Applied Learning Solutions
Access Pointe’s Applied Learning Solutions are developed as a custom learning ecosystem based on your organizational needs. We create solutions by working together with our customers to understand their needs, priorities, schedule, budget, and organizational objectives. We craft a tailored training blueprint, that may include knowledge assessments, self-paced learning modules, microlearning bursts, workshops, presentations, and expert interactions as deliverables.
MA-IQ BaselineTM and MA-IQ BenchmarkTM are knowledge assessment tools that measure comprehension and proficiency in navigating the intricate pharmaceutical market access landscape. These products are ideal for identifying knowledge gaps, crafting targeted learning and development strategies, and establishing a baseline for progress tracking.
Self-paced modules are interactive, trackable offerings accessible on a variety of devices from desktops to tablets and smartphones. They are ideal for groups who need flexible scheduling and targeted, durable content.
Market Access MinutesTM are a customized and flexible microlearning subscription that delivers essential information in minutes. Formats include print, digital, and interactive e-learning. Market Access Minutes help teams adapt quickly and capitalize on emerging opportunities, elevate market access acumen, and promote cross-functional collaboration across teams through shared knowledge and aligned strategies.
Workshops, presentations, and expert interactions are live, facilitated group events ideal for rolling out new information, problem solving, hosting interactive Q&A sessions or gaining deep insights from subject matter experts and industry decision makers.
Market access is all we do. Some of our recent learning solutions included content about:
- Pricing and contracting
- Payment and reimbursement
- Product acquisition and distribution
- Buy and bill
- Specialty pharmacy
- Benefit design and coverage policies
- Denials and appeals
- Commercial payers
- Government payers – Medicare, Medicaid, VA/DoD
- Health policy – IRA, FDAMA 114
Case Studies
Market access in action.
Coverage Policy Conundrum
A large biotech company was competing in a marketplace with nearly a dozen competitors and struggling to generate opportunities to interface with customers.
The Sky is Falling
A company with a newly acquired buy and bill drug had a mixed team of sales, reimbursement, and payer personnel.
“Coverage Policy Conundrum” Coverage Policy Analysis Case Study
Background: A large biotech company was competing in a marketplace with nearly a dozen competitors and struggling to generate opportunities to interface with their payer customers.
Because the payer didn’t have adequate resources to stay on top of market changes in such a busy competitive landscape, the policy they developed was confusing, in some ways inaccurate, and difficult for providers to interpret.
Helping payers see areas for improvement in their polices helps both payers and their providers.
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Situation: The company wanted to create opportunities for their account team to strengthen relationships with payers, and were specifically interested in building relationships based on their team’s ability to provide meaningful and credible information to their customer’s under-resourced departments.
They recognized that payers were not able to keep pace with the growing list of competitors in the category, which resulted in the development of policies there were sometimes outdated, inaccurate, and confusing to providers.
Understanding Organizational Needs
When people think about a coverage policy, they usually think only about how their product is covered or restricted and fail to see the opportunity for policy analysis. Most payer account managers, when discussing this discrepancy with their customers, end up in contentious conversations about why the coverage parameters do not reflect the most positive access available.
The company needed its payer account managers to be able to have conversations with payers that were not contentious, that didn’t deal with any aspect of their particular product. This would help the company evolve from solely advocating for maximized use of its own product to understanding the payer business and ultimately demonstrating a willingness to help payers navigate marketplace fluctuations.
Meeting Organizational Needs
- Two-day coverage policy workshops were conducted to address the situation. Workshops included team education on the anatomy of a coverage policy and exercises on analyzing and scoring various policies in the category
- After the appropriate teams were educated, Access Pointe provided them with a process for both:
- separating and analyzing the different coverage policy sections, and
- identifying which areas of a coverage policy could be valuable in supporting their interactions with payers
By seeking Access Pointe’s expertise, the company was able to develop a payer account team that became:
- More familiar with coverage parameters for their own products as well as those of their competitors
- Experts in identifying coverage policy issues that could generate positive payer interactions
- Valued assets to their payer customers beyond providing information about their individual product
“The Sky Is Falling” Denial by Claims Error Case Study
Background: A company with a newly acquired buy and bill drug had a mixed team of sales, reimbursement, and payer personnel. Because of their multifaceted organizational structure, there was a lack of guidance on who does what when a reimbursement situation arises. All teams had difficulty understanding how to work both collaboratively and independently to rectify the situation while making efficient use of company resources.
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Situation: A manufacturer’s sales representative visited a high-volume office and was informed by the practice manager that they had received two denials from Aetna, who will no longer pay for their buy and bill therapy. The representative alerted their manager of the issue, who then contacted the company’s Regional VP of Sales, who in turn contacted the Vice President of Market Access. All available resources were then mobilized to address the situation. Since there was no protocol in place for addressing the denials, as well as a lack of clearly defined roles and responsibilities, dozens of people and hundreds of hours were spent addressing this situation. After an egregious amount of time and effort, it was determined that both denials were caused by a simple claim submission error–the same error in both cases.
Understanding Organizational Needs
The company needed to have a system in place with internal stakeholder alignment that prescribed an efficient process for identification, responsibilities, communication, resolution, and ultimately tracking of market access issues and outcomes.
In order to focus on company sales, the representative who discovered the problem needed to be able to take their hands off the wheel and trust that the appropriate parties could rectify the situation. For this to happen, departments needed to understand and adopt a process that promoted efficient, appropriate reactions and approaches that get to the root of the issue without engaging unnecessary resources, wasting time and money.
Meeting Organizational Needs
- Addressing the situation began with interviews of key internal stakeholders to learn how they viewed the existing process (or lack thereof) and how it could be improved. Stakeholders included sales team members and leadership, reimbursement management, payer account management, market access leadership, and senior brand leadership
- Interview feedback was analyzed and then used to design an organizational process focused on clarifying roles and responsibilities in a range of situations
- The process was socialized among all interviewees to obtain consensus on its organization
- Once the process plan was refined and agreed upon, it was developed into an interactive series of tools, including process maps, descriptions, communication tools, and team dynamics and accountability layouts. The series was packaged into a digital tool and rolled out at a national sales meeting
By seeking Access Pointe’s expertise, the company was able to gain:
- Training that instructed the field organization on how to address access issues efficiently
- Clear expectations from leadership and better overall understanding of individual duties and responsibilities
- Tools to support the process
- The ability to track success metrics for market access teams
- Peace of mind for their representatives, who were able to carry on with their selling duties calmly and appropriately with confidence that other teams were addressing and ultimately resolving the situation
“Coding Trifecta” HCPCS Coding Case Study
Background: The company was new to buy and bill — the field organization was preparing to sell in an environment where reimbursement required the use of a miscellaneous J-code. The specialty providers to whom they were primarily selling had previous negative experiences billing miscellaneous J-codes and were apprehensive because of uncertainty about reimbursement.
In a short period of time, CMS issued a temporary C-code, and a temporary Q-code, and the company was concerned about the field organization’s ability to supply the right information to their customers at the right times.
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Situation: A company with its first buy and bill product prepared to launch with a miscellaneous J-code, which they expected would convert to a permanent J-code the following year. Approximately 3 months following launch, the company was notified that they would be issued a C-code (with pass-through) for use in processing claims in hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC).
Just a month later, CMS notified the company they were being issued a Q-code because there was confusion in the marketplace about which J-code should be used when billing for their product. Shortly after the Q-code was announced, the company was made aware that they were being issued a permanent J-code in 3 months (the following January). The C-code was important because it was a product-specific code that allowed customers treating in HOPDs and ASCs to be reimbursed outside the bundle; the Q-code would effectively eliminate confusion until a permanent J-code was issued; and the permanent J-code replaced them all.
Understanding Organizational Needs
While the company was prepared to sell in a complicated environment with a miscellaneous J-code, they were not prepared for rapid-fire issuance of a variety of product-specific codes. While all of the new codes helped support access for the product, the situation became increasingly complex, and the potential for mistakes in claims submission was magnified. Customers would experience claims denials if they:
- Used the C- or Q-code too early
- Used the miscellaneous J-code after the C- or Q-code became active, or
- Used the permanent J-code before it became active
Communicating the appropriate information on time was essential to avoid confusion, and the company realized immediately that they needed to have a plan to avoid disorder both internally and externally.
Meeting Organizational Needs
- To address the situation, Access Pointe developed individual training programs for each of the company’s field organizations. Different levels of training programs were developed for departments to get the exact amount of information they needed to be successful.
- Tools were developed that focused on helping guide teams in delivering the right information at the right time. Delivered tools included:
- FAQs
- Information flash cards
- Home-study materials
By seeking Access Pointe’s expertise, the company was able to gain:
- Training that enabled their teams to deliver information appropriately and effectively
- Protection for their customers from making claims submission errors, allowing for increased sales growth with minimal reimbursement issues
