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Building your field reimbursement and access team: The translational experience and skills that matter most

By AmerisourceBergen

What are the most important qualities to look for when outsourcing field solutions? The answer isn't always obvious.
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When bringing a new pharmaceutical product to market, field support is essential for many products. Field reimbursement and access teams work closely with providers and their staff to help them understand how to resolve reimbursement issues and overcome barriers to therapy for patients. But for some manufacturers tasked with outsourcing field support, it may not be immediately obvious what types of experience and expertise are most essential when building their teams. Others may think they need a certain type of experience set when another set of core skills is really what's critical.

The true value provided by a pharma field team is in its ability to help provider offices navigate the complexities of the modern healthcare system. Often, it's helpful for a manufacturer to think about the particular nuances of the therapy they are providing in order to identify the specific reimbursement and access challenges they will need to address and the types of field skills and experience that would be relevant.

Manufacturers sometimes say they want field reimbursement specialists with direct experience in a specific clinical category, such as oncology. It's a perfectly reasonable ask, but one that demonstrates that some manufacturers may be prioritizing this type of one-to-one experience over more valuable skill sets that translate from one clinical category to another. This can lead clients to undervalue field services professionals who have more relevant expertise to bring to the table — and who may actually be better equipped to navigate reimbursement hurdles.

It may be easier to spot the shortfalls of this type of thinking when looking at another industry. Say, for instance, that General Motors is looking to hire someone to assemble trucks, but will only consider applicants who have already built a truck for General Motors. In that case, they might miss out on someone with the skills they need who has assembled trucks for Ford. In the same way, a field reimbursement specialist may gain the skills they need to work with oncology providers and patients through experience working in another clinical area, such as immunology. Both fields serve patients with severe chronic diseases and both involve specialty therapies that may face complex reimbursement and access challenges. Once a field services professional demonstrates their ability to provide significant prior authorization education and support for an IV or injectable product, experience in a specific clinical specialty becomes secondary to those essential skills in improving access.

Of course, all this is not to say that there aren't particular challenges that are specific to individual products or clinical areas. After all, a General Motors truck is not identical to a Ford. Rather, it's to say that the specifics of a disease state may be easier to learn than some of the core skills that come with a wide range of field services experience and expertise. Especially when it comes to rare or orphan diseases, a manufacturer would be wise not to sacrifice problem-solving skills and experience with a wide range of applications for niche clinical knowledge that a seasoned professional would be able to pick up through training.

Having a breadth of experience in different clinical areas can also make it easier for field specialists to understand and assist the providers with whom they're working. In the past, an outpatient infusion center might have only served oncology patients, but given recent innovations in how therapies are delivered, that same site of care might now offer a variety of infusible treatments across multiple specialties. At the same time, small private practices have given way to large, multi-speciality physician groups with a range of reimbursement and access issues to consider.

In another example, consider what happens when patients change sites of care. When first designing an access strategy and field solution, manufacturers may prioritize experience with an oncology infusion therapy. But upon closer inspection, a manufacturer may realize that the biggest reimbursement challenge for that therapy stems from the fact that it is initially provided on an inpatient basis in the hospital and then later provided on an outpatient basis at a different site in the community. What they need most is not someone who has worked in oncology — although that would be a nice bonus — but someone who knows how to ensure that a patient's insurance coverage is transferred from one clinical setting to another without any disruption to patient care. Often, team members with prior experience as case managers are very experienced in navigating through transitional sites of care and could be a good fit for this type of solution.

It may be helpful to think about the key qualities needed in a field reimbursement team as the layers of a pyramid. At the bottom, forming the foundation, are the technical knowledge and skills, such as experience in prior authorization or revenue cycle management, that are essential to the job. These are non-negotiable and transferable from one product to another. The middle layer is experience with a particular disease state or patient population. This is nice to have but can also be learned and can be bolstered by experience with other clinical areas or patient groups that have overlapping challenges. At the top is specialized knowledge of the product the manufacturer is bringing to market, which is something that field reimbursement and access specialists routinely attain through training for the job at hand.

As manufacturers look for a field solutions partner, it will be critically important to find one that understands how to prioritize experience and skills and why translational experience matters.

Find out more about Xcenda's innovative field solutions and expertise in reimbursement and access support.