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Assessing The Reimbursement And Economic Landscape For A New Portfolio Of Products In The Cardiovascular Space—Large Medical Device Company

A large medical device client was considering entering a new segment of the cardiovascular (CV) space via several product/company acquisitions.  The client was still evaluating several products, which utilized novel technological approaches and spanned different applications and diverse customer bases.  At the same time, the U.S. reimbursement environment generally, and for several of the product types specifically, was evolving significantly.

BMI was brought on as a partner to help the company identify areas of unmet need and potential value that it could offer in the CV disease segment and to assess the impact of the current and emerging reimbursement landscape on the new product portfolio being evaluated.

BMI Approach

BMI brought its deep understanding of the U.S. reimbursement and health economics landscape, as well as cardiovascular therapeutic expertise, to this project.  We performed a comprehensive assessment of the company’s potential position in the disease segment through secondary and primary research.  We conducted over two dozen interviews with physicians, hospital/clinic administrators, commercial and Medicare Advantage plans, integrated delivery systems (IDNs)/accountable care organizations (ACOs), and others.  The research spanned a wide range of topics, including:  disease segment treatment pathways; opinions of current/emerging technologies seeking to improve disease management; details around disease segment economics, including insurer coverage criteria, hospital inpatient and outpatient pathways/guidelines, and quality metrics used by hospitals and payers to track success; value assessment committee evaluation criteria for relevant technologies; and numerous other issues.

Deliverables

The engagement spanned several years, during which we prepared multiple deliverables.  These included a comprehensive assessment of the disease segment’s reimbursement landscape and opportunities for the company to address unmet needs with the products under consideration.  We also prepared a condensed deck for our direct client to use for presentations internally.  We visited the company midway through the engagement to lead a planning workshop that helped advance several related internal strategic initiatives.  Finally, at the end of the initial engagement, we were retained to monitor the reimbursement environment for the new product portfolio, the findings of which were reported monthly.

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Elizabeth K. Brooks, Partner, San Francisco 

Ms. Brooks has worked in market research and health care policy for 30 years. During this time, she has helped biotechnology, pharmaceutical, and medical device companies develop marketing, reimbursement, distribution, and overall launch strategies for their products.  Ms. Brooks has analyzed markets for, and provided due diligence support on, hundreds of therapeutics.  She is also expert at reimbursement issues, offering analysis, education, and tactical support to pharmaceutical and biotechnology concerns, as well as medical device companies. In addition, Ms. Brooks has developed a model for helping companies evaluate the need for pharmacoeconomic studies and has trained hundreds of staff on the appropriate use of outcomes research tools.  Ms. Brooks holds a Masters of Business Administration and an Honors Bachelor of Arts degree in English, both from the University of Chicago. She also earned a Certificate from the University of Chicago Graduate Program on Health Administration and Policy.

Elizabeth K. Brooks, Partner, San Francisco 

Ms. Brooks has worked in market research and health care policy for 30 years. During this time, she has helped biotechnology, pharmaceutical, and medical device companies develop marketing, reimbursement, distribution, and overall launch strategies for their products.  Ms. Brooks has analyzed markets for, and provided due diligence support on, hundreds of therapeutics.  She is also expert at reimbursement issues, offering analysis, education, and tactical support to pharmaceutical and biotechnology concerns, as well as medical device companies. In addition, Ms. Brooks has developed a model for helping companies evaluate the need for pharmacoeconomic studies and has trained hundreds of staff on the appropriate use of outcomes research tools.  Ms. Brooks holds a Masters of Business Administration and an Honors Bachelor of Arts degree in English, both from the University of Chicago. She also earned a Certificate from the University of Chicago Graduate Program on Health Administration and Policy.

Paul C. Nagle, Partner, San Francisco

Mr. Nagle has advised medical product manufacturers on a wide range of strategic issues for over 30 years. He specializes in market assessments, payer and reimbursement strategy, and pricing and contracting strategy. With his thorough knowledge of payer policies, he has helped dozens of product manufacturers understand and penetrate managed care, Medicare, and Medicaid segments, as well as provider segments when they are de facto payers. He also frequently conducts due diligence for M&A and licensing opportunities for manufacturers and the investment community. Mr. Nagle performs pricing analyses and develops contracting strategies (including multiple product contracting) using a variety of methodologies. Mr. Nagle also has significant expertise in international market assessments.  Mr. Nagle is frequently called upon by his clients to research, analyze and strategize about particularly unique and challenging manufacturer dilemmas and novel areas of interest.  Mr. Nagle holds a Bachelor of Science in Business Administration from the Olin School at Washington University in St. Louis.

Paul C. Nagle, Partner, San Francisco

Paul C. Nagle for over 30 years, Mr. Nagle has advised medical product manufacturers on a wide range of strategic issues. He specializes in pricing strategy, payer and reimbursement strategy, and assessing markets and products for licensing and M&A due diligence. Mr. Nagle’s focus is most frequently on the US and Europe, but also includes Japan and Brazil. He frequently consults to the investment community for opportunities under consideration. Mr. Nagle performs pricing analyses and develops pricing and contracting strategies using a variety of methodologies. Mr. Nagle also has significant expertise in third-world market assessments. Mr. Nagle is frequently called upon by his clients to research, analyze and strategize about particularly unique and challenging manufacturer dilemmas and novel areas of interest. Additionally, Mr. Nagle has helped state Medicaid programs and private payers understand the impact of specialty products, and his analyses have impacted Medicare legislation. Mr. Nagle holds a Bachelor of Science in Business Administration from the Olin School at Washington University in St. Louis. Before co-founding BioMedical Insights, Mr. Nagle was at Health Technology Associates, which became part of Covance.

Christopher A. Nicita, Partner, San Francisco

Mr. Nicita specializes in market and technology assessment, new product planning, and pricing and reimbursement strategy. He has over 30 years of experience in health care market analysis and medical research. Mr. Nicita has helped identify and evaluate opportunities afforded by dozens of new products, technologies, and markets and has helped the firm’s clients develop and launch a number of innovative new therapies. He has worked with a range of companies, from industry leaders to start-ups, to make sound portfolio investment decisions and to optimize clinical development strategy. Mr. Nicita frequently consults to companies on prospective in-licensing and merger and acquisition candidates, and has provided due diligence services to a variety of health care investors. He has broad expertise in most therapeutic classes and disease areas including oncology, infectious diseases, immune-mediated and inflammatory diseases, endocrinologic diseases, ultra rare genetic diseases, and cardiovascular diseases, among others. Mr. Nicita holds a Masters of Business Administration and an Honors Bachelor of Science in Molecular Biology, both from the University of Michigan.

Christopher A. Nicita, Partner, San Francisco

Mr. Nicita specializes in market and technology assessment, new product planning, and pricing and reimbursement strategy. He has over 30 years of experience in health care market analysis and medical research. Mr. Nicita has helped identify and evaluate opportunities afforded by dozens of new products, technologies, and markets and has helped the firm’s clients develop and launch a number of innovative new therapies. He has worked with a range of companies, from industry leaders to start-ups, to make sound portfolio investment decisions and to optimize clinical development strategy. Mr. Nicita frequently consults to companies on prospective in-licensing and merger and acquisition candidates, and has provided due diligence services to a variety of health care investors. He has broad expertise in most therapeutic classes and disease areas including oncology, infectious diseases, immune-mediated and inflammatory diseases, endocrinologic diseases, ultra rare genetic diseases, and cardiovascular diseases, among others. Mr. Nicita holds a Masters of Business Administration and an Honors Bachelor of Science in Molecular Biology, both from the University of Michigan.

Andrew P. Kloek, Ph.D., Principal, Nashville

Dr. Kloek has worked in market research, reimbursement and technology assessment with BioMedical Insights since 2007. He holds a Bachelor’s degree in Genetics and Chemistry from Western Kentucky University and a Ph.D. in Genetics from Washington University in St. Louis. Prior to joining BioMedical Insights, he spent eight years with biotechnology start-up companies including three years working with Affymetrix-based micro-array technologies at Perlegen Sciences, a Mountain View, California-based company focused on pharmacogenomics and personalized medicine. He has co-authored 20 peer-reviewed scientific publications and 10 issued patents in the fields of genetics and biotechnology.

Andrew Kloek, Ph.D., Principal, Nashville

Dr. Kloek has worked in market research, reimbursement and technology assessment with BioMedical Insights since 2007. He holds a Bachelor’s degree in Genetics and Chemistry from Western Kentucky University and a Ph.D. in Genetics from Washington University in St. Louis. Prior to joining BioMedical Insights, he spent eight years with biotechnology start-up companies including three years working with Affymetrix-based micro-array technologies at Perlegen Sciences, a Mountain View, California-based company focused on pharmacogenomics and personalized medicine. He has co-authored 20 peer-reviewed scientific publications and 10 issued patents in the fields of genetics and biotechnology.

Jacqueline D. Koenig, Principal, Houston

Ms. Koenig has been with BioMedical Insights since 2004. She helps life sciences and medical device companies conduct due diligence, analyze market nuances, assess licensing and investment opportunities, prioritize clinical indications, and create market access strategies across numerous therapeutic categories. Prior to joining BioMedical Insights, Jacqui worked at the Kaiser Family Foundation developing national public education campaigns and conducting public opinion and provider surveys. She started her career at what is now Covance (formerly Health Technology Associates). Ms. Koenig holds a Bachelor of Arts degree in Economics from Vassar College and a Master of Science in Business degree from Johns Hopkins University.

Jacqueline Koenig, Principal, Houston

Ms. Koenig has been with BioMedical Insights since 2004. She helps life sciences and medical device companies conduct due diligence, analyze market nuances, assess licensing and investment opportunities, prioritize clinical indications, and create market access strategies across numerous therapeutic categories. Prior to joining BioMedical Insights, Jacqui worked at the Kaiser Family Foundation developing national public education campaigns and conducting public opinion and provider surveys. She started her career at what is now Covance (formerly Health Technology Associates). Ms. Koenig holds a Bachelor of Arts degree in Economics from Vassar College and a Master of Science in Business degree from Johns Hopkins University.