One of the most critical and challenging analytics of healthcare M&A is evaluating a company’s health policy strategy and reimbursement pathway
The U.S. Healthcare delivery system, unlike any other industry, is based on the economics of a complex private and public sector third-party payer system and has become ever increasingly problematic to navigate. 
  • The health policy decision-making process is complicated.
  • The reimbursement methodologies are convoluted.
  • The funding is not keeping pace with healthcare demand and innovation.
​WHG provides clients a systematic and focused analysis by working sequentially through an interconnected group of analytics and pathways.
We evaluate a transaction's potential to help maximize stakeholder value based on real-life experiences.
Health Policy Challenges That Can Affect Transactions
  • Government agency and reimbursement processes are not always intuitive and can lead to uncertainties and misconceptions.
  • FDA approval and FDA clearance allows for commercialization. It does not mean that a product is covered or eligible for reimbursement by Medicare, Medicaid, or commercial insurance.
  • FDA approved indications for use and FDA product coding, can result in potential downstream consequences.  These FDA controlled regulations affect site of care utilization, benefit category determination, coverage criteria and payment.
  • Establishing a new HCPCS/CPT code does not equate to CMS coverage or payment, as these reimbursement steps are separate CMS processes.
  • The cost of innovation is not an inevitable part of payment calculation processes.​
WHG Core Set of Essential Strategy Analytics
  • Comprehensive Medicare, Medicaid and commercial insurance reimbursement pathway analysis
  • ​Categorize the foundation of the opportunity and/or pinch points
  • Identify the current political and policy landscape
  • Prioritize actionable pathway and milestones to maximize stakeholder value
Due Diligence
  • We know what questions to ask
  • We know how to translate the answers and understand the consequences
  • We know how to prepare clients for policy questions
  • We know how to craft succinct and powerful messaging to best articulate their position  

WHG assist in evaluating a transaction's potential to help maximize stakeholder value based on real-life experiences