This blog is the fourth in a series that shares our vision for a unified access platform. I’ve examined the  commercial,  financial, and operational goals that Market Access teams need to as the world moves to specialty and precision medicine. Today, I’ll dive into how we believe a unified platform can help.

Creating a future-proofed Market Access function is daunting without the integration of data managed by channel and patient data aggregators with the applications and business processes executed in revenue management and forecasting systems. Traditional revenue management systems simply don’t have the data reach – nor even the data integration and management capabilities – that today’s Market Access teams need. They are fundamentally working in silos: a contracts and pricing island cut off from the commercial and gross-to-net dimensions of Market Access. 

That’s where our vision for a unified market platform comes in. We recognized that successful Market Access teams must break down these silos and usher in a new way of achieving their goals that address the evolving industry. But first, let’s review some of the technology, systems, and staffing barriers to next-generation Market Access.

Overcoming Barriers

Outdated Revenue Management Infrastructure

Life Sciences manufacturers have been hobbled by aging revenue management infrastructure. These inflexibly designed, multi-million-dollar-TCO systems are not the nimble, agile systems for which the future calls. For too long, manufacturers have been charged a king’s ransom for customizations, and yet they still are constantly behind the eight ball in addressing evolving needs. While virtually all manufacturers are heading to cloud – or software as a service (SaaS) – revenue management applications, cloud migration costs are enough to raise the eyebrows of budgetary authorities. New SaaS revenue management applications alleviate the burden on corporate IT but deliver minimal innovation to the business. Yes, the support model changes, but from a Market Access perspective the applications still essentially do what they’ve done for the last ten years. Their data management scope is unchanged, as are functional gaps such as forecasting and planning capabilities.

Excessive Manual Work & Toil

Success of the new Market Access function will require streamlining of processes and prioritization of expertise. A symptom of the times is that today’s knowledge workers in Market Access teams are too bound up with data wrangling across multiple spreadsheets, manual imports and exports of data sets, and other “shoe-leather” integration toil required to move data between the Market Access ecosystem and the enterprise. On average, manufacturers have to utilize and maintain 40ish data interfaces from their revenue management system(s) to other enterprise systems, and that doesn’t count “manual” interfaces such as weekly or monthly data downloads. Those interfaces and manual data pulls – all essential for organizational visibility into access barriers, pricing, gross-to-net, and contract performance – come with significant IT, business analyst, and change management overhead. A telling sign of the cost of that overhead is the slow pace of adoption for gross-to-net automation solutions. More than 95% of the industry is still spreadsheet-bound in its gross-to-net accruals and forecasts, with automation initiatives blocked or abandoned because the data and system integration costs proved prohibitive. 

Scarce Commercialization Expertise

There are more companies commercializing therapies today than ever before. The innovation is astounding, but it has created significant brain-drain for the Market Access function. Most Market Access managers and directors in smaller biotechs have more than 10 years of Big Pharma experience. They’ve left the big players to strike a new path with an emerging innovator with scarce resources and strapped teams. One of the first reality checks is when they realize they had to leave their Big Pharma teams and resources behind. With their new lean teams, now this top talent is tied up with massive amounts of overhead work, forcing these experts to do “below-pay-grade” work.

Unifying the Market Access Function

Manufacturers can evolve the Market Access function to work toward their commercial,  financial, and operational goals (which I described in previous posts) while overcoming these barriers with a unified Market Access platform.

Integrated Applications

A true Market Access platform expands beyond the traditional revenue management system. Of course it includes applications for government pricing, Medicaid and managed markets rebate adjudication, and chargeback management. But it doesn’t have to stop there. A next-generation Market Access unified platform must address all the critical business functions of Market Access. By integrating gross-to-net forecasting and accrual applications along with inventory management and distribution contract management, Market Access teams can span their full mandate – in just one platform. 

Unified Data Backbone

To drive these applications and the related business analysis and decisioning, we must start with the foundation of a unified data backbone. This backbone breaks the silo walls to integrate all the key data sets of market access across contracts, pricing, patient access, and channel, allowing for the first time:

• Leveraging combinations of payer-reported utilization data with patient-level data from the channel, labs, and health systems to make value- and purchase-based agreements and other innovative contracts possible
• Better integration of specialty pharmacy, hub, co-pay card, and contracts and pricing data so that the team can more quickly identify the policy restrictions and out of-pocket costs that are most materially gating therapy initiation and success
• Integration of new sources of channel data that must efficiently and accurately flow data into government pricing and gross-to-net processes for innovative channel and patient access models and the operationalization of new contractual relationships
• Integration of data for nearly every fee and price concession in market access, including the channel, patient support programs, and all payers and institutional accounts to forecasting net pricing
• Integration of claims and specialty pharmacy data, rebate data, formulary insights, and co-pay program utilization to measure potential share shift
• Integrating specialty pharmacy dispensing and 867 data into gross-to-net forecasting and accrual process to improve accuracy and insights  
• Uniting 867 data, chargebacks, and claim-level rebate details to common customer master data, including critical elements such as 340B eligibility, to identify duplicate discounts and reverse chargebacks

Central to the unified backbone is ongoing data curation and the creation of unified master data. These are our data science roots, which fill a critical gap of traditional revenue management systems. A unified platform must all deliver on-demand data access by stakeholders throughout the organization, purpose-built advanced analytics to drive decisioning, and adapters to move data easily between the Market Access ecosystem and enterprise CRM and CDW systems – reducing the data wrangling and toil that is now burying teams.

Transformative Tech

A future-proofed Market Access platform takes advantage of some of the latest technological innovations to reduce toil and overhead. These might include robotic process automation, which can be used for processes such as reviewing state claim level detail for errors and overcharges – saving valuable human resources. Other innovation such as machine-learning can be utilized for claims processing and master data management. With IntegriChain’s foundation in data science, we also take advantage of the latest innovation there, including tapping intelligent data enrichment to resolve data gaps and improve data quality such as in patient status reporting from specialty pharmacies for better visibility and analysis. As analytics leapfrogs from reactive to predictive – moving beyond the world of merely reporting to now real-time insights and predictive alerts and trending – Market Access teams can proactively take action to improve access and address patient initiation and adherence barriers rather than always solving these problems retroactively.

Optionality of Implementation

Every manufacturer is different. Some keep all of the Market Access functions internal, utilizing a cloud platform with SaaS applications. Others find that certain business processes are better handled by business-process-as-a-service (or BPaaS) providers – wherein a centralized external team of experts utilizing a system that can support business scale and the changing regulatory environment is employed. For many Life Sciences manufacturers, BPaaS unitization mitigates risk. Whether SaaS or BPaaS implementations, a unified platform still offers the benefit of collaborative workflows and shared operational dashboards combined with on-demand expert support and cloud migration expertise available.

Our vision for a unified platform – much of it rapidly becoming reality through our innovation – is designed to serve next-generation Market Access. We welcome discussions about how we can help support your team.