HighPoint Blog

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

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When your organization embarks on a project — whether it’s a technology implementation, a strategic alignment for sustained growth, process improvement, or solving an innovation issue — you want someone with the breadth and depth of expertise that will keep things moving forward.

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Since the infancy of specialty drugs on the market in the 1990s, specialty pharmaceuticals have attracted attention in part due to the complex supply chain and high-touch requirements before, during and after administration, according to the National Pharmaceutical Services (NPS), 2018.

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Given the importance and growing symbiotic relationship between manufacturers and wholesalers, it’s increasingly essential to streamline contracting and pricing communications. Failure to rationalize these communications will continue to result in significant operational inefficiencies.

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Prior authorization is the process providers use to request pre-approval by health plans for health services payment for their patients. Like other areas of healthcare, prior authorization is entering a new era of technology transformation.

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Membership data poses a significant challenge to operational excellence for pharmaceutical and medical device manufacturers. Because membership data is the foundation of contract management, many of the challenges focus on the manual nature of customer information that manufactures receive on an ongoing basis. The challenges include:

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For most companies who perform worldwide transactions, there is a certain challenge to creating ASP transparency. In an ideal world, all the transactions are properly consolidated and budgeting your price is a kid’s game.

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In 2020, all medical device companies will have completed the implementation of the new medical device regulation. Reading European Union (EU) Regulation 2017/745 of the European Parliament and of the Council of 5 April 2017 on Medical Devices[1], it sounds like many new data requirements.

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Co-written by Ed Koller and Jeff Forgang

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Co-authored by Lori Harris-Stevens, RN, MHA and Kathleen Craft

Is your organization an NCQA-accredited health plan, or a managed behavioral health, care management or population health vendor? Is your healthcare organization shopping for a new population health IT vendor? As part of HighPoint’s continued coverage of the new NCQA Population Health Standards, we want to take a closer look at...

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When presenting at the HighPoint Identification of Medicinal Products (IDMP) workshop in Geneva, Switzerland in April 2016, I compared the IDMP journey not just to any marathon, but to the Jungfrau[1] marathon. The Jungfrau Marathon is one of the best known mountain marathons in the world, in full view of the famous EigerMönch, and Jungfrau mountains in the Bernese Oberland area of the Swiss...

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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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Co-authored by Yann Chappuis, Life Sciences Consultant

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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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