End-to-End Risk Management Solutions for Payers of Revolutionary Therapies
Emerging Therapy Solutions® (ETS) offers a comprehensive suite of services for solid organ and bone marrow transplant, cell and gene therapies, and other highly specialized therapies. These therapies can cost hundreds of thousands to millions of dollars per patient – and usually require unique reimbursement strategies and plans for catastrophic claims.
End to end, we are here to help you manage the immense costs, potential risks and intricate processes, especially as scientific breakthroughs rapidly bring more of these life-changing therapies to market.
Our leading services include:
Network Access and Referral Management
When a member is referred for complex, high-cost care, we can help you evaluate and guide the terms and process.
We provide options and knowledge about where to receive care, and can compare available metrics to assist you in the decision-making process. To do this, we monitor and analyze comprehensive data, the clinical pipeline, existing reimbursement policies, compliance regulations and industry trends to fully understand the market.
Turn to us for:
- Network Access – Our Programs of Excellence model identifies healthcare facilities that deliver quality, cost-effective care. We focus on programs with proven performance that evaluate all treatment options and consider the member’s entire condition.
- Negotiated pricing – The share of procedure charges varies widely between therapy and facility costs. With our established rates, we help payers control costs and reduce variability, so your risk is more predictable.
Network Access and Referral Management
- Negotiated contracted rates, claims review and claims repricing
- Single Case Agreement contract negotiation for cases currently not under contract
- Access to medical services team for clinical considerations and referral management
- Access to Programs of Excellence
ETS Knowledge Center and Clinical Content
We monitor the cell and gene preclinical and clinical trial landscape to identify conditions being targeted for genetic and cellular therapy. Our pipeline curation process spans from identification of conditions targeted by emerging cellular and gene therapies through pre-clinical, monitoring of the clinical trials, post-market approvals, the manufacturing market, and supply chain development. Our ETS medical services team of registered nurse clinical consultants offer content, consultation and a condition-specific knowledge base for these conditions and therapies in the pipeline.
We regularly convene expert clinical panels based on the emerging gene and cellular therapy pipeline that include leading medical researchers, clinical teams and facilities with experience and knowledge in each chosen therapeutic area.
We offer a full complement of materials and documents to help your team navigate this changing environment, with content available through subscription to our online ETS Knowledge Center Portal.
ETS Knowledge Center Portal 24/7 Web Access Subscriptions
- Weekly and monthly news curation
- Condition overviews on all monitored conditions
- Therapy overviews on U.S. Food and Drug Administration approved gene and cellular therapies
- Expert panel insights
- On-demand condition-specific webinars
- Additional subscriptions and reports available, including comprehensive clinical compendiums and quarterly pipeline reports
Cell and Gene Therapy Forecasting Report Service
ETS has the tools, data, relationships, and expertise to quickly help you understand the risks related to approved and soon-to-be-approved high-cost and/or complex treatment options.
Our customized forecasts are purpose-built to estimate cost and utilization of emerging therapies specific to your population. Our models focus on the whole episode rather than the therapy alone to provide a clear picture of potential costs. Using these models, we can work with your strategy teams to advise on the expected range of outcomes to help with your cost containment and risk forecasting for these catastrophic claims.
To do this, we monitor the US clinical trial pipeline, analyze administrative claims data, model the unknowns, and leverage our relationships with independent physician experts to provide input to validate assumptions and develop algorithms.
As a result, your actuaries, finance team and underwriters can better understand the associated risk and anticipate your potential exposure, so your team can be prepared and keep pace.
Cell and Gene Therapy Risk Forecasting Report Service
- Pipeline of emerging therapies with manufacturer name and prospective approval time frame
- Estimated exposure along with medical cost offset
- Incorporates clinical input from ETS physician panels
- PMPM impact by line-of-business
- Full distribution on cost and utilization for each condition that ETS is monitoring
Other Ways We Can Help
Let ETS consulting services help you with plan design, analytics, clinical data modeling, policy design, and more related to high-cost and complex conditions. We specialize in these rare and high-cost conditions that many organizations do not have the scale to tackle. We offer a wealth of information, experience and content to design a solution specific to your needs.
