Health Industry

The healthcare industry in the United States and abroad is experiencing a period of profound change. Economic factors, national health policy, payer mandates and consumer effects are now driving a new paradigm in the delivery of medical care.

Sector Trends

Despite continuing reform and uncertainty, identifiable trends exist that will continue to drive medical industry:

  • Evidence-based clinical care
  • Continuous versus periodic delivery of care
  • Coordinated and efficient models of patient care
  • Technological solutions for transactions and data management
  • Increased regulatory, accreditation and transparency mandates
  • Clinical practice diversification and consolidation
  • Expansion of retail and direct-to-consumer services
  • Outcomes-based reimbursement models
  • Global pricing and contractual capitation

These trends represent an opportunity for clinicians and organizations to provide enhanced clinical care and for business entrepreneurs to develop novel medical interventions and technologies. They also represent significant risk for those unable to assess and adapt within the changing sector landscape.

Providers and Healthcare Organizations

For many clinicians, facilities and healthcare organizations, the challenge remains to deliver optimal clinical care and service to beneficiaries in an environment of reduced resources and declining margins.

Physician practices, hospitals and facilities face the challenges of generally declining reimbursement coupled with staffing challenges, rising administrative overhead, increasing malpractice rates, new mandates for regulatory compliance, and intensifying competition. Effectively navigating these factors may mean modifying existing infrastructure, assessing billing, coding and staffing patterns, and revising internal and external business practices.

Global management of these complex dynamics is becoming progressively more difficult and time consuming, particularly for clinicians already managing considerable administrative demands in addition to increased patient volume required to maintain prior income levels. Providers and organizations must identify and utilize tools to build a solid financial foundation leading to sustained success.

Contact SCG to discuss a customized operational and financial strategy for your clinical practice or organization.

Biomedical Technology and Life Science Companies

For development efforts in the medical device, diagnostic and pharmaceutical spaces, changes in the health sector have fundamentally altered the path to successful product launch. Corporate strategy must now reinforce reimbursement planning as the primary determinant of both short and long-term commercial success.

In contrast to regulatory approvals which focus on safety and efficacy, reimbursement review seeks to evaluate medical interventions as reasonable, cost-effective and medically necessary for populations of interest. Global agencies and payers are implicitly looking for the value gained from therapeutics and technologies in improving health outcomes. Further, the comparative effectiveness of a regimen versus standard of care and other therapeutic options is of increasing importance. As a result, trial strategy and post-market surveillance must be guided at onset to satisfy reimbursement needs and to ensure capture of the economic data required. Failure to conduct clinical trials with reimbursement considerations in mind may have significant and potentially deleterious effects on future determinations for coverage and pricing. Assessment of market deployment must also be performed on a regular basis to capitalize on opportunities and address weaknesses in support of robust market growth.

Sustainable commercialization critically depends on early and active integration between clinical, regulatory, payer and user demands. Assessing and aligning stakeholder incentives through strategic planning is critical path for life science and biomedical companies.

Contact SCG to discuss the importance of a customized strategic reimbursement plan for your company.