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Products & Services Medical Affairs Health Outcomes

Medical Affairs Strategies to Deliver Value to Payer Groups

ID: POP-284


16 Info Graphics

31 Data Graphics

600 Metrics

Pages: 58

Published: Pre-2019

Delivery Format: Shipped


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In recent times, pharmaceutical companies have turned to their Medical Affairs function to establish meaningful relationships with payer groups, including Accountable Care Organizations (ACOs) and Integrated Delivery Networks (IDNs), owing to their rising influence on market access.

With Medical Affairs being relatively new to this role, Medical Affairs leaders face many questions around ensuring effective interactions with payers, including identifying and targeting key payers, presenting critical data, deploying field resources to support interactions, ensuring optimal training to staff and improving internal coordination and outreaches to deliver value to payer groups.

Best Practices, LLC undertook benchmarking research to identify leading Medical Affairs strategies for payer and ACO/IDN engagement success, capturing critical metrics and insights on payer segmenting and targeting, data presentation, field resource deployment, staff training, internal coordination, desired staff background, success factors and top challenges.

Industries Profiled:
Health Care; Pharmaceutical; Diagnostic; Biotech; Manufacturing; Consumer Products; Medical Device; Chemical; Biopharmaceutical; Clinical Research; Laboratories

Companies Profiled:
Abbott; Abbvie; Actelion; Astellas; Bayer; Daiichi Sankyo; Genentech; Grifols; Jazz Pharmaceuticals; LEO Pharma; Novartis; Roche; Sanofi; Seattle Genetics; Shire; Sunovion; Tesaro; ViiV Healthcare

Study Snapshot

Best Practices, LLC engaged 18 Medical Affairs leaders from 18 leading pharmaceutical and medical device companies in the United States, Singapore, South Africa and Europe through a benchmarking survey.

Key topics covered in this report include:

  • Setting the Stage for Payer and ACO/IDN Engagement Success
  • Medical Affairs Engagement with Payer Groups and ACOs/IDNs
  • Medical Affairs Training around Payer Services
  • Medical Affairs Outreach and Internal Coordination with Payer Groups
  • Desired Background and Experience when Working with Payers
  • Success Factors

Key Findings

  • A majority of Medical Affairs teams serve 8 payer types: Four of 18 companies serve 10-11 payer types, but a majority of participating companies serve 8 of the 11 payer types evaluated in this study. The payers most commonly served include local or state teaching hospitals, elite national teaching hospitals, large medical groups and commercial payers. ACOs (registered and unregistered with CMS) were among the least likely to be served by Medical Affairs groups.
  • Robust data key to successful payer interactions: Half of the benchmark class believe that sharing robust data with payers is the top success factor for developing strong working relations with payer groups and ACOs/IDNs. Other success factors include building strong relationships, previous experience, market understanding and communication.

Table of Contents

I.Executive Summarypgs. 3-9
Research Overviewpg. 4
Participating Companiespg. 5
Key Findingspgs. 6-8
Participant Demographicspg. 9
II.Setting the Stage for Payer and ACO/IDN Engagement Successpgs. 10-30
III.Medical Affairs Engagement with Payer Groups and ACOs/IDNspgs. 31-37
IV.Medical Affairs Training Around Payer Servicespgs. 38-44
V.Medical Affairs Outreach and Internal Coordination with Payer Groupspgs. 45-47
VI.Desired Background and Experience when Working with Payers pgs. 48-50
VII.Success Factorspgs. 51-56
VIII.About Best Practices, LLCpg. 57

    List of Charts & Exhibits

    • Types of payer groups and delivery networks that Medical Affairs currently serves, plans to serve within 12-24 months and doesn't serve
    • Importance of listed influencers on market access in the next 24 months
    • Average frequency of access to key stakeholders at each payer group or ACO/IDN
    • At each of the selected payer group and ACO/IDN decision-makers, what groups of people does medical team within participating companies meet with?
    • Data presentation methods for each of the selected payer group and ACO/IDN decision-makers
    • Type of field-based resources deployed by Medical Affairs to support payers
    • Team deployment during each phase of the product life cycle
    • Criteria used by Medical Affairs to target payers and ACOs/IDNs
    • Importance of listed criteria in determining the number of field-based medical team members to be dedicated to an ACO/IDN network
    • Effectiveness of each approach used by Medical Affairs to identify the key decision-makers in payer groups and ACOs/IDNs
    • Preparation and training provided to Medical Affairs staff supporting payer and ACO/IDN clients
    • Frequency of Medical Affairs staff training on internal functions
    • Knowledge sharing channels utilized by Medical Affairs to share information internally
    • Knowledge sharing frequency across internal functions
    • Effectiveness of the channels utilized by Medical Affairs to share knowledge with internal functions serving payers and ACOs/IDNs
    • Types of data and materials used by field-based medical teams in the field
    • Approaches employed to coordinate Medical Affairs team with other functions to avoid redundancy or confusion
    • Effective educational background for Medical Affairs staff working with payers
    • Effectiveness of Medical Affairs staff experience background for providing payer services
    • Top success factors for Medical Affairs in developing and maintaining strong capabilities for work with payer groups and ACOs/IDNs
    • Top challenges for Medical Affairs in developing and maintaining strong capabilities for work with payer groups and ACOs/IDNs