Health Economics Analysis

Proving clinical effectiveness is half the solution. We can help you demonstrate evidence of cost to payers so they’ll cover your medical technology.

Medical Policy Research and Coverage Advocacy

LIM conducts Medical Policy Research and Coverage Advocacy to provide companies with insight into the probable coverage status of new and emerging technologies among government and private health insurers. Advocacy opens the doors for coverage. When medical coverage policies do not cover such technologies or when coverage does not exist, LIM staff will meet with health plan medical policy makers to advocate for change.

Reimbursement Strategy Development

The Patient Protection and Affordable Care Act of 2010 changed the dynamics of all healthcare delivery and financing. LIM understands government and private payer coverage and payment policies within the context of the current health economics environment. We design strategies around specific objectives targeted toward any reimbursement barriers that would otherwise limit broad market adoption of emerging medical technology.

Interviews can be arranged with existing health plan medical directors to assess payer reaction to new technologies either pre-lease or prior to final design. The former can help guide the extent of payer relations work that will be required for successful medical policy coverage. The latter can be used to determine if a new product is perceived as reasonable and necessary before making final product decisions, thereby de-risking the investment. These interviews can be done individually or via facilitated advisory board discussion.

Health Economic Analysis

Health Economics Analysis has become increasingly important as payers often demand evidence of cost effectiveness, not just clinical effectiveness before covering new technology and services. LIM works with medtech companies with varying types of analyses which may be required to demonstrate cost effectiveness and to accelerate favorable medical policy coverage.

Cost Analysis
Cost Analysis provides a complete accounting of the expenses related to a given policy or program decision. It supplies the most basic cost information that both decision makers and practitioners require and forms the foundation of all other economic analyses.

Budget Impact Analysis (BIA)
A Budget Impact Analysis is a comprehensive study of all governmental revenues, expenditures, and savings that will result from the proposed policy or program. This type of analysis helps policymakers determine whether a proposed initiative is affordable from a budgetary standpoint.

Cost Effectiveness Analysis (CEA)
A Cost Effectiveness Analysis is used to evaluate which program or policy creates the result payers want at the lowest cost. CEA is a valuable tool for weighing programs or policies with similar outcomes, but it should not be used to compare programs that have different outcomes.

Cost Benefit Analysis (CBA)
A Cost-Benefit Analysis is a method for comparing the economic pros and cons of policies and programs to help policymakers identify the best or most valuable options to pursue. A characteristic feature of CBA is that it monetizes all the benefits and all the costs associated with an initiative so that they can be directly compared.

Medical Technology Product Adoption Special Services

Our teams areavailable throughout the entire product life cycle including early, middle product adoption phase and late phase.

LIM provides special services often required throughout the product adoption phase including ongoing clinical-user support for coding, billing, coverage support and procedure prior authorization.

Solutions for Complex Needs

Healthcare in the United States is complex. Medical technology, pharmaceutical or diagnostics companies looking for answers about how or whether a new technology or device will be reimbursed need a team of experts in marketing strategies, reimbursement strategies and payer relations.

Demonstrating clinical effectiveness is mission critical for new products and services. Achieving the right reimbursement strategy—one focused on proper coding, appropriate insurance coverage, and adequate payment—is critical for bringing a medical device to market in the U.S. successfully today.

LIM offers a full spectrum of clinical and reimbursement strategy services and solutions. Our team specializes in market strategy development and implementation as well as payer relations for new and existing medical technologies.

Our Solutions

Contact Us

info@leaders-in-medicine.com

1.630.524.4058
Corporate mailing address:
Leaders in Medicine, Inc.
P.O. Box 449
Wayne, Illinois 60184

Business development
LIM designs and develops growth strategies and market opportunity assessemnt for our clients worldwide

Advisory Boards
Advisor resources to support development, implementation and management of hgh level advisory and expert panels for the healthcare industry.

Registry Design and Development
Design and development of clinical and patient reported outcomes registries.

Reimbursement Helpline/Hotline Support
Reimbursement Helpline/Hotline Support. Our highly-trained team is available via a Helpline to service clients whose customers require guidance in reimbursement issues throughout the product lifecycle.

Reimbursement Guides
LIM professionals assist clinical users in providing guidance to hospitals and physicians in the proper billing and coding of manufacturer-sponsored products.

FAQs for Payers/Providers
We often help clients in creating a list of frequently asked questions for payers and providers to help communicate key information for use by hospitals and physicians when first billing for new technologies and services. These may be sufficient in many cases to get new procedures paid.

Draft Appeal Letters
Physicians using new technology to treat patients often hit road blocks when payers do not understand the technology. LIM can draft appeal letters for clients who want to help physicians readily appeal insurance denials.

FAQs for Sales Staff
Your sales staff is on the front lines introducing prospective customers to your new product. That’s why it is so important to provide them with fundamental education to accurately pass onto physicians, nurses, and hospital administration when promoting your medical technology. Our team helps clients develop information such as FAQs for sales staff to use.

Our Solutions

A Life Sciences International, Inc. Company / www.lifesciencesint.com

Learn about our solutions below:

Solutions for Complex Needs
Reimbursement Strategy Development
Medical Policy Research and Coverage Advocacy
Health Economics Analysis
HCPCS and CPT Code Analysis and Applications
Medical Technology Product Adoption Special Services