CareSet's Advanced Approach to Navigating Product Launches in the Medicare Ecosystem

In healthcare provider analytics, where omni-channel data clouds and artificial intelligence (AI) play emergent roles, understanding the system dynamics of product launches for older Americans is more crucial than ever. This “Medicare-aged” population’s unique experience demands innovative methods to uncover deeper insights into treatment adoption and market access.

Simplified Access to Medicare Market

Market access is not just a factor; it's the driving force behind the success of healthcare product launches. For example, the FDA's decision on coronavirus vaccines, followed by rapid CMS response with billing codes, exemplifies the scaling of an innovation, and that requires coverage. In fee-for-service Medicare, everything is “covered."

Treatment options are based on the physician's discretion, grounded in the patient's medical condition. That is in contrast to commercial insurance and Medicare Advantage. Both of those systems require prior-authorization, which can limit access to the availability and adoption of new treatments. CareSet's approach to product launches in Medicare combines nuanced analysis and multidimensional methods. It uncovers treatment adoption patterns and highlights access disparities and biases. These insights are crucial for successful product introductions for this complex and growing older population.

Pioneering Methodologies for Adoption Analysis

Our team is at the forefront of maximizing the potential of a new treatment option for patients. To do this work, we use two key approaches, each customized to the disease and innovation our clients developed.

Physician Understanding

Starting with an analysis of the physician's patients, we seek to understand the diagnosis and treatment trends.

• What types of patients are they referred to?
• What types of diseases do they tend to manage versus refer to their colleagues?

This method helps us to understand how healthcare providers introduce patients to new treatments, particularly those naive to care planning.

This is also rooted in Centers for Medicare & Medicaid Services (CMS) own data transparency and reporting initiatives over the last 10 years. Look into Provider Compare and STAR reports for more information, but if monthly data is critical, we bring the up-to-date monthly claims into the analysis.

Look Back Methodologies

Taking a patient outcomes perspective, also reflecting that the patient, physician, and the healthcare system are outcomes focused, we implement a retrospective analysis of past claims.

This can help us to understand the following:

• How many of the doctor’s patients have treatments?
• What options they typically manage through?
• Where are the support opportunities in physician education?
• What are the possible care gaps?
• Which geographic obstacles or opportunities are available to provide patient education in multiple languages?

These methods allow our partners to track patient outcomes over time, offering a holistic view that integrates patient, provider, and healthcare system perspectives.

Again, rooted in similar perspectives shared by CMS in the past, public reporting examples of this are the hospital readmission rates every US hospital must self report into CMS.

Charting a New Course in Treatment Adoption Analysis

CareSet’s methods mark a significant improvement in understanding how treatments are adopted in Medicare. We prioritize actionability over quantity, and patient journeys over snap-shot approaches. It’s due to our long standing researcher status with CMS that we developed insight extraction methods that provide a fuller picture of the patient and physician journey.

Integrating Unique Data for the Future of Contracting

Our commitment to bringing novel data sources together changes how our clients contract. This integration goes beyond just gathering data; it helps us to understand market access, physician and pharmacy choices, and patient outcomes more clearly in a team-based healthcare system.

Redefining Healthcare Analysis

At CareSet, we do more than just data analysis; we're reshaping healthcare analytics. As the most experienced Medicare analysis team in the country, we offer new expert insights to our clients. We would be happy to show you CareSet’s approaches beyond adoption, looking into adherence, persistence, and outcomes that your organization can use to create successful strategies for product launches.

#PatientOutcomes #DataIntegration #MedicareAnalysis #MedicareMarket