• Aventria Health Group

The Impact of Payer Transformation on Provider Access Is Real

Pharmaceutical market access vice presidents, executive directors, market access marketing, and brand leads:

You’re all too familiar with payer evolution through vertical integration that has resulted in a concentration of buying power with a small number of influential customers who have intensified drug cost management and utilization. These same payers are quietly transforming their business model to protect revenue and strengthen both their provider footprint and member engagement experience by developing controlled provider networks. In your quarterly business reviews with senior management, are you proactively including an assessment of the trend and potential impact on brand access and financial performance in your risks and opportunities discussion?

Payer Transformation Is Real—Are You Ready?

As a market access or brand leader, have you allocated time to assess the impact of this almost stealth-like payer transformation to enhance their provider services by building and expanding integrated networks and capabilities in local MSA (Metropolitan Statistical Area) ecosystems, which include primary care, behavioral health, urgent care, and specialty medicine, as well as captured populations of patients?

The payer transformation to own/manage provider networks is real. Are you ready with a rigorous assessment of payer-controlled networks in local market ecosystems and their effect on provider access, patient engagement, and brand financial performance? This includes:

  • Size of the business in prioritized MSA ecosystems

  • Growing influence on brand access and selection

  • Potential impact to enhance/hinder utilization based upon payer formulary position

Aventria can help you proactively develop brand strategies to effectively execute in this new ecosystem as well as educate senior management on the implications of this trend to the business. Find out how.