The impressionist painter Claude Monet explored the effects of light on the color of objects. He often painted the same subject many times to capture these effects throughout the day, across the seasons, and under different weather conditions. Whether they were of haystacks, a famous cathedral, or water lilies, Monet’s paintings demonstrate how a single subject can appear different, depending on the light, the angle or how the image is cropped.
Manufacturers that take a one-size-fits-all marketing approach with payers, hospitals, and health systems typically do not optimize market access. These organizations have different needs and wants, and an optimal solution is built for a particular product under specific market conditions. One cannot successfully target messages, contracts, or programs without segmenting stakeholders. Using variables to maximize between-group differences and minimize within-group differences is science, but selecting the variables for the segmentation analysis is an art.
Firmographics
Use of general descriptive attributes, or firmographics, to segment payers, hospitals, and health systems is a common yet somewhat lazy approach that often misses important differences. Size is the most commonly used firmographic variable. Variables describing size — payers by number of covered lives, hospitals by number of beds or visits/admissions, health systems by number of sites — are attractive because larger customers often represent a larger market opportunity. In general, however, size is not highly correlated with an organization’s perceptions and behaviors that impact access decisions. Decisions by some very small organizations mirror those made by some very large organizations.
The firmographic variable typically most predictive of organizational perceptions and behaviors — yet often missing from a palette of segmentation variables — is the organization’s financial health. Does the payer have sufficient funds to invest in predictive analytics and artificial intelligence? Does the health system have sufficient funds to buy hospitals and group practices? More profitable organizations behave differently than less profitable ones.
Interorganizational relationships
The relationship between specific payers and hospitals can have a profound impact on coverage. In turn, coverage has an impact on both treatment recommendations and whether authorization is sought by the hospital. For a given payer, some hospitals will be in network and others will be out of network. Of those that are in network, some may be designated a center of excellence for specific services (e.g., bariatric surgery). The care a hospital provides to a patient is often governed by its relationship with the patient’s insurer.
Beyond access decisions, manufacturers may want to segment payers, hospitals, and health systems based on their level of engagement and/or willingness to partner. For large organizations, past participation in value-added programs or value-based contracts may help predict future participation in the same. However, the causality of lower levels of engagement among smaller organizations is murky. Some of these smaller, less-engaged organizations are interested in engaging with manufacturers but receive fewer opportunities to do so. For obvious reasons, manufacturers typically give larger customers more time and attention.
Philosophy and culture
An organization’s philosophy and culture are often predictive of its perceptions and behaviors. While these are less visible than the public-facing (and often empty) vision and mission statements, philosophy and culture may provide insights into organizations that share beliefs about cost, quality, or value. Such beliefs and the values that underpin them are often based on shared history of what works and does not work.
For example, some organizations making access decisions believe that a focus on quality will result in better performance and clinical outcomes, ultimately lowering costs and resulting in financial success. Those organizations do not need or want the largest rebates or deepest discounts — they need and want evidence demonstrating performance and are willing to pay a premium for an advantage they deem to be clinically significant. Is such an orientation naïve or quixotic? No. Some of the most successful organizations have a quality orientation.
Some organizations crave opportunities to boost their reputation through marketing and public relations. Payers may promote their NCQA accreditation, HEDIS scores, and NCQA Multicultural Health Care distinction as measures of success. Similarly, hospitals may tout their American Nurses Credentialing Center Magnet designation for nursing excellence or their U.S. News “Best Hospitals” ranking. Organizations highlighting their investments and innovations to attract members and patients often behave differently.
Perceptions and behaviors
Segmenting payers, hospitals, and health systems based on perceptions can be valuable, but only if such perceptions are leading indicators of the behaviors of interest. Knowing that access decision makers perceive a product more or less favorably on the basis of one or more of its attributes is not helpful if those perceptions do not give the product advantaged or disadvantaged access. In contrast, segmenting organizations by their behaviors — their past, current, and predicted future access decisions — is often more telling.
Organizational perceptions are also often viewed as leading indicators of organizational behaviors, but the directionality of this relationship does not always flow this way. Access decision makers often make temporary decisions and then evaluate the impact. Did outcomes improve? Did costs go down? Real-world evidence, or lack thereof, can impact access decision makers’ perceptions of a product’s efficacy, safety, cost, or other attribute. As a result, an organization’s behaviors can impact its perceptions.
Step back
Stand too close to a painting by Monet, and all you’ll see are colorful little squiggles of paint. Step back, and you’ll see the subject within context in all its glory. Segmenting and then profiling and targeting payers, hospitals, and health systems using multiple vantage points and little squiggles of data for a particular product under specific market conditions in a way that sees the light and optimizes market access is truly an art.
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