Consulting Services / Managed Care Support

The Pinnacle Health Group assists pharmaceutical, biotechnology and medical device manufacturers with the development of comprehensive managed care payer strategies tailored to meet their reimbursement needs. Our team will help you clearly articulate the value proposition of your product to a managed care audience, which will provide you with the cost/benefit rationale and economic arguments to successfully approach and negotiate reimbursement with payers. Our consultants have managed care expertise both on the payer and the provider side, thereby offering a unique perspective to assist you with your managed care strategies. Our services and support include:

Value Proposition Development

The Pinnacle team will perform a complete review of all your organization's materials and prepare a payer presentation that describes a value proposition and economic rationale of how your organization's product benefits a managed care payer and their respective members. We will assist you in using the payer presentation to approach payers and to identify and target the appropriate payer representative.

Payer Surveys and Interviews

Some organizations require further research to successfully develop the value proposition of their product. The Pinnacle team will develop surveys and interview questions to target managed care organizations for information crucial to our client's products and services. We include information that will reliably test your organization' targeted audience on various treatment concepts, new ideas, existing clinical practices, desired member objectives and managed care outcomes. In addition to developing these important tools, The Pinnacle also performs these surveys and interview on our client's behalf.

Economic Modeling

The Pinnacle Health Group will develop an economic model integrated with clinical rationale to show ROI to a managed care payer. The model can include utilization, cost and disease management returns and would be adjusted for different populations such as Medicare, Medicaid and commercial payers. Pinnacle's modeling accounts for your organization's specific needs and tailors it to the specific payer, as the mix of members within a payer differ

Sales and Marketing Strategies

The Pinnacle assists clients with the development of a comprehensive sales and marketing strategy tailored to the client's products and services that targets payers, geographic areas and payer members. The sales and marketing strategies include and encompass elements such as who to approach at the payer level, how to approach payers, what tools to use based on the audience sought and recommendations for local, regional and national approaches. We work closely with each client to develop the appropriate written and other collateral materials to achieve successful marketing campaigns.

Sales Training

We will assist in training your organization's sales team to maximize their sales in the managed care market. The Pinnacle team will formulate sales strategies that include how to present a value proposition, how to approach payers, what type of presentations to utilize and how to convince payers of the need for your organization's product or services.

Pricing and Reimbursement Strategies

The Pinnacle team helps clients develop a pricing strategy that maximizes the value of their product or services. Strategies include market comparison, competitor analysis, fee for service programs, capitation (per member per month costs) as well as reimbursement opportunities. Pricing strategies are tailored to the specific payer, whether it is employers, employees or commercial payers.

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