HighPoint Blog

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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Medecision’s acquisition of AxisPoint Health brings 58 VITALS and CCMS solution clients under the Medecision umbrella. These organizations have been aware of plans to sunset CCMS and VITALS since before Medecision’s acquisition, but they now have the opportunity to make a streamlined transition to Medecision Aerial platform, in addition to the option of selecting a new vendor.

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Brief overview of 340B reimbursement

In 1992, the 340B drug discount program was passed as Section 340B of the Public Health Service Act. This program allows “covered entities”, hospitals and clinics which have enrolled in the program and demonstrated a minimum disproportionate share adjustment percentage, to receive discounted pricing when purchasing drugs from the manufacturer. 

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Co-authors: Norita Wilson and Becky Jones

In our previous blog A Closer Look at Population Health/Care Management Solution Vendors , we looked at Gartner’s March 2018 “Market Guide for Healthcare Payer Care Management Workflow Applications,” and its recommendations for health plans who are evaluating care management workflow application vendors.

We will now explore how health plans should...

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Co-authors: Norita Wilson and Becky Jones

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On July 18, 2018, the FDA published its guidance for biosimilars, “Labeling for Biosimilar Products.” This guidance provides an overview of the FDA’s recommendations for biosimilar labeling, so that prescribers can make informed decisions. The FDA states the intent of the guidance is to help manufacturers “develop draft labeling for proposed biosimilar products for submission in an application...

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At the simplest, Relative Value Units (RVUs) measure the value used in Medicare reimbursements for physician services.

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

In our previous blog, you learned about the strengths of both NCQA and URAC accreditation. Now we’ll look at how you can prepare for accreditation.

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In a world of frequent biopharma mergers and divestitures, the optimal size and structure for a pharma company’s contract operations department is a moving target. Whether you’re setting up a new department or adjusting an existing one, meeting these shifting expectations is a challenge. There is typically no single way to determine your company’s unique best fit – one that balances management...

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

Health plans will look to two prominent and nationally recognized organizations, NCQA or URAC, when they are seeking accreditation. Accreditation provides an impartial opinion on a health plan’s quality. URAC or NCQA accredit a health plan when it has been determined its practices meet national standards.

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The pharmacovigilance (PV) team at a large, global biopharma company faced a challenging operational environment. Plagued with a host of disconnected systems, their day-to-day operation weighed them down with a stream of recurring inefficiencies, inaccuracies, and added oversight costs.

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Co-author: Yann Chappuis, Senior Associate Consultant

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In the patented drug manufacturing world, fixed manufacturing costs are not usually a key driver of profitability. Achieving the right price is typically a much greater driver of profit.

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