Reimbursement Strategy as an Essential Element of a Medical Product Business Plan
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When developing an idea into a medical business product, addressing the reimbursement strategy at the onset should not be ignored. Entrepreneurs need to create a clinical use scenario for their product so that they can best determine what patients will be using the product, what providers will be prescribing it and what setting the product will be used in. Determining these facts allows one to more accurately assess which organizations will be in charge of regulating your product, knowing if current coding applies, and who will be paying for it.
As the product development cycle progresses, diligence must be maintained as rules, regulations, and coding are constantly updated. When the overall strategy has been achieved, the process must be put into action. Many of these processes involve important timelines and deadlines and care must be made so that reimbursement issues do not delay a successful product launch. A global approach to managing reimbursement will be presented.
- Reimbursement is a key issue that needs to be addressed at the earliest stages in a product development cycle.
- Reimbursement concept consists of a clinical use scenario to describe how the product will be used and the payment environment; this should be your first step.
- The clinical use scenario describes exactly what the product does, to/for whom and where it is done and what types of providers are involved in the treatment process.
- This allows for a more accurate assessment of current coverage, payment and coding that may affect the product before its release.
- Directed efforts need to be undertaken early in the development cycle for any obstacle found as the time to remove obstacles can be lengthy.
- The reimbursement concept needs to grow and adapt with the product—things change and it must change with them.
- As the product nears launch, the reimbursement plan must be finalized and execution should become the focus.
Robert C. McDonald, MD, MBA is the President and Founder of Aledo Consulting, Inc. Prior to this role, he served in a variety of senior medical and operations positions at Anthem Blue Cross and Blue Shield and its predecessor company, The Associated Group, including Medical Director of Medical Policy, Medical Director of Anthem Prescription Management, LLC, and Medical Director of Health Care Management, Anthem Inc.
Among his responsibilities at Anthem were the creation and contracting of the first network of national scope for hemophilia factor and immunoglobulin providers. Prior to Anthem, he served for three years at Eli Lilly and Company as a Health Economics Research Physician performing cost effectiveness analyses both as part of developmental trials and on site at health plans across the United States.
Dr. McDonald received his Medical Doctor degree from University of Texas Southwestern Medical School and his Masters of Business Administration from the University of Pennsylvania Wharton School of Business.
Riley Alexander, MD, MBA is a Senior Healthcare Consultant at Aledo Consulting, Inc. where he assists clients with strategy, market and reimbursement issues. Prior to Aledo Consulting, Dr. Alexander completed a medical residency in anatomic and clinical pathology at Indiana University School of Medicine. During his time in residency, he co-authored over 40 peer-reviewed articles and abstracts presented at national conferences in addition to a book chapter with international experts in molecular pathology.
Dr. Alexander is board-certified in anatomic and clinical pathology. Additionally, he has served as a junior member of the Economic Affairs Committee of the College of American Pathologists and as a Resident Representative for the American Society of Clinical Pathology. Dr. Alexander has a strong interest in health information technology, having served as a physician consultant for a number of companies in this space.
Dr. Alexander earned a combined MD/MBA degree from Indiana University’s School of Medicine and Kelley School of Business. He attended Indiana University at Bloomington for his undergraduate studies where he graduated Phi Beta Kappa with a major in Biology.
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