By Abbey Bernardi, LexisNexis Risk Solutions Health Care

Pressure is at an all-time high for providers to find a way to deliver the highest quality care at the lowest possible price: Enter the shift toward integrated delivery networks (IDNs) and Accountable Care Organizations (ACOs). In an attempt to better coordinate care, the US healthcare system has identified consolidation as the ideal means to achieve significant value feats.

While cost/benefit analyses on IDNs are a mixed—and complicated—bag, from the life sciences organization (LSO) perspective, one thing is for certain: there’s a need to reframe the way provider commercial models are approached. For LSOs, high-level strategies must change today—actually, make that yesterday.

One of the biggest challenges LSOs face is determining the level of influence an IDN has over its service providers in terms of formulary decision making, and how strict the use of specific products and therapies is enforced. IDNs are not traditional providers, or friendly physicians across the table who will listen carefully about how a drug will help them deliver the best treatment possible. IDNs often are comprised of a complex web of decision makers, many of whom aren’t prioritizing friendships with pharma. Still, their interests are critical to understand, and only the right summation of data will provide the power to express LSO value measures in specific IDN markets.

IDNs: Who they are and how they’re different

The IDN is a formal system of service providers that includes a variety of care sites such as hospitals, primary care offices, post-acute and long-term facilities, and other specialty and home care environments. Some organizations, such as ACOs, may even include a health insurance plan. IDNs are typically specific to a region and, no doubt, many of these organizations ring a bell: Sacramento’s Kaiser Permanente, Boston’s Partners Healthcare System, and New York City’s New York-Presbyterian, to name a few.

All of these giants function quite differently, but one thing’s for certain: they are huge. After all, their purpose, in part, is servicing a large geographic area to leverage volume for coordinating care to improve outcomes while reducing costs.

The shift toward consolidation is an established paradigm: As much as 80% of hospital and nursing home non-labor expenditures are funneled through group purchasing organizations (GPOs) or IDNs. [1] The largest among these associate with about 10,000 physicians each, and may include more than 1,000 hospitals, physician offices, and nursing homes. [2]

What do we really know about all these IDNs?

A select few networks operate nationally and include hundreds of hospitals. The rest are regional or local; some include dozens of facilities while others only have a handful. They are faith-based (or not), offer bundled payments (or not) and boast completely integrated technologies and processes (or intend to integrate them!). Essentially, every one of the 900 IDNs in the US is unique, making it challenging to navigate from “the outside.”

Operations, management strategies, and purchasing processes are very much a complex mystery that pharmaceutical sales reps seek to solve—for every target. Efforts no longer focus on simply demonstrating the product’s ability to achieve efficacious outcomes. As players change, the pitch must change, as must the tactics that get them to the table.

Outcomes and offices, studies and samples: yesterday’s strategies must evolve to meet tomorrow’s demands. Consolidation on a massive front means more centralized decision making, the responsibilities of which involve concerns and issues on a grander scale. IDNs must consider purchase risks and benefits over the scope of an entire organization, not in solely a clinical silo. While physicians or department heads were once the pharmaceutical sales audience, the attention of administrators, executives, purchasing managers or an entire Pharmacy and Therapeutics committee—some of whom are hard to reach—must now be garnered.

Once a pharmaceutical representative does get their collective or personal attention, knowledge about that organization must be leveraged to convey very specific, targeted promotion. The network trend demands a marketing shift from the B2C approach, in which reps sell to a customer, to B2B, in which reps sell to a business or account. So, this shift translates to lots of homework for pharmaceutical companies.

To evaluate the potential of a product with a specific IDN, brands should identify various types of care sites in the system, and how many providers staff them. They need to get answers to the following questions during their planning stage:

Which providers are most influential, and how do they split time among the network’s different facilities?

What are the providers’ relationships like across the network, GPOs and ACOs, as well as with various payers?

What do referral patterns look like within and outside of the IDN?

Beyond referrals, it is also important to understand patient centered care teams within the relevant therapeutic areas – and how those care teams align from an IDN perspective.

What specific services are being done and on what frequency?

Mostly, claims data will reveal diagnoses and procedure specifics, but this information can be analyzed to generate actionable and most useful insights. When presenting to administration (vs. clinical experts), reps must be ready to address efficiency, improved outcomes, market share gain and ROI. It’s imperative to focus on relationship building within the IDN CEO, CFO, CIO and various directors to understand their wants and needs and determine the company’s ability to meet them.

None of this complex analysis of IDN configuration, care provision and market dynamics is conceivable without access to the right type of data. A successful sales strategy requires true understanding of the behaviors and product needs of different IDNs. Useful insights must be the foundation of creating that perfect pitch since the interests of today’s stakeholders are so broad and varied.

Targeted LSO sales approaches demand thorough demographic and profile data analysis on IDNs and every single provider’s treatments. This includes up-to-date claims and contact data, financial information, and defining attributes of the network’s internal structure.

Claims data must also be analyzed from the value perspective of each IDN, so reps can better prioritize outreach and drive growth in particular markets. With the right data, brands can even attribute a dollar value for a provider organization’s business to a specific product. Layering complex claims data with demographic information optimizes sales and marketing strategies.

Armed with the data insights described above, LSOs companies can start to unpack the 900 IDNs nationwide, which include 67,000 parent/child relationships; 250 GPOs, with more than 94,000 purchasing relationships, 800 ACOs, with more than 4,000 relationships to healthcare organizations and IDNs, and more than 2.7 million healthcare provider and healthcare organization affiliations.

LSOs should focus on the IDN market dynamics to paint the clearest picture possible of how products deliver on promises of revenue growth and outcomes generation. This is the future of the healthcare marketplace: get the data, and start executing.

1. http://www.jhconline.com/group-purchasings-impact-on-spending-examined.html

2. http://www.pharmaceuticalcommerce.com/latest-news/which-are-the-top-integrated-delivery-networks-idns-and-how-many-docs-do-they-have/

Abbey Bernardi is director of market planning for LexisNexis Risk Solutions Health Care. LexisNexis Health Care solutions leverage the industry’s leading public, claims, provider and consumer data to transform the business of healthcare. Industry solutions include provider data management and patient identity intelligence.

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