Setting Your Company Up for Success When Navigating Coverage Conversations

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By: Dr. Christopher von Jako, CEO and President of BrainsWay 

There is a myriad of challenges that a healthcare company can face when looking to demonstrate the value of a product to potential insurance partners. Companies are charged with demonstrating that their products or services improve care and reduce overall costs.

When it comes to mental health issues in particular, showing that value can be challenging due to the difficulty in measuring the impact of a treatment. Through our years of experience in treating mental illnesses, we work with insurance companies to deliver the metrics they need to make informed decisions. As a result, BrainsWay’s Deep TMS™ treatment is covered by most insurance companies throughout the U.S. for its first indication in depression, and continuing to work on additional indications.

Educating payors: best practices

At BrainsWay, we look to educate and inform all insurance payors that have an interest in addressing mental illnesses with cost-effective solutions. The first step is increasing awareness around our treatment method, Deep Transcranial Magnetic Stimulation (Deep TMS™), which is FDA-cleared to treat depression, obsessive-compulsive disorder (OCD), and smoking addiction. We aim to demonstrate why this offering is unique when compared to other available treatment methods. Taking the time to explain the differences in your product versus what already exists in the market you are targeting is a key step in securing interest from insurance partners.

Deep TMS noninvasively treats select mental illnesses using a helmet that sends magnetic pulses to activate and regulate the neural activity of the different brain regions it aims to reach. When presenting this treatment to potential partners, we highlight that we are the only company offering Deep TMS specifically, which reaches deeper and broader structures of the brain than alternative technologies. By emphasizing this difference and our associated impressive body of clinical evidence to payors, we can stand out.

It is also essential to emphasize the number of lives your product or service could impact to insurers. Insurers want to maximize the number of people they can reach through insurance coverage. With mental health issues specifically, which have been on the rise over the past year and a half due to COVID-19, the number of potential patients who may benefit from insurance coverage could be quite high. For example, in a non-pandemic environment, major depressive disorder alone impacts an estimated 17.3 million adults in the United States. The more lives that Deep TMS access and coverage extends to, the more opportunity for people to use and find success with this treatment.

What to keep in mind when partnering with insurers

Above all, remember your audience. Although insurance companies may not have a thorough understanding of your space or the technology you are offering, they do not need to be experts to understand the value of the products or services you have presented. Be mindful of their time and present the most crucial and relevant information. Be prepared to answer their follow-up questions, as they look to dig for a deeper understanding.

Insurers’ primary responsibility is to help patients gain access to high quality care. As such, they are driven by evidence. If you can provide concrete evidence that demonstrates the value of your product, which typically comes in the form of studies, insurers are more likely to listen and understand that value. 

Outside of partnerships, how can companies provide cost-effective solutions?

If a company is looking for additional ways to provide cost-effective solutions to patients, they should look to identify if and how they can lower the cost of their product or service. When a company begins offering a treatment, it is a best practice to set out with concise, target product profiles, as well as minimum product profiles. As the company expands the reach of its offerings, it should aim to adhere to its initial models to ensure patients are being charged the lowest possible cost for the care being offered to them. 

Choosing the right partner

When it comes to choosing the right partner, healthcare companies should remember that insurance payors are also seeking the right partnerships to meet goals and best serve their members. Prior to a meeting, preparation from all parties is essential to form successful partnerships. Both the company and the payor have ample research to do before a partnership is even proposed. Without doing its due diligence before connecting with potential insurance partners, a healthcare company risks losing an opportunity to serve a large group of patients who might need its services most. 

About Dr. Christopher von Jako

Christopher R. von Jako, PhD, is President and CEO of BrainsWay. He is a technology-driven executive who brings over 25 years of leadership and experience in the global medical device market. He is especially passionate about the development and commercialization of minimally invasive techniques to improve health and transform lives. For more information on BrainsWay, visit https://www.brainsway.com/.

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