Reframing Payors as a customer is the key to profits

discover your true Reimbursement opportunity

Evaluate all the entities that drive the reimbursement market in the US to determine a product’s potential commercial value. Knubach’s reimbursement outlook assesses:

  • Reimbursable Addressable Market (RAM) and channel analysis
  • Government market implications (Medicare/Medicaid)
  • Reimbursement Risk Profile
    • Clinical evidence and medical policy coverage
    • Competition
    • Market forces and compliance
  • Reimbursement forecast and timing (e.g., top line revenue vs revenue recognition)

identify practical ways to Improve reimbursement

Payors-as-a-customer is not just a perspective, it is a process. This entails:

  • Research to collect and synthesize the direct input from national, regional and government payors (ideally, as part of the development scope)
  • Determination of the minimum evidence requirement to initiate coverage and the iterative progression towards national payor acceptance, societal endorsement and differentiation through the reimbursement lens
  • Strategic programs to simultaneously drive payor interest and customer utilization for mutual leverage

Have a game plan for your team to pursue in unison

Let us help you with:

  • Integration with Commercial Strategy
    • B2Payor – Foster compelling payor engagements
    • B2Business – Broker partnerships that support reimbursement value
    • B2Consumer – Develop non-traditional paths for revenue and advocacy
    • B2Investors – Gain investor support with predictable reimbursement strategies
  • Coverage and evidence development planning
  • Health plan prioritization and forecasting
  • Strategic contracting and sales planning to drive in network coverage
  • In/out of network revenue modeling

F.A.Q.

Common questions

The Reimbursement Model shifts the emphasis of the commercialization approach from the technology itself to the ability for the technology to be accessible and reimbursed.  There are endless breakthrough testing technologies being launched but most are failing to reach their market opportunity due to unsustainable margins. By focusing on the reimburseability in addition to clinical and health economic value, we realize a product’s true opportunity based on its Reimbursable Addressable Market (RAM). 

Services for The Reimbursement Model are customized to your specific needs and will therefore be determined by the scope desired.  The initial reimbursement outlook evaluation is typically the first project and will be priced based on factors including market size, technology, and time requirements. Performing this will ensure you are informed on its true return on investment and therefore minimize your portfolio risk from ventures with poor market viability. Furthermore, the insight drawn from the project will help you understand what to ask and look for – a critical process designed to nurture alternative strategic options.

Implementation time varies by project and the level of commitment of your team.  The reimbursement outlook evaluation typically lasts 30-90 days, depending on the scope. The time frame for follow-up recommendations are based on the outcome of the initial diligence and your desired path forward.