    • 4. Venture backed
    • 5. Corporate office in San Diego, California
    • 6. Analysis that helps maximize product value for stakeholders
    • 7. Manufacturers
    • 8. Patients
    • 9. Providers
    • 10. Third-party payors
    • 11. Third-party vendors
    • 12. Investors
  • 3
    The Aequitas GroupWhat Makes Us Unique
    Industry experts
    Brand, Marketing, and Sales Operations Directors
    Centers for Medicare and Medicaid National Administrator
    Hospital Administrators
    Commercial Payor Medical Directors and Reimbursement Specialists
    Health Economists
    Global Government Affairs Specialists
    Regulatory Affairs Specialists
    Medical Affairs Specialists
    Patient Educators
  • 13. 4
    Specialty Pharmacy & PBM
    Payor Assessment
    Clinical Assessment
    Marketing Assessment
    Health Policy Assessment
    Hospital Administrators
    Call Centers
    The Aequitas GroupWhat Differentiates Our Approach
    • Evaluation of Complex Commercialization Factors
    • 14. Analysis and strategy for each aspect of the commercialization process
    • 15. Focus on ALL customers and service providers
  • 16. 5
    Clinical Trials
    Market Launch
    The Aequitas Group Maximizing Patient Access By…
    • Obtaining optimal coverage and reimbursement
    • 17. Translating product attributes to multiple stakeholders (patients, doctors, HMOs)
    • 18. Educating management, field force, and call center staff on product attributes and challenges
    • 19. Navigating the increasingly complex competitive landscape and regulatory environment
    Product Filings (NDA, BLA, 510K, PMA)
    Phase IV
    New Indication
    • Clinical Study Design Review
    • 20. Competitive Intelligence
    • 21. Coverage, Coding, and Payment Plan
    • 22. Pharmaco-economic Studies
    • 23. Payor Mix Analysis
    • 24. Formulary Analysis
    • 25. Physician and Sales Force Education
    • 26. Reimbursement Billing Guides
    • 27. Reimbursement Call Center Training
    • 28. Patient Assistance Program Design andOIG Guidance
    • 29. HCPCS Code Applications
    • 30. Payor Messaging and Presentation Development
    • 31. Payor Market Research
    • 32. Competitive Intelligence
    • 33. Formulary Kit and AMCP Dossier Development
    • 34. Payor Information Tracking
    • 35. Formal Policy Response
    • 36. Pharmacoeconomic Studies
    • 37. Formulary Placement Appeals
    • 38. Reimbursement Training
    • 39. Ad hoc Reimbursement Commercialization Consulting
    • 40. Competitive Intelligence
  • 6
    Call CenterDesign and Compliance Auditing
    Managed Markets Consulting
    Reimbursement Training and Patient Educators Programs
    Competitive Intelligence
    The Aequitas Group Complementary Specialties
    • Reimbursement, distribution, and access plan development
    • 41. Payor plan data collection and analysis
    • 42. Named patient programs
    • 43. Ad hoc consulting support
    • 44. Comparative effectiveness and health economic assessments
    • 45. Customized and certified reimbursement training programs
    • 46. Certified patient educator program
    • 47. Scenario planning
    • 48. Competitor review and disruptive technology analysis
    • 49. Compliance audit of patient assistance and reimbursement hotlines
    • 50. Process optimization based on patient access, channel design, and budget
  • 7
    Provider Perspective
    Payor Perspective
    Patient Perspective
    Payor Perspective
    Provider Perspective
    Patient Perspective
    Managed Markets ConsultingActivities To Match Perspectives
    • Out-of-Pocket Analysis to Inform Patient Assistance Programs and Foundation Development
    • 51. Facilitating the Client’s Patient Experience through the Reimbursement and Patient Assistance Process
    • 52. Enhance Prescriber Access Through Coverage Review and Coding Applications
    • 53. Collateral Material Development and Website Content Population
    • 54. Product Analog Analysis
    • 55. Payor Landscape Review
    • 56. Payor Marketing Plans and Message Development
    • 57. Product Dossiers
    • 58. Competitor Product Review
  • 8
    Clinical Value
    Economic Value
    Reimbursement Likelihood
    Managed Markets Consulting Aequitas Reimbursement Likelihood Ratio™
    0 100 200 300
  • 59. Managed Markets ConsultingCoverage Dashboards and Payor Tracking Systems
  • 60. Time Frame for Planning a Named Patient Program
    Marketing Authorization Anticipated
    Prepared Documents and Contracts
    Named Patient Program Established
    6 Months
    12 Months
    Managed Markets ConsultingNamed Patient Program Support
    Is Product Covered by Partner
    Authorized Country
    Send Physician
    Product NamedPatient letter LOA PI Forms Price
    Are received documents complete
    Send Letter to Physician asking for Missing Info
    Refer to Partner
    Send polite letter Can not provide drug
    Review Requestby Patient Access
    Send Polite “Reject” Letter. Can not Provide Drug
    Pass Request to Trade forDelivery of Product to Physician
    Re-label Product as Required
    Get Import License
    Ship Product to Physician Using Import Vendor
    • Information for physicians and pharmacists
    • 61. Dose and administration of drug
    • 62. Patient treatment criteria
    Receive Confirmation of Delivery ofDrug and Receipt by Physician
  • 63. 11
    Payor Introduction
    Purchasers and Distributors
    Sites of Service
    Plan Types
    Coverage and Payment
    Billing and Coding
    Payment and Alternative Funding
    Post-Graduate Institute of Medicine Certification
    Objection Handling
    Reimbursement & Patient Educators ProgramsTraining Customized by Product and by Need
  • 12
    Patient Education Hierarchy
    Reimbursement & Patient Educators ProgramsA Way to Support Your Providers and Your Patients
    The Institute of Medicine estimates that health literacy generates an annual cost of 73 billion dollars per year in healthcare
    Seventy-five percent of chronically ill Americans have low literacy skills
    Poor literacy yields a longer length of stay in healthcare entities, and it’s been estimated that poor “health literate” patients cost four times more than a “health-literate” patient to treat
    There is evidence to conclude that teaching tools, i.e., “videos, brochures, etc., help with teaching patients, but a healthcare provider who is trained on how to educate, yields the best outcomes in the progression patient knowledge
    As patients attain greater knowledge, they move up the hierarchy which allows greater control & autonomy in their personal healthcare
    Self Actualization
    UnifywithPersonal Life
    Problem Solve
    Informed Decision
    Treatment: General & Specific
    Disease- Patho-Physiology
  • 122. ScenarioPlanning
    Environmental Scan
    • May focus on Regulatory, Global Markets, Direct Competitors, Payors, Disruptive Technologies
    • 123. Informed by primary and secondary research
    • 124. The Aequitas Group experts filter and interpret data
    • 125. Anticipate issues for proactive management
    • 126. What factors will Influence the success or failure of my product or service?
    • 127. What trends may derail my opportunity?
    • 128. Review potential competitors by modality, target, or therapeutic area
    • 129. Identify opportunities and threats
    • 130. Data may inform clinical trials, publication schedules, launch plans
    • 131. What other entities have fallen out of development and why?
    • 132. Who will be competing for my clinical trial patients?
    • 133. What endpoints do I need to hit for differentiation?
    Actionable Intelligence Informs Critical, Key Decisions
    • Review best-in-class strategies to develop yours
    • 134. Test your plan prior to launch
    • 135. Strengthen your team and develop tactics for strong execution
    • 136. Is my strategy informed by the most up-to-date, reliable market information?
    • 137. Am I looking at the right competitors?
    • 138. What are the real issues my plan will face in the marketplace?
    Competitive IntelligenceAcross the Commercial Lifecycle
  • 139. 14
    Call Center Design and Compliance AuditingIs the Fox Guarding the Hen House?
    Call center audits are normally delivered by specialized firms who possess expertise regarding the industry and who are trained to identify gaps and propose methods of correction.
    Performance gaps: The gaps may cover specific teams, the entire operation, and even identify individual contributors
    Compliance: Review of how well the organization observes the various laws and regulations that guide the operations and responses
    Organizational Risks: Listing of various factors that constitute an internal or an external risk
    Reporting: The audit may cover metrics and other information used by managers to guide their decisions
    Opportunities: Internal and external situations that present improvement or cost minimization opportunities
    Weaknesses: Any areas that are clearly not at par and that must be addressed in order to improve the overall functioning of the call center
    Technology: An in depth look at the technology used by the call center to handle call routing, staffing, forecasting, etc.
    Quality: Call center QA scores, approach to scoring and coaching, feedback loop
    Management: Support staff competency,  career paths, management philosophy and approach
  • 140. 15
    Call Center Design and Compliance AuditingKnow the Rules to Design a Sophisticated Program
    Co-Pay Assistance
    Hardship Exception
    • Pharmacy Switch Only?
    • 141. Legal Interpretation of Programs Allowed for Government Covered Patients
    • 142. Collateral
    • 143. Pre-Populated Website
    • 144. Advocate Letters
    • 145. Attestation/Form 4506-T
    • 146. Drug Expense
    • 147. Service Expense
    • 148. Foundation Design
    • 149. SPAP Utilization
    • 150. LIS Review
    • 151. Inclusion of Total Medical Costs
    • 152. Income Variable or Sliding Scales
    • 153. FPL or Straight Line Income
    Language & Literacy
    Alternative Funding
    Formal Signature
    Alternative Communication
    • Foreign Language Lines
    • 154. Collateral at Appropriate Language Arts Level
    • 155. Transportation Costs
    • 156. Utility Bills
    • 157. Quality of Life Items (e.g., wig for cancer patients)
    • 158. Electronic Signatures
    • 159. Verbal Authorization
    • 160. Text Messages
    • 161. Email Based Communication
    • 162. Web Portals
  • 16
    The Aequitas Value Proposition
  • 163. 17
    Insight. Strategy. Execution.
    12680 High Bluff RoadSuite 110San Diego, CA 92130
    T: 858.847.9126F: 858.509.4739