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Essential ACO Engagement: Mapping New Networks of Influence

Introduction

Accountable Care Organizations are set to transform the US health market, establishing efficiencies in patient care and physician working. While their impact to date is limited, ACOs ever widening remit as key funding and decision-making stakeholders makes them important players in the state and privately funded health market. Are ACOs friends or foes of pharma and how should the industry expand and adapt its stakeholder engagement strategies for best advantage?

Essential ACO Engagement: Mapping New Networks of Influence is essential reading for commercial planners and practitioners. The report is based on the insights and experiences of sales and market access professionals working in US pharma companies and experts working in ACOs see who they are. Packed with insights and actionable information, this study identifies the issues, threats and opportunity areas that ACOs present to the pharma industry.

“If pharma doesn’t work with the ACOs and show their product is of value, they won't prescribe it. The physician is at risk now, so companies have to demonstrate value for their product.”

Reasons to Purchase

Answering key questions

ACO Structure: There are 6 types of ACO – what are they, how do they differ from each other and why is it important to know?

ACO Challenges: What are the challenges ACOs face and what role might industry play in overcoming them?

Next Generation ACOs: How do the “next generation” ACOs differ from the pioneer ACOs and what should industry know about them?

Data exchange? Industry can support its value proposition with real world data, while ACOs’ access to electronic medical records brings a wider perspective – could data be a platform for partnership?

Drivers for change: What are the ACO drivers and priorities that could impact pharma sales?

Drug Pricing: How might ACO value for money considerations impact drug prices?

Engagement: In future, industry will have to engage with a wider group of stakeholders – what are the implications for resourcing and the structure of sales and market access teams?

With this report you will be able to

Learn the impact ACOs are currently having and know how “next generation” ACOs will differ

Understand the patient care and cost saving drivers and priorities that are shaping ACO activity

Know how and why ACOs will eventually influence prescribing and formulary decisions and develop value-based propositions that meet ACO and patient needs

Identify the areas of mutual interest and collaboration between ACO and industry and formulate strategies for engagement

Use the insights to review your current sales and market access resources and plan for wider stakeholder engagement in the future

Key topics explored

With an agenda for improving patient outcomes while reducing cost, ACOs are now part of the health landscape and will grow in importance.

ACO organization varies widely and reflects the patient population needs it serves – this is a challenge for industry in establishing engagement and communication policies.

Industry has been slow to accommodate ACOs in their stakeholder strategies, but as ACOs become more influential pharma must ensure the appropriate resource to engage effectively.

Long-term relationships with KOLs may become less valuable as decision making moves to ACO teams and committees.

Patient awareness of ACOs is low and the model of integrated care alien to US society: what communication issues does this raise for industry.

Contributors

Jeff Carbone, VP, The Bloc Value Builders

Les Duncan, Vice President of Accountable Care Initiatives, River Health ACO

Jeb Dunkelberger, Executive Director, Accountable Care Services

Lloyd J. Guthrie, MBA, Program Manager, Statewide Initiatives, Center for Improving Value in Health Care

Managed Care Medical Director

Market Access Director, midsize pharmaceutical company

Senior director, global pharmaceutical company

VP Managed Care

What is an Accountable Care Organization?

Essentially, an ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients and so limit unnecessary spending. ACOs are characterized by a payment and care delivery model that ties reimbursement for providers to quality metrics and reductions in the total cost of care for a particular population of patients. In essence, providers will receive payment if they are able to deliver outcomes that are shown to reduce overall spending on patient health – and that includes making cost effective medicines choices.

About FirstWord

FirstWord is an innovative industry intelligence leader serving over 240,000 Pharma and MedTech professionals worldwide. FirstWord offers a range of products and services designed to help your company gain a competitive edge by making key business decisions with speed and confidence.

FirstWord Pharma PLUS is a personalised and comprehensive intelligence service delivering up-to-the-minute pharma news, insight, analysis and expert views of importance to your company’s success.

FirstWord Reports deliver timely, need-to-know intelligence about your products, your competitors and your markets. Covering biosimilars, market access, medical affairs, sales & marketing, technology and therapy areas, FirstWord Reports provide expert views and intelligence on the challenges facing pharma today.


1. Executive summary
2. Research objectives and methodology
3. Contributors
4. Accountable care organisation overview
4.1. Key Insights
4.1.1. ACOs were established through the Affordable Care Act
4.1.2. There are a number of requirements to participate in an ACO
4.1.2.1. ACOs can be made up of any type of healthcare provider
4.1.3. The payment structure for ACOs heralds a move away from traditional fee-for-service
4.1.4. The impact of ACOs has been limited to date
4.2. The structure of ACOs varies across organisations
5. ACOs and their impact on the US healthcare environment
5.1. Several benefits of ACOs
5.2. Key Insights
5.3. There are significant cost savings that could be realised
5.4. Providers are incentivised to provide quality not quantity of care
5.5. A key benefit of ACOs is the continuity of care they provide
5.6. Improved access and a reduction in administration is anticipated
5.7. There are a number of challenges with ACOs
5.8. There is significant initial investment needed to form an ACO
5.9. Technology is a key challenge for ACOs
5.10. Conflicting interests of different providers can defeat the purpose of an ACO
5.11. There is still a lack of patient understanding about ACOs
5.12. ACOs are driving changes in decision making
5.13. ACOs are making decisions around reimbursement and listing
5.14. Technology is having a greater impact on decision making
5.16. Patient satisfaction is a key driver for ACOs
6. Implications for the pharmaceutical industry
6.1. Key Insights
6.2. There are several key reasons why pharma should engage with ACOs
6.3. Drug costs are likely to be a target for cost savings
6.4. Drugs that have demonstrated value are likely to be favored by ACOs
6.5. ACOs are expected to implement guidelines and lists to govern product use
6.6. Pharma companies face significant risks if they do not engage with ACOs
6.7. Pharma faces several challenges in engaging with ACOs
6.8. The complexity of the ACO system means many companies have not yet adapted to it
6.9. There is limited consistency between different ACOs
6.10. Access to physicians in ACOs can be challenging
6.11. Pharma is starting to collaborate with ACOs
6.12. Teams interacting with ACOs
6.13. Outcome data key to be a valuable partner
6.14. Data exchange is a key area of focus
7. The future for ACOs
7.1. Key Insights
7.2. The ‘next-generation’ ACO model is being rolled out
7.3.. There is a greater level of risk and reward for the next-generation model
7.4. Flexible payment options are being introduced
7.4.1. Patient engagement has been made easier in the next-generation model
7.4.2. ACO benchmarks have been improved
7.4.3. There will be a transition from fee-for-service to value-based care
7.4.4. Greater interaction with pharma is expected
Products must provide value for the specific ACO population
Real-world data is highly valued by ACOs
Working as a genuine partner is the optimal way to interact with ACOs

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