One of the most critical and challenging analytics of healthcare M&A due diligence is evaluating the health policy strategy component = Reimbursement
M&A Due Diligence to Maximize Stakeholder Value
WHG can help clients prepare for a successful due diligence process.
Health Policy Challenges That Can Affect Transactions
- Government agency regulations 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 with significant reimbursement implications.
- Drugs covered under Part B vs. Part D?
- New HCPCS J-Code and/or pass-through status?
- New drugs and new technologies covered under Part A MS-DRG vs. New Technology Add-On Payment (NTAP)?
- These FDA controlled regulations affect site of care utilization, benefit category determination, coverage criteria and payment.
- Establishing new IPPS/HCPCS/CPT codes does not equate to CMS coverage or adequate payment, these reimbursement steps are separate CMS processes.
- 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
- 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