HighPoint Blog

Multiple “market conditions” are forcing manufacturing companies to rethink global launch strategies, as well as local market access strategies such as interaction with payers, prescribers and authorities in order to achieve the expected Return on Investment and achieve market share. In a sense, the “market conditions” have changed and “traditional” product global launch strategies no longer...

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Back in 2016, HighPoint’s tendering benchmark study identified joint procurement (or supra-national tenders) as a potential uncertainty in the procurement methodology. At that time, companies were already seeing the risk of countries teaming up to increase purchasing power. However, until recently, this uncertainty was only materializing in Gulf region countries. With a recent development in...

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The increase in tendering as well as the entry of multiple biosimilars is disrupting the healthcare market in Europe, with plenty of new players and procedures. This blog looks at how the perspective of game theory could support understanding of these market dynamics.

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A controversial new health insurance plan benefit design option has recently been introduced by insurers, which will further shift specialty drug costs away from payers and onto drug manufacturers and consumers. Known as copay accumulator adjustments, the true price of this new approach to copay assistance programs may reveal as reduced prescription volumes, and therefore, revenue, for...

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A health plan with solid roots in the south west United States is taking a unique approach to caring for its members by leveraging its knowledge and expertise in creating other health plans through scalability and efficiency. The health plan is leveraging its strategy, management, product design and administrative functions — all things it has done successfully in its own community — that can...

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Co-authored by Suzanne Kunze, RN, CCM, MBA and Lori Harris-Steven, RN, MHA.

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Co-authored by John Miller, Carl Keller, Ash Datta

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Part 2 in a series exploring project improvement through the use of a PMO implementation

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Co-authored by John Miller, Carl Keller, Ash Datta

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What is RPA?

Robotic Process Automation (RPA) is the application of computer software, or “robots”, to execute specific tasks within a process. RPA has gained traction in recent years as a way of automating tedious and repetitive tasks. These tasks can range from processing transactions, manipulating data, or communicating with other systems. Most RPA software programs are designed to capture...

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Like other organizations, healthcare payers want to get the most out of their IT investments. But keeping up with operational maintenance of fee schedules, code sets, and industry changes can be a daunting task for any health plan.

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Co-authored by Suzanne Kunze, RN, CCM, MBA and John Miller

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Co-authored by Suzanne Kunze, RN, CCM, MBA and John Miller

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The latest pricing structure shift from Medicaid won’t be the destruction of the generic industry. But drug manufacturers will be impacted and need to take steps to comply with the proposed regulation.

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Your healthcare organization has just spent millions of dollars to migrate to a new Electronic Health Record (EHR) system (pick the application, Epic, Cerner, Allscripts, because this affects all of them), and, you’ve got all the legacy applications and data that’s left behind still incurring costs.

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Due to the unabated growth of prescription drug prices and the resulting increase in consumer spending, drug prices have become a highly prioritized public health matter. To address this issue, Health and Human Services (HHS) Secretary Alex Azar and President Donald Trump released the American Patients First blueprint, an extensive plan to reduce prescription drug prices and patient...

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Co-authored by Suzanne Kunze, RN, CCM, MBA

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Co-authored by: Suzanne Kunze, RN, CCM, MBA

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New regulations are in effect, with transition periods ending in 2020 and 2022

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A core claims and adjudication system that was no longer delivering on its promise, was the main reason a large East Coast health plan decided to replace its technology in 2016. It needed to have a system that was easy to configure, and would help the health plan move forward with its business goals.

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Co-authored by Ann Mendlowitz, Director, Provider Solutions

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Co-authored by Todor Finkov, Manager, Pricing, Tenders & Contracts

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Co-authored by Alexis Ashman, Senior Consultant, Tech., Pricing, Contracting & Market Access and Anami Patel, Senior Associate, Pricing, Contracting & Market Access.

As the pharma/healthcare marketplace for specialty drugs such as cancer and immune treatments continues to grow, distribution channels are shifting in response. Traditional buy-and-bill distributors are beginning to be displaced...

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There are many reasons that a health plan will decide to go through the process of selecting a new care management vendor. It could be due to a change in its line of business, the need for improved operational efficiencies, a merger, or sunsetting of the vendor’s platform, to name just a few.

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In this continuing blog series, we explore the adoption challenges of risk-based monitoring (RBM) of clinical trials. So far, we’ve addressed the risk assessment process and centralized monitoring of analytics. In our latest post, we explore the broader challenges of organizational change that research teams face when moving to RBM.

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In our first blog on data governance, we described what data governance is and the important role it plays in health care.

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Large pharma company facing a critical forecasting challenge

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In the life sciences industry, gross to net (GTN) is the management process at the heart of the pricing and contracting lifecycle. Within this process, manufacturers forecast demand and accrue for rebates, chargebacks, and any other adjustments to the price charged for a product’s sale.

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The shift to risk-based monitoring (RBM) is not without challenges for clinical research teams. In a previous blog, I outlined three key adoption challenges teams face. That blog also provides an in-depth review of the first challenge, risk assessment. In this blog, we focus on the challenge of establishing and performing the sophisticated statistical analyses which are critical to detecting...

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To begin, there should be two processes for integrating tendering and global price management that lead to a harmonized governance routine, as at the end of the tendering procurement process. It’s about governing the tender bid price.

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Co-authored by Olasile Abolade, Associate Consultant

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By now, there is strong consensus that Risk Based Monitoring (RBM) is an essential practice in clinical research. There are ample resources and supporting data on the benefits of a Risk-Based approach to monitoring, and we will not add to the chorus of voices promoting its adoption.

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One of the most stressful situations a patient can encounter is navigating through a hospital stay.  Throughout the process, the patient and family are trying to wrap their heads around the entire experience but forget the financial impact.

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Who doesn’t love Faith?

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Think of test management tools as the Swiss Army knife in the back of your pocket. Test management tools can be the one-stop resource for a multiple purpose benefit. There are thousands of test management tools available, however they all have a few benefits in common if used proficiently.

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Outcome-based contracting is definitely a buzzword in the life sciences industry. Over the past few years, many companies have tried to implement such contracting strategies. Nevertheless, after years of efforts, and even if the benefits are widely recognized, the reality is that only a few contracts have materialized. When looking at the last years’ numbers, these are not so promising.

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Co-authored by Suzanne Kunze, RN, CCM, MBA and Norita Wilson, RN BSN

Population health is advancing as the health care industry shifts from fee-for-service to value-based care. As population health evolves, we are seeing the merging of care management (CM), disease management (DM) and utilization management (UM).

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Co-authored by Ann Mendlowitz, Director, Provider Solutions

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SETTING THE SCENE

This is it. Your Global Price Management and Tender Management tool has finally been deployed based on your global and local requirements. Your data is integrated from various sources ranging from enterprise resource planning (ERP) to finance to publicly available sources. Your users are trained; roles and responsibilities are clearly defined; processes outlined and...

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Co-authored by Mattias Berger, Associate, Shared Services

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