Optimi Systems Overview

The Optimi product
and its uses

© Optimi Systems Limited 2010

What Optimi does

•  Optimi enables life science companies to improve the efficiency of their
planning processes and the effectiveness of their plans for sales and
marketing

•  Optimi provides the tools to assemble and analyse the data, development
programmes to improve the skills of the staff writing the plans, and an
environment for team coordination and effective management review

•  Optimi is built round a scalable data model and process that enables a
consistent view from global forecast down to activity plans for major
accounts

•  Optimi draws data from the underlying transactions systems (Financial,
CRM, clinical, market audit) and provides outputs into the corporate
financial and business intelligence systems


The Optimi tools enable companies to:

•  Map the incidence and progress of disease and the impact of alternative
treatments so that they can identify where demand may be available to
them

•  Map the complex treatment delivery and funding processes, match them to
the disease and treatment information, and to identify where they need to
take action to enable their products to be purchased and used.

•  Understand the connections, motivations and procedures of the people
taking and influencing key decisions and where they can take action to get
decisions favourable to their products.

•  Provide a common framework for actions, a consistent repository for market
information, analysis and decisions, and planned actions, enhancing
teamwork and effective management review.


How Optimi fits with other systems
Corporate financial management Corporate business intelligence / reporting

The Optimi products
Country portfolio for Major account
Marketing planning Account selection
product planning
and strategy
Optimise investment by country
Competitive situation,
Product portfolio for Market analysis, strategy selection, Account opportunity
account decision making
positioning, actions plans, financial forecasts analysis, strategy
country at a product / country or region level
process, account strategy
selections, target setting
Optimise investment by product and implementation plan

Skill development processes

Clinical management Financial and market CRM / closed loop selling systems
systems audit systems Performance dashboards
Cycle plans
and KPI’s

Investigator relationships Market research data Product sales by Sales rep diary
hospital / brick management
Sales by product /
New product tracking Call plans
customer
Hospital / brick
Indications / registrations
Selling costs Doctor prescribing status
tracking Doctor profile

Clinical differentiation Marketing investment
Webs / E- Call Sample Call
Averts Events
Health economics blogs detailing centre tracking report
Market audits
indicators


Optimi processes and
components


The Optimi planning process flow
Market data Financial data Customer data
(ERP / Data warehouse) (CRM/ data warehouse)
(various sources)
Input including market audits, research studies
Including sales, costs and profitability by Including size, capabilities, organisation
product, market segment, geography and and procedures, company’s contacts and
competitor analysis and informal sources
customer relationships

Transform and group into standard definitions
for product, units, customer, and market
Transform
Integrate into models of markets and segments, customers and channels.
Quantify market dynamics of segment, customer and channel

Customer and channel Investment and results
Market situation Alignment of sales and marketing effort to
Quantified competitive situation and Attractiveness and business strengths with
Analyse customer / in channel
level of potential and results in relation to
profitability In each market segment effort

Market strategy Positioning Messaging
By segment, channel, customer Proposition and benefits Content and medium

Plan

Action plan Investment Impact on sales
Impact of investment on market share,
What when and who Resources required, costs and timing
persistence and decay

Integrate and optimise mix and timing of possible actions
Quantify Product P&L and ROI for 3-5 years projection

Forecast

Country plan Global product plan Customer plan
Aggregate and optimise product portfolio in Aggregate and optimise product for group of Aggregate and optimise product portfolio for
country geographies a customer


Optimi modules to integrating the total process
All components are available in English
Account strategy and account planning tools and account
planning e-learning are also available in French, German,
Spanish, Italian and Russian

Global product
situation
(Therapy maintenance)
Country situation
(Country maintenance)

Global marketing Marketing planning
management Plan for product in and account strategy Account strategy
country for each country
(Marketing planning) (Account management)

Country marketing
management Account planning

Country portfolio Product portfolio Account plans for
for each product for each country strategic accounts
(Account plans)


The benefits of Optimi


Optimi planning delivers process and profit improvement
How much time do you spend setting-up, modifying, and aggregating spreadsheets
and presentation slides? How often do you lose control over where the numbers
come from, or on what assumptions they are based?

Focus on business choices not plan Optimi provides you with
mechanics • Clear connection between assumptions, choices, and outcomes
• Visible accountability for decisions
• Version control and traceability
• Simple update for forecast revisions and new year
• Accessible from any secure intranet location
• Integrated skill development

Can you describe clearly where your opportunities are and what they could be
worth? Do you understand how your resources are aligned to these opportunities
and how productive your investments have been?

Align resource and incentives to Optimi enables you to
opportunity • Identify market opportunity by location
• Analyse current business compared to the market by location and product
• Analyse current business compared to amounts invested
• Analyse allocation of sales resource compared to opportunity
• Analyse resource mix in relation to market opportunity
• Focus investment on opportunities with best growth

Can all of your functions and every level of management see the same picture? Can
they all contribute their insights to improve the plan?

Optimi delivers
Develop and deliver better products and • Shared process between marketing and sales
• Product marking plans linked to sales plans
services
• Data shared consistently across the organisation
• Local market insights captured in a consistent way
• Linkage of product features, customer types, sales effort and results
• Identification of what works and what needs improvement


Examples of the use of Optimi


Responding to changes in management of purchasing by major hospitals - Diagnostics in Europe

Hospitals are merging and developing purchasing processes that give them greater control of supplier and product selection. For
example in Germany 8 major national chains now run over 120 hospitals, in France public hospitals have merged by city so Paris now
Situation has 34 hospitals under common administration, in UK hospitals over 500 hospitals have been merged into 179 trusts. The sales force,
used to selling on clinical performance to doctors, must now also sell on economic performance to administrators.

Understand the development of the new organisations and their relative importance in the market. Understand the new decision
making processes and the key decision makers involved. Provide national and regional sales management with the tools to plan
Business solution strategy and allocate resource in the new situation including realigning the sales force to reflect the new customer organisation.
Provide a mechanism to co-ordinate activities with customers that have a wide geographical spread of hospital locations. Increase
the skill level of sales staff in managing larger and more complex sales on an economic as well as a clinical platform.

For 18 counties in Europe. Identified major hospitals groups (accounts) and buying groups used by independent hospitals to gain
purchasing leverage on suppliers. Assessed the relative buying power of each major account. Aggregated sales and call activity by
Project scope hospital management group to establish the relationship between potential, effort invested and results achieved for each account.
Worked with sales management to develop new strategies. Worked with sales forces to develop account plans for major accounts and
to change selling processes.

Tools Skills
Key Optimi Data integration for sales data, call data, and market data E-learning and case study - Introduce concepts and test understanding
Account portfolio analysis tools to develop strategy Sales management workshops – Develop strategy by country
capabilities used
Account DMU analysis to understand buying process and Account manager workshops – Embed planning and new selling skills
relationships with key decision makers
Account planning tool to develop implementation plan

Greater clarity as to the relative importance of accounts and the competitive situation within them
Business benefits Clear account level strategy for each country and the allocation of resource in line with that strategy
Fuller understanding of the decision making process in each account, and of the product proposition and relationships required
Clear action plan for each account for the implementation of the national strategy
Improved coordination between sales management and all of the people interacting with any part of each major account


Structure for account management project

Senior manager sponsorship Signed off by Regular overall Set-up workshop
•  Facilitated by Miol senior team review process in each region

Data collection & analysis Market & sales Sales force
Financial data Account data
•  Facilitated by Miol data data

Managers’ programme
Account Managers’
•  In English screening,
E-learning on
workshop
Coaches’
•  Facilitated by Miol overall process workshop
selection

Planners’ programme
•  In local language E-learning for Planners’ Implementation
•  Facilitated by coaches planners workshop to and further plans
•  Coaches facilitated by Miol develop first plan


Consistency in product marketing plans – Pharmaceuticals in emerging markets

Following a merger the client wanted its major products managed on a global basis for greater consistency. The product and business
plan process needed to deliver global consistency to the maximum extent possible, but have flexibility to accommodate local
Situation conditions where necessary. The project needed to be roll out with considerable speed and at low cost. Excel spreadsheets and
Powerpoint slide had been the tools used historically.

Define a consistent process that provides the output necessary for corporate consolidation and the management review processes
while accommodating the diversity of the countries involved. Provide the tools to facilitate the process. Provide a skill enhancement
Business solution process so that product managers and the country and regional marketing management understand how to analyse their market,
select suitable strategies, develop implementation plans and make financial forecasts based on those plans.

75 countries in Asia, Eastern Europe, Middle East, Africa and Latin America with over 1,000 product managers. Many had medical
qualifications but limited commercial experience.
Project scope E-learning course on marketing planning integrated with a detailed case study using the planning tool to test understanding for
product managers and marketing managers. Workshops building on the case study and transferring the learning into real business
situations.
A web based planning tool enabled central definition of the market and assumptions to be merged with local market information to
provide a product / market specific analysis, development of strategy and implementation plan and financial forecast.

Tools Skills
Key Optimi Definition of market, products and global strategy E-learning and case study - Introduce marketing and planning concepts
capabilities used Definition of country treatment delivery and funding and test understanding for product and marketing managers
Market analysis for product in country Strategy development, creative implementation and team building
Strategy and action plan development workshops based on case study material and real business situations.
Sales and marketing investment plans, financial forecasts
Remote management review and approval of plans

Provided a consistent methodology and process across products and geographies
Business benefits Common definitions and process promoted sharing and team building
Plan development and review could continue when staff were working out of the office
Identified widespread shortage of skills in market research and use of financial information
Increased the transparency of business operations to senior management, although this caused significant resistance at country from
country management


Improving the effectiveness of new products introductions – Pharmaceuticals global

The development of a globally consistent commercialisation plan for a new product from phase 3 trials. The plan needs to be solidly
based on evidence and to develop a strong long term position for the product that will work in all of the major countries. Outside of
Situation a small central group no resource can be dedicated to the product until it is closer to launch. Marketing time available from
managing current products is limited and has to be used to maximum effectiveness.

Use a central group with medical, marketing, market research and health economic skills. The core group to develop initial
positioning. They then test this positioning and expand the market data in several rounds adding at each stage more major countries
Business solution with disparate healthcare systems. Use the results to improve the positioning and prioritise countries for launch time and
investment. Using the structured process to share with each new group to be involved the work done to that point and to be clear
about the additional information and analysis required thus minimising the time required at a country level. Using the information
and analysis done in the development phase to provide the platform for detailed launch plans.

Management of the pre-launch phase for a product. See the flow diagram for the process followed
Project scope

Tools Skills
Key Optimi Clinical and treatment delivery and funding maps Market data analysis
capabilities used Market sizing and dynamics. Workshop facilitation
Market life cycle analysis E-learning on marketing planning and market research
Needs analysis and needs based segmentation
Product positioning and pricing
Global and country level strategy

It is expected that this process will develop a more sustainable positioning for the product. It will also enable management to make
better choices as to the order in which countries should introduce the product, and the most effective way to allocate the marketing
Business benefits
investment. The sales and marketing organisations that have to launch the product are better informed and able to target the
marketing investment more effectively. The process minimises disruption to current operations.


New product process
Activity Process Output
Pre-work Preliminary definition of market, competitors, patients Core definitions

3-4
Outline total process. Understand current clinical process / clinical map. Key needs by customer, provisional
months Workshop 1 Identify unmet needs. Provisional product profile. Possible positions product positioning
Quantified patient flows. Treatment delivery and funding map. Quantification of opportunity and
Data Collection 1 country Market size and dynamics. Quantification of needs test of position in one market

How robust is the provisional positioning. Should it be modified. Identification of major information gaps.
Workshop 2 Identify major gaps in information Update of provisional positioning

3-6 Quantified patient flows. Treatment delivery and funding map. Quantified opportunity and test of
Data Collection 4 countries Market size and dynamics. Quantification of needs. position in range of key countries
months
How positioning works in different healthcare systems. Significant Refined product positioning. Clinical and
Workshop 3 differences and their impact. Identify key decision makers and economic data required to support position
evidence required to support positioning. identified. Top level OL cascade
E-learn / workshops for E-learning, case study and workshop to introduce country and Country marketing management introduced
6-12
other major countries marketing management to process and results to date to the process and product
months
Data collection other major Use of MP tool to quantify market. Needs based Quantification of opportunity and provisional
countries segmentation. Map buying processes. Initial investment plan investment requirements by market
Aggregation of market opportunity and investment
Roll-out priorities and levels of investment by
Global roll-out plan (workshop) needs. Preferred launch sequence and allocation of
country. Major implementation issues identified
Annual investment funds between countries
from 2 Use MP tool for market analysis, strategy selection and Launch plan, critical issues, forecast investment
Country marketing plan development of implementation plan. and results by country
years
pre- Use AS tool to assess relative attractiveness of
launch
Account selection accounts and current connections. Prioritise and Priority accounts identified and resource allocated
allocate resource
Use AP tool to map decision making. Prepare Detailed implementation plan by account to deliver
Major account plans detailed implementation plan the country plan

LAUNCH

Integrating sales of multiple products to a hospital – Medical equipment in the UK

A large medical equipment company that has built its business by acquisition and has six business units and over 40 major product
lines most of which are being sold to common customers. Each of the Business units, and many of the product lines have retained
Situation their own sales forces so that in some cases more than 40 sales people were involved on the same account. Despite the number of
salesmen involved the relationships with the senior managers in most hospitals are weak. The company wanted to provide better
integrated offerings that used the breadth of the product range to differentiate themselves from competitors They also wanted to
reduce selling costs.

The appointment of strategic account managers each covering 3 or 4 major customers with a remit to improve overall medium term
Business solution sales performance in the selected accounts. They assembled and analysed information on the business and relationships with each of
these key accounts. They understood and documented the hospital’s business situation and future plans and its decision making
processes. They identified the senior management relationships that needed to be strengthened and activities that could raise the
company’s profile in a positive way. Sharing this analysis with the Business Unit heads they identified major projects that would be
more profitably tackled on a cross business basis and set-up cross product line teams to deliver them.

Work with the new strategic account managers as a group and individually to understand their needs and guide their activities. Work
Project scope with the project analyst to extract and organise data on the selected accounts from multiple systems. Validated the selection of
accounts for strategic management. Collated public data on the hospitals and worked with the strategic account managers to
identify critical issues for the selected hospitals and the business opportunities that could flow from those issues. Facilitated account
team meetings to investigate opportunities and plan suitable responses.

Tools Skills
Key Optimi Data integration for sales and market data Workshops on strategic account management
capabilities used Account portfolio analyser Complex data analysis
Account DMU and relationship mapping Facilitation and coaching
Account situation analysis

Started to move from responding to requests for tenders and current quarter closings to identifying probable opportunities far
Business benefits enough in advance to be able to build the necessary relationships, influence the tender content, and put together more complex and
imaginative proposals. Identified many organisational and system issues that will need to be addressed to enable fully integrates
sales and service delivery to major customers.


Selling to diverse customers with many products over a complex geography – Vaccines in Russia

Company sells a varied product range to several different types of customers including federal and state healthcare organisations,
government agencies and companies, private health insurers, private companies and individuals. The states and many of the
Situation government agencies and private companies are spread across a massive geography and many of the wealthiest areas are in locations
that are hard to access. Demand is growing fast and the market is moving from serious supply shortages to a more normal balance.
The company has a geographically based sales force with regional sales managers based at HQ. These Regional Sales Managers also
managed directly the major accounts. The sales operation needed to be reconfigured an skilled to take advantage of the developing
opportunities.
Understand the customers and their needs. Prioritise the possible customers and develop a portfolio strategy. Determine the sales
force organisation required to manage such a portfolio and the skills and support infrastructure necessary to effectively deliver this
Business solution strategy.

Assess 100 potential major customers over 7 product lines. Integrate the market, sales and sale force activity data available on these
potential customers. Train the sales managers on account management processes. Facilitate workshops with sales managers to
Project scope develop an overall portfolio strategy for customers. Train sales manager on the development of account plans and facilitated the
construction of plans for selected major customers. Considered the overall performance of the sales force and made
recommendations for the development of the organisation, skill levels and procedures.

Tools Skills
Key Optimi Data integration for sales calls and market data E-learning on account management and account planning (in Russian)
Account portfolio analysis and strategy selection Data analysis
capabilities used
Account DMU and relationship mapping Workshop facilitation
Account situation analysis

The client understood the need for substantial change in the way in which major accounts are managed including the recruitment of
dedicated account managers for major accounts. The project led to a reconsideration of the relationships between regional sales
Business benefits managers, the new account managers and the territory sales representatives. The project identified major growth points and the
realignment of resource required to deliver from them.


New product introduction – New hospital product in UK

A VC backed US pharmaceutical company making is first ever product launch. They wanted to run a substantially virtual operation
and had contracted a sales force for the launch phase. The product had many uses within a hospital setting particularly in post
Situation operative care. In order to sell the product in most hospitals the company required to get the product onto each hospital’s
treatment protocols and formularies. The sales force was too small to address more than 30% of the available hospitals in the launch
phase, and had two months pre-launch time for investigative work.

Identify the group of hospitals into the trusts that controlled protocols and purchasing. Quantified the surgical throughput of each
trust (in-patient and day case), and its capacity in terms of OR’s and consultants. Ranked hospitals in terms of potential to select the
Business solution initial target list. Sales reps use account planning tool to record each account’s decision making process and key people, and to
assess the time required to get the necessary approvals. Every 2 weeks the findings were summarised and accounts ranked in terms
of potential and time to get access. At the end of the pre-launch phase management were able to review the quality of the
implementation plans, and to make sales estimates based on a clear understanding of customer’s key decision points.

One product, 10 sales representatives selecting 70 hospital trusts out of a possible 220.
Project scope

Tools Skills
Key Optimi Accounts management Data set-up and analysis
Facilitation and coaching
capabilities used Account planning

Clarity as to target accounts
Clarity as to the key processes and events that customers had to do to allow them to purchase
Business benefits Action plans for the sales teams with clear objectives, timing and responsibilities
Management knew what specific actions they had to do in support of the sales team


Developing marketing skills in emerging markets

Following the introduction of a product planning process and development of planning skills it became apparent that in many
emerging market countries the level of skill in market research and financial analysis was very low. In many of these markets there
Situation were relatively few high quality market research agencies to whom the work could be contracted, and even where contracting was
possible a higher standard of briefing and interpretation was needed. The managers concerned were widely spread geographically,
and cost of delivery precluded extensive workshop based training.

E-leaning modules on market research and financial analysis for pharmaceutical markets was developed using case studies and
market analysis tools. The tutoring for the workshops was provided by an experienced market research for the country or local group
Business solution of countries. The tutors were trained in a series of regional workshop. Using local tutors also made it possible to address issues of
local language and issues relating to local sources of data.

Product managers from 45 countries in Asia, Eastern Europe and the Middle East covering seven different therapy areas.
Project scope

Tools Skills
Key Optimi Market analysis tool including market sizing, market E-learning modules on market research and financial analysis
dynamics, segmentation and forecasting techniques for the pharmaceutical industry. Case study examples.
capabilities used
Workshop for course tutors

Improved use of the data that was available in each country.
Business benefits Better identification of situations in which additional research was required
Better briefing of agencies and improved design of internally conducted work
Better interpretation and use of the results of research
A low cost but high impact programme


The life science market model
in Optimi


The healthcare market

The Optimi process enables sales and marketing teams to understand the issues in their
markets and choices that they can make. The Optimi tools put data into a context and
structure that gives an accurate understanding of their market. This model is built
around the features that are unique to life science companies and the healthcare
market. These unique features are:

•  The involuntary nature of demand
•  The complex and regulated purchasing process
•  Influence chains outside of the control of the industry determine product usage

To accommodate these special features Optimi organises data around four major
themes:

•  The clinical pathway
•  Treatment delivery and funding
•  Opinion formation and communication
•  Company organisation, planning, investment and implementation processes


Healthcare decision processes
Optimi provides the skills and tools to analyse

Clinical pathways •  The disease, diagnosis, severity, incidence by
Buying
decision demographics, and patient numbers by disease
state.
•  The needs of patients for relief from disease
and symptoms and the tolerability of
The demand for healthcare is driven by the treatment
incidence of illness or actions to avoid illness
•  The needs of prescribers and healthcare
providers for efficacy of treatment and the
management of patients
The amount and location of total demand is
largely outside the control of life science •  The classes of treatment and products
companies available, and the extent to which they meet
the needs of patients, prescribers and
providers
•  The regulatory processes over the provision of
clinical services and the licensing of medical
products

Optimi map’s the incidence and impact of disease and alternative treatments so that
planners can identify where demand may be available to them

The clinical pathway

Define key Identify key Identify product
Quantify patent performance
characteristics clinical needs
numbers against needs
and build clinical
map
How does each class of
treatment perform
• Disease definitions What are the needs of against each need
How many patients are
and stages • Prescribers
there in each branch
• Patient types • Patients How does the product
of the clinical map.
• Classes of treatment • Healthcare providers
under consideration
• Treatment outcomes • Funders perform against each
What proportion of
• Disease progression
patients get each type need.
How important is
of treatment
Select the each need, where In what areas does the
characteristics and are there similarity product meet needs
What are the cure
choices specific to of needs, and where
rates, remission and not currently met by
therapy area do needs conflict. other treatments.
relapse rates
How are such
Map the conflicts resolved. What non-product
combinations that (service) features can
best describe the
meet needs.
clinical processes


Optimi provides the skills and tools to analyse
Managed Prescribing
Treatment delivery and funding care
Hospitals
doctors
•  The organisation for diagnosis and the delivery
of treatment and the people and organisations
involved in the clinical decision making process
Buying •  The organisation for funding treatment and
decision
facilities and the economic decision making
process

Life science companies rarely sell directly to the •  The regulatory processes over the pricing and
person requiring the treatment reimbursement of healthcare costs
•  The financial and service requirements of
The organisation and funding of the delivery of prescribers, treatment providers and funders,
treatment is complex, and varies from country to and the extent to which they are met by life
country science companies and their products

Optimi map’s complex treatment delivery and funding processes and matches them to the
disease and treatment information to identify how products are purchased and used.


Treatment delivery and funding pathways
Where is treatment delivered

Specialist out- Hospital inpatient Specialist centre
patient treatment treatment treatment
Point of initial
diagnosis

Community Community based Step-down
treatment support services treatment centre

How is treatment paid for

Provision of funds Disbursement of funds

•  Patient self-pay •  Patient self-pay
•  Patient co-payment •  Patient co-payment
•  Risk base insurance •  Reimbursement of patient paid fees
•  Income based insurance •  Health maintenance capitation fee
•  General taxation •  Block budget (hospital or community)
•  Fee for service (full cost based)
•  Fee for service (fixed tariff)
•  Fee for service (tariff plus selected costs)


Opinion formation Life science products require Optimi provides the skills and tools to understand
and communication
a large number of clinical and
Clinical Economic Patients commercial approvals before •  Key organisations that control or influence clinical
they can be used and economic regulatory access to markets,
medical education, and treatment and purchasing
Much of the information used processes
in these processes is •  The approval and decision making processes
generated by or required to enable the product to be purchased
communicated outside of the
and used
Managed
Hospitals
Prescribing direct control of the
care doctors
companies •  The individuals within these organisations that
have a significant role in the decision making
process
•  The relationships between the people in the
Buying
decision making processes
decision
•  The strength and nature of all the relationships
that the company has with decision makers

Optimi shows the connections, motivations and procedures of the people taking and
influencing key decisions


Influencing opinion and actions
Political
processes

Research Medical
Healthcare Healthcare Patient
science and professional
funders policymakers organisations
clinicians bodies
“This can be done” “This is what we can afford” “This is what we want”

Community
Medical Senior Hospital
medicine
journals doctors management
management
“This is best practice” “This is what its worth”
Health
Medical Clinical
economic
meetings protocols
assessments

Medical Formularies
Medical Public
professional and buying
Schools Internet
internet “This is what you can do” practices

Prescribing
Patient
doctor

Pharmacist


Product
Communications
and
account Relationships
Optimi tools provide the facilities to
plans
+/- 10 products •  Record assumptions, decisions and action plans
100 countries
100,000 institutions
2,000,000 doctors
•  Track plan development, reviews and approvals
Service and pricing
•  Provide controlled access on a global basis
Product
Life science companies need to
performance coordinate activities for 10-20 •  To provide action plans by team / individual
products in 100+ countries across •  Forecast the financial consequences of actions
numerous business functions
•  Enable the aggregation of plans and forecasts
Actions taken can have long term
impacts and be hard to reverse •  Retain the history of plans for future reference
Actions taken in one country have •  Enable updates and revisions as new information
impacts in many others is available

Optimi provides a consistent repository for market information, and record of analysis,
decisions, and planned actions to enhance teamwork and effective management review.


Product Opinion formation
Communications
and and communication
account Relationships Clinical Economic Patients
plans
+/- 10 products
100 countries
100,000 institutions
2,000,000 doctors

Service and pricing

Managed Prescribing
Product
Treatment delivery and funding care
Hospitals
doctors
performance

Clinical pathways Buying
decision


Clinical and funding interaction – 6 basic models
Prescriber is a relatively independent agent paid on a fee for service or capitation basis
that excludes drug costs. Drugs funded by patient self pay, full cost of drug reimbursement
Individual insurance, or relatively unconstrained block budget for drugs. Prescriber typically works in
community medicine or as an independent specialist. Drugs are supplied through the retail
chain.

Prescriber is normally contracted to funder. Prescriber is paid on a fee for service or
capitation basis that either includes drug costs or drug costs are funded when prescribing is
Managed care compliant with funder protocols and formulary. Drugs are supplied through the retail chain.

Prescriber is either an employee of, or contracted to, the institution and works within the
medical protocols and formulary established by the institution and / or its funders. Funding
Institutional is typically through a fee for treatment or procedure or block budget basis. Drugs are
usually purchased directly by the institution.

Purchase or leasing of capital equipment and related supplies and services by institutions
and individual prescribers. Funding is either by way of direct capital budget, allocation of
Capital block budgets, or built into fee for treatment pricing.

Operates within the individual,
Self selected and
managed care and institutional areas
paid for by patient
mainly through influencing the
Consumer with little or no Generic protocols and formularies of funders
medical inputs
and institutions, or through the
supply chain.

Optimi Systems Overview

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