BIOPHARMA INTELLIGENCE | MARKET ACCESS

Health Plan Analysis

Strengthen account call and meeting preparation, strategic planning and sales strategy development

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US managed care from every angle

National and regional healthcare is in constant flux due to shifting health plan realities. You need to understand payer realities and reactions to build effective relationships.

  • Can you pinpoint which health plan dynamics are most critical to your business?
  • Do you leverage claims data to inform your strategy with payers and PBMs?
  • How do you know if you’re pricing strategy matches the markets you want to penetrate?
  • How do you know which payers you should target to expand your market share?
  • How do you track the state level effect high-deductible health plans will have on your product?

Insight by state, health plan, MCO and exchange

Our clients need to understand control and influence over benefit utilization and each market segment. They also need to understand payer challenges and how those payers are responding to challenges and how that affects benefit cost and utilization. Additionally, they need to understand key relationships between payers, providers and PBMs.

Our team of analysts are dedicated to researching trends affecting enrollment and benefit utilization in each market and our reports and insights keep you up to date on those trends, saving you time and resources.

Our insights provide forward-looking analysis so you can anticipate future changes and challenges.

For account managers, our insights provide a deep understanding of the broader market place and the policies/regulations and rules that may influence access to drugs and requirements placed on payers/providers and pharma.

HPA reports track such developments within the context of payer/provider and pharma relationships.

View our Health Plan Analysis research reports

Strengthen account call and meeting preparation, strategic planning and sales strategy development

  1. Use our statewide predictive analysis of health plan enrollment and benefit design, down to the county level
  2. Assess payer and provider influence over benefit utilization through our data and insights, including HDHP analysis
  3. Identify the emerging payer cost control trends and strategies and investigate the dynamics driving payer decisions
  4. Understand the policy decisions and rules affecting access to medical and pharmacy benefits
  5. Gain a state level understanding of the relationships between payers, providers, and pharmacy benefit managers and how the market is changing.
  6. Leverage our event-driven reports to stay abreast of changes in your markets and eliminate blind spots in your sales strategy
  7. View CMS Star Ratings by plan and by state
  8. Plan with Clarivate’s Medicare Advantage enrollment forecast

We leverage our unparalleled market access data and analysis to deliver personalized, actionable insights, from pre-launch through product maturity and down to the hyper local level to answer the most important questions your Market Access team faces.

The Health Plan Analysis Dashboard

Insights include:

  • County level heat maps of enrollment, allowing quick analysis of where the largest payers are most prevalent
  • HDHP impact on drug utilization within each state based on DRG real world pharmacy claims data
  • Cost impact on drug therapy areas by state
  • Full Medicare Advantage rate information by plan and by state
  • Medicare Advantage enrollment forecast
  • Full CMS Star Ratings by plan and by state
  • PBM enrollment and market share analysis

Download factsheet

Powerful and comprehensive analysis:

Key market events

  • Major M&As and their impact on the state’s healthcare environment
  • Updates on recent healthcare reforms
  • Recent legislations passed/ proposed by the state that will affect participating insurers, providers, PBMs and pharma manufacturers

Executive summary

  • Key developments and their implications summarized in an easy to assimilate, tabular format

Market profile

  • Provides an in-depth overview of economic indicators such as unemployment rate and un-insurance rate at MSA level
  • Explains regional differences within the state
  • Explores the relationships between providers, payers and patients with respect to drug reimbursement

Exchange watch

  • Detailed description of state’s exchange platform
  • Exchange enrollment trends
  • Copay structure of the largest silver plan explained
  • Detailed plan designs, including views of premiums, copay/ co-insurance structure and coverage for largest exchange plans

Commercial carriers

  • Commercial sector enrollment trends, market share of key insurers
  • Influence of ACOs and IDN in driving value-based reimbursement
  • Pharmacy benefits
  • Formulary decisions of key insurers and their impact on the availability of certain high-cost drug treatments
  • Payers’ partnerships and alliances with providers in the state

Managed Medicaid market

  • Medicaid enrollment trends, market share of key insurers
  • Administration
  • Key decisions taken by the state regarding expansion of Medicaid eligibility, implementation and adopting mandatory managed care policies, and more
  • Medicaid spending, including recent budget adjustments and their impacts

Managed Medicare market

  • Medicare enrollment trends, market share of key insurers
  • Detailed description of Medicare Health Plan Quality and Performance Ratings (commonly known as star ratings)
  • Changes to star ratings measures (new measured introduces and/ or expected changes)

Regulation / legislation

  • List of key regulations (including those that will affect reimbursement)

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