Our Core Services

Clinical and Regulatory Plan

Clinical and regulatory support services include clinical strategy, FDA interactions, protocol development, study execution and reporting. We incorporate health economic endpoints into the study design for improved payer acceptance and accelerated market adoption.

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Market Access Strategy Report

A comprehensive evaluation and report of your health solution’s fit into current health policy, coding, coverage, reimbursement, including its clinical and health economic value compared to reasonable alternatives.

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Reimbursement Plan

An evaluation of appropriate coding and reimbursement to describe the condition, procedure or intervention. A summary report is then generated with the timeline required to obtain new codes for your procedure, device, diagnostic, or biologic.

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Health Policy

Interpretation of Federal and State health policy resulting in a report on government treatment standards, quality measures, provider requirements (MIPS), coverage and payment policy relative to your health solution.

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Health Economic Modeling

Creation of a mathematical framework based on high level published clinical evidence which estimates the effects of an intervention on valued health consequences and costs compared to reasonable alternatives. Models enable an evaluation to be extended beyond what has been observed in a study and can bring together data from a variety of different sources.

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HEOR Studies

Health Economic and Outcomes Research (HEOR), both retrospective and prospective, services are offered. Using this method we evaluate patient outcomes and the cost to deliver those outcomes compared to reasonable alternatives in a real-world setting. HEOR studies are used to inform healthcare coverage and access decision makers. We use both medical claims and EHR datasets for retrospective studies and also offer prospective study design services to optimize market access and buyer adoption. This approach differs from a randomized controlled trial.

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Code Applications

A comprehensive service which includes code identification, financial evaluation, medical society collaboration, application, and all steps necessary to obtain a new code. Our medical code service includes new CPT, PLA-CPT, ICD-10, and HCPCS codes. In addition, DRG analysis and new assignment, as well as Medicare add-on payment applications can be conducted on your behalf.

VBHC Contracts

Value-Based Health Care (VBHC) contracts are based on clinical and economic evidence in support of your health solution. Expected patient outcomes and resource allocation are the basis of all VBHC contracts with payers or providers, and business models are unique to your solutions attributes. All necessary analytics, contract development, and negotiations of sound VBHC contracts are included in this service.

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Value Proposition Development

Identification of all peer reviewed published clinical and economic evidence in support of your health solution. A fully referenced report in support of your health solution’s market value for each perspective; hospital, physician, patient and payer, will be produced. Value propositions that can be supported with currently available evidence will be offered, and any further evidence generation required to attain desired value statements will be recommended.

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Product Pricing

A full evaluation of applicable reimbursement mechanisms such as DRGs, APCs, CPT codes, as well as clinical and economic evidence, market demand, supply and competition will be aggregated to estimate an ideal price, including a price range for your solution to best fit the healthcare market.

Healthcare Education & Training Services

The ABCs of US healthcare. Education and training services include but are not limited to healthcare system structure, coding, reimbursement, quality measures, Medicare, Medicaid, Private Health Insurance, ACOs, Health Economics, HEOR, and VBHC. Global system reimbursement requirements and process for coverage.

Innovative Payer/Provider Partnerships

Creative solutions that bring together partners and your health solution with the goal of significantly improving patient outcomes and advancing population health. This service includes analysis of your solution's value, healthcare market positioning, direct collaboration with payers and providers, contract negotiation, HEOR study design, study execution, measurement, and published results.