Payer Influence Mapping: Integrating Strategy and Data Analytics

Client Situation

A global biopharmaceutical company’s multi-indication therapeutic was poised to enter a new market crowded with competitors and emerging therapies offering novel mechanisms of action. Because most US health plans do not have indication-specific formularies, flexibility to expand patient coverage for the anticipated new indication was limited. As a result, the company wished to identify and better engage influential individuals involved in P&T decision-making related to its product to improve market access.

Specifically, our client sought to identify the top influencers in the disease who may drive decisions related to tier placement as well as the individuals involved in emerging fields like population health with whom the company may engage to further educate on the value the product provides to patients.

Our Solution

We started by breaking down the overall business objective of the client into smaller goals to allow an incremental build of an enterprise-wide, scalable, self-service platform that would serve the data and analytics needs of both our client and its partners. To do so, we followed an agile methodology—breaking up the overall project into shorter “sprints,” with each 8- to 10-week sprint designed to accomplish a specific objective.

To improve access in a crowded market, our client needed a highly specific and detailed payer engagement strategy, and the use of data analytics throughout the process was a key part of our solution.

We began by identifying and ranking priority key opinion leaders (KOLs) based on their level of influence, as measured by the frequency of their citations across medical policy documents. We first assembled data sets containing hundreds of policy documents for the top 100 payers in the US. We then mined those documents to identify all of the healthcare provider (HCP) references and citations and assembled a comprehensive list of all HCPs identified in the medical policy documentation. Many of the HCPs were cited on multiple policy documents from the same health plan as well as being cited on multiple documents across health plans. Individuals cited multiple times across multiple health plans were thus determined to possess a higher degree of influence, and we categorized the HCPs into tiers based on their level of influence.

Of the approximately 2,500 unique HCPs referenced, 650 unique HCP KOLs were selected for assessment. From here, a wide range of analyses could be performed, including the number of KOLs cited by a single health plan, the number of health plans citing an individual KOL, and the specific topics on which KOLs were cited.

We consolidated all of this information into a KOL database that contains KOL identification information—including National Provider Identifier (NPI) number, specialty and subspecialty, affiliated healthcare institutions, publication history, and subject matter expertise—and a prioritization framework.  This resource provided our client’s account representatives detailed information about priority KOLs that would contextualize their outreach and ensure more relevant discussions. Based on this information, the representatives can prioritize which accounts to engage with about the product.

The data analytics component was supported with a robust qualitative market research effort, providing a perspective on the priorities of each payer account’s P&T committee and how our client may improve its engagement with influencers on those decision-making groups. We recruited payer stakeholders across national, regional, and local priority accounts to participate in 60-minute phone interviews. Stakeholders in a mix of roles across multiple payer types were targeted for interviews, focusing on individuals involved in and having familiarity with decision-making around therapies similar to our client’s product.

Through the interviews, we were able to identify key internal decision makers and influencers. We then combined the internal influencers and internal decision-making dynamics with the external KOL influencers we identified via data analytics to create a comprehensive database of influencers that would be relevant for engagement.

EVERSANA MANAGEMENT CONSULTING supplemented the analytics and primary research with an additional data scrub of information in the public domain to identify potential engagement points to support the targeted strategy.

As an additional resource, we built 40 account profiles derived from the primary market research, detailing the key influencers, decision-makers, and payer decision-making criteria.  In these profiles, we specified the key topics and questions payers were struggling to address for the specific indication and corresponding therapeutics, creating an invaluable tool for account managers to help them understand which influencers would be most relevant to engage with based on those “struggle” topics. We also specified an action plan illustrating key steps, opportunities, and discussion points with payers moving forward.

Finally, the team provided recommendations on multiple paths to rollout based on the level of refinement the client desired on the account profiles to ensure their actionability and stickiness.

Through the integration of strategy and data analytics, EVERSANA MANAGEMENT CONSULTING assisted our client in identifying the key influencers in the disease space, determining their involvement in decision-making, and understanding how to engage with them to improve market access for its product.

In addition to a targeted engagement strategy and rollout plan, our client came away from this project with powerful new tools, including (1) a robust KOL database supporting strategic analysis of KOL influence dynamics to inform prioritization and engagement, and (2) detailed field-ready account profiles providing a view into the breadth and depth of expertise and capabilities across accounts.


We Are Ready

We can help you generate insights to inform and develop customer segmentation and strategy, or how any of our other offerings can help increase the value of your products.