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The Aequitas Group Capabilities Overview


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The Aequitas Group Capabilities Overview

  1. 1. INSIGHT | STRATEGY | EXECUTION The Aequitas Group Advantage Capabilities Presentation
  2. 2. The Aequitas Group Who We Are  Boutique strategic healthcare  Analysis that helps maximize advisory firm product value for stakeholders  Manufacturers  Established December 1999  Patients  Venture backed  Providers  Third-party payors  Corporate office in  Third-party vendors San Diego, California  Investors 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. INSIGHT | STRATEGY | EXECUTION 2
  3. 3. The Aequitas Group What 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 INSIGHT | STRATEGY | EXECUTION 3
  4. 4. The Aequitas Group What Differentiates Our Approach  Evaluation of Complex Commercialization Factors Clinical Marketing Health Policy Payor Assessment Assessment Assessment Assessment  Analysis and strategy for each aspect of the commercialization process  Focus on ALL customers and service providers Patients Providers Payors Company ROI Hospital Specialty Pharmacy & Call Centers Investors Administrators PBM INSIGHT | STRATEGY | EXECUTION 4
  5. 5. The Aequitas Group Maximizing Patient Access By…  Obtaining optimal coverage and reimbursement  Translating product attributes to multiple stakeholders (patients, doctors, HMOs)  Educating management, field force and call center staff on product attributes and challenges  Navigating the increasingly complex competitive landscape and regulatory environment Clinical Trials Product Filings Launch Phase IV New Indication (NDA, BLA, 510K, PMA) Pre-Launch Market Launch Post-Launch  Clinical study  Physician and Sales Force Education  Formulary Kit and AMCP Dossier Development design review  Reimbursement Billing Guides  Payor Information Tracking  Competitive  Reimbursement Call Center Training  Formal policy response Intelligence  Patient Assistance Program Design and  Pharmacoeconomic Studies  Coverage, Coding OIG Guidance and Payment Plan  Formulary Placement Appeals  HCPCS Code Applications  Pharmaco-  Reimbursement Training  Payor Messaging and Presentation economic Studies Development  Ad hoc Reimbursement Commercialization  Payor Mix Analysis Consulting  Payor Market Research  Formulary Analysis  Competitive Intelligence  Competitive Intelligence INSIGHT | STRATEGY | EXECUTION 5
  6. 6. The Aequitas Group Complementary Specialties  Reimbursement, distribution and access plan development  Payor plan data collection and analysis Managed Markets Consulting  Named patient programs  Ad hoc consulting support  Comparative effectiveness and health economic assessments Reimbursement Training and Patient  Customized and certified reimbursement training programs Educators Programs  Certified patient educator program  Scenario planning Competitive Intelligence  Competitor review and disruptive technology analysis Call Center  Compliance audit of patient assistance and reimbursement hotlines Design and Compliance Auditing  Process optimization based on patient access, channel design and budget INSIGHT | STRATEGY | EXECUTION 6
  7. 7. Managed Markets Consulting Activities To Match Perspectives Provider Perspective Patient Perspective Payor Perspective 1 2 3 Patient Perspective Provider Perspective Payor Perspective  Out-of-Pocket Analysis to Inform  Enhance Prescriber Access  Product Analog Analysis Patient Assistance Programs Through Coverage Review and  Payor Landscape Review and Foundation Development Coding Applications  Payor Marketing Plans and  Facilitating Clients Through the  Collateral Material Development Message Development Reimbursement and Patient and Website Content Assistance Process Population  Product Dossiers  Competitor Product Review INSIGHT | STRATEGY | EXECUTION 7
  8. 8. Managed Markets Consulting Aequitas Reimbursement Likelihood Ratio™ Clinical Value Economic Value Lowest Reimbursement Likelihood Highest 0 100 200 300 INSIGHT | STRATEGY | EXECUTION 8
  9. 9. Managed Markets Consulting Coverage Dashboards and Payor Tracking Systems INSIGHT | STRATEGY | EXECUTION 9
  10. 10. Managed Markets Consulting Named Patient Program Support Is Send Physician Product No Yes Product Named Covered Authorized by Country Patient letter Partner LOA PI Forms Price Yes No Are Send Letter to received No Refer to Partner Physician asking documents for Missing Info complete Send polite letter Yes Can not provide drug Review Request Send Polite “Reject” by Patient Access Letter. Can not Committee Provide Drug Time Frame for Planning a Named Patient Program Re-label Product as Pass Request to Trade for Get Import License Required Delivery of Product to Physician Prepared Documents and Contracts Ship Product to Physician Using Import Vendor  Information for Marketing Authorization physicians and Anticipated pharmacists Receive Confirmation of Delivery of  Dose and Drug and Receipt by Physician administration of drug Named Patient  Patient treatment Program Established criteria 6 Months 12 Months INSIGHT | STRATEGY | EXECUTION 10
  11. 11. Reimbursement & Patient Educators Programs Training Customized by Product and by Need Post-Graduate Institute of Medicine Certification Purchasers Payment and Payor Sites of Coverage and Billing and Objection and Plan Types Alternative Introduction Service Payment Coding Handling Distributors Funding Initiation Completion  Medicare  Wholesalers  Physician Office  Medicare Part A  Policies  NCPDP  AWP  Active listening  Managed Care  Group Purchase  Hospital  Medicare Part B  Bulletins  NDC  ASP  Probing for  Medicaid Organizations Outpatient  Medicare Part C  Articles  CPT  WAC information  Veterans Affairs  Wholesalers  Hospital  Medicare Part D  Contracting  ICD-9 and ICD-  Best Price  Fluency with  Specialty Inpatient 10 FAQs  Department of  Medicaid FFS  Rebates  FUL Defense Pharmacies  Home  DRG  Working all Four  Managed  Utilization  AMP (4) sides of a  Indian Health  Specialty  Long Term Care Medicaid Controls  HCPCS Distributors  Samples case Service  Dialysis Center  Private Pay  Formulary (i.e., patient,  Pharmacy  Coupons  Infusion / Shot  Medical  Preferred Drug provider, payor, Benefit Clinic distributor) Managers Benefits Lists  Ambulatory  Pharmacy  Generic  Physician Surgical Center Offices Benefits Positioning  Specialty Benefits  Durable Medical INSIGHT | STRATEGY | EXECUTION 11
  12. 12. Reimbursement & Patient Educators Programs A Way to Support Your Providers and Your Patients  The Institute of Medicine estimates that health literacy generates an Patient Education Hierarchy annual cost of 73 billion dollars per year in healthcare As patients attain greater Self knowledge, they move  Seventy-five percent of chronically ill Actualization up the hierarchy Americans have low literacy skills Unify with which allows greater Personal Life control & autonomy  Poor literacy yields a longer length of in their personal stay in healthcare entities, and it’s healthcare been estimated that poor “health Problem Solve literate” patients cost four times more Informed than a “health-literate” patient, to treat Decision Treatment: General & Specific  There is evidence to conclude that teaching tools, i.e., “videos, brochures, etc., help with teaching Disease- Patho-Physiology patients, but a healthcare provider who is trained on how to educate, yields the best outcomes in the Safety progression patient knowledge INSIGHT | STRATEGY | EXECUTION 12
  13. 13. Competitive Intelligence Across the Commercial Lifecycle  May focus on Regulatory, Global Markets, Direct Competitors, Payors, Disruptive Technologies  What factors will Influence the Environmental success or failure of my product  Informed by primary and secondary research or service? Scan  What trends may derail my  The Aequitas Group experts filter and interpret data opportunity?  Anticipate issues for proactive management  What other entities have fallen  Review potential competitors by modality, target or therapeutic area Pipeline out of development and why?  Who will be competing for my  Identify opportunities and threats Analysis clinical trial patients?  What endpoints do I need to hit  Data may inform clinical trials, publication schedules, launch plans for differentiation?  Is my strategy informed by the most up-to-date, reliable market  Review best-in-class strategies to develop yours Scenario information?  Am I looking at the right  Test your plan prior to launch Planning competitors?  What are the real issues my  Strengthen your team and develop tactics for strong execution plan will face in the marketplace? Actionable Intelligence informs critical, key decisions INSIGHT | STRATEGY | EXECUTION 13
  14. 14. Call Center Design and Compliance Auditing Who is Watching? Pharmacists Medical Offices Patients & Care Givers Competitors Insurers INSIGHT | STRATEGY | EXECUTION 14
  15. 15. Call Center Design and Compliance Auditing Is the Fox Guarding the Hen House? Call center audits are normally delivered by specialized firms who posses 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 INSIGHT | STRATEGY | EXECUTION 15
  16. 16. Call Center Design and Compliance Auditing Managing the RFP Process The Aequitas Team Criteria Percentage  Design RFP with Procurement and MM Team needs in mind HIPAA Covered Entity and Disaster Recovery 5%  Define optimal process Distribution Capabilities 5%  Manage review Previous Experience in Therapeutic Area 5%  Summarize key findings  Submit cost Model to procurement for review Problem Solving 5% Technology / Innovation 10% Cost 10% Quality Assurance / Escalation Process 10% Training and Ongoing Information Sharing 10% Coordination with the Field 10% Credentials Criteria Lead(s) of Account Review 15% Collaboration Reporting Capabilities 15% HIPAA Covered Entity and Utilizes BA agreements Disaster Recovery Distribution Capabilities US Oncology Distribution Services and CareAdvantage Specialty Pharmacy Services Previous Experience in Yes. Oncology, Neuro and HIV Therapeutic Area Problem Solving; Question Answer showcases understanding of payor 53 of the RFP environment, but it is very light in regard to Our Client understanding the variety of approaches and solutions allowed for PAP and  Define optimal process Reimbursement Hotlines. Small volume clients may mean that Vendor has not been  Review summary findings challenged to find solutions  Select vendor INSIGHT | STRATEGY | EXECUTION 16
  17. 17. Call Center Design and Compliance Auditing Designing the Process To Match Your Patient’s Needs Benefits Investigation Initial Payor Prescription Coordination Received Financial Prior Billing Reassessment Authorization Patient Assistance Process Optimized Financial Distribution Coordination INSIGHT | STRATEGY | EXECUTION 17
  18. 18. Buying Factors Service Price Quality INSIGHT | STRATEGY | EXECUTION 18
  19. 19. The Aequitas Value Proposition Insight Strategy Execution INSIGHT | STRATEGY | EXECUTION 19