Two things are easy to find these days. One is a think piece on GameStop trading. The other is the government’s changing positions on healthcare, powered by a short-term focus on COVID-19 within the context of longer-term structural changes.
The recent three-month re-opening of open enrollment for Obamacare is important in itself but also because it signposts an approach that’s very different from what we’ve seen for the past four years. In some ways, we’re going back to where we were. But in other ways, everything has changed.
Are we ready to keep up? Let’s talk about what is different, why it matters, and how nimble brand and market access professionals can lead from the front.
- Change 1: Longer open enrollment should mean more insured people … and signals more changes to come. Simply put, additional opportunities to sign up always lead us to expect more sign-ups and resulting changes in the payer mix. The Kaiser Family Foundation reported that after declines in enrollment from 2017 through 2019, preliminary data show that total enrollment in Medicaid and CHIP programs grew to 77.3 million in September, an increase of 6.1 million from actual enrollment in February 2020 (8.6%), right before the pandemic and when enrollment began to steadily increase.
- Change 2: Pandemic-era patients have a new appreciation for healthcare. Tragically, the potential for catastrophic illness has become far more real to people over the past 12 months. We expect to see this new realization increase people’s interest in coverage.
- Change 3: There’s a new model in place for care delivery. As Medical Economics put it recently, “Patients are fully primed for the digital revolution.” The average patient has very different expectations than they did in 2016. Even a year ago, telemedicine was still not commonplace, but today, 83% of patients expect to keep using it. And there’s a rising role for personnel who help patients make their way through the healthcare system to find the care they need, whether you call them coordinators, managers, navigators, or educators.
- Change 4: There’s a new model in place for pharma sales. The sales rep is not going away, but companies that have been able to nimbly reposition toward digital resources have been – and will continue to be – far better off.
It’s not enough to say that we need to return to an Obama-era mindset. It’s true that, in many ways, we do expect the Biden administration’s approach to healthcare to look similar. But this is a very different world, and simply returning to the old playbook is not enough. It’s time to rethink. The time is now to:
- Monitor and understand changing consumer behavior in enrollment.
- Investigate and track how care is delivered in new integrated models, how patients today (not six months or a year ago) are using care, and the impact these forces exert on HCPs and extended care teams.
- Consider and predict how prescribing behavior and financials will change, given the above. This includes analyzing total prescription growth and gross to net financials based on Medicaid mandatory and supplemental discounts.
- Reconsider short- and medium-term planning – resource allocation, strategy, and more – with these changes in mind to address new and evolving needs (including the inequities inherent in technology access).
- Work with partners who understand, and can help you see, the long view.
There’s no time to be caught flat-footed. Brand and market access leaders are ready for this need, being accustomed to having a several-year horizon, given the typical formulary management, contracting and brand planning cycle.
It’s time for you to be the tip of the spear for your organization. But are you – and your organization’s assets and knowledge – positioned to optimize the patient, caregiver, and healthcare professional experiences as we navigate these changes? Now is the time to set your organization up for success.
Peter Weissberg is vice president of market access at Intouch Group.