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 the Client’s Patient  Collateral Material Development Message Development Experience through the and Website Content Reimbursement and Patient Population  Product Dossiers Assistance Process  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 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 No 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  Managed  Utilization  AMP Four (4) Sides  Indian Health  Specialty  Long Term Care Medicaid Controls  HCPCS Distributors  Samples of a 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  Informed by primary and secondary research success or failure of my product or service? Scan  The Aequitas Group experts filter and interpret data  What trends may derail my opportunity?  Anticipate issues for proactive management  What other entities have fallen  Review potential competitors by modality, target, or therapeutic area out of development and why? Pipeline  Identify opportunities and threats  Who will be competing for my clinical trial patients? Analysis  Data may inform clinical trials, publication schedules, launch plans  What endpoints do I need to hit for differentiation?  Is my strategy informed by the most up-to-date, reliable market  Review best-in-class strategies to develop yours information? Scenario  Test your plan prior to launch  Am I looking at the right competitors? Planning  Strengthen your team and develop tactics for strong execution  What are the real issues my plan will face in the marketplace? Actionable Intelligence Informs Critical, Key Decisions INSIGHT | STRATEGY | EXECUTION 13
  14. 14. Call Center Design and Compliance Auditing Is 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 INSIGHT | STRATEGY | EXECUTION 14
  15. 15. Call Center Design and Compliance Auditing Know the Rules to Design a Sophisticated Program Insurance Co-Pay Hardship Documentation Verification Assistance Exception  Pharmacy Switch  Collateral  Drug Expense  Inclusion of Total Only?  Pre-Populated  Service Expense Medical Costs  Legal Interpretation of Website  Foundation Design  Income Variable or Programs Allowed for  Advocate Letters  SPAP Utilization Sliding Scales Government Covered  Attestation/Form  FPL or Straight Line Patients  LIS Review 4506-T Income Language Alternative Formal Signature Alternative & Literacy Funding Requirement Communication  Foreign Language  Transportation  Electronic  Text Messages Lines Costs Signatures  Email Based  Collateral at  Utility Bills  Verbal Authorization Communication Appropriate  Quality of Life Items  Web Portals Language Arts Level (e.g., wig for cancer patients) INSIGHT | STRATEGY | EXECUTION 15
  16. 16. The Aequitas Value Proposition Insight Strategy Execution INSIGHT | STRATEGY | EXECUTION 16
  17. 17. Insight. Strategy. Execution. 12680 High Bluff Road Suite 110 San Diego, CA 92130 T: 858.847.9126 F: 858.509.4739 INSIGHT | STRATEGY | EXECUTION 17