Building Payer Coverage & Facility Adoption: Budgetary Impact Models


The client’s innovative technology used to diagnose heart arrhythmias by means of an extended wear recording device and artificial intelligence algorithm can match the performance of certified cardiologists and exceed standard-of-care shorter-term monitoring in detecting and diagnosing arrhythmias. Despite the technology’s proven diagnostic yield, the client was experiencing market access delays; facilities were reluctant to switch from Holter and Event monitoring as first and second line arrhythmia diagnostics, and payers were denying coverage due to the technology’s Cat. 3 CPT code. The client lacked an up-to-date synthesis of rapidly expanding clinical publications that could summarize the advantages and benefits of the product to U.S. payers, thereby expanding coverage and payment. TTi proposed utilizing the client’s Medicare SAF analysis and the peer-reviewed literature to construct a model of the “diagnostic odyssey” from both facility and payer perspectives. Sales representatives were trained to utilize the model as a part of the VAC evaluation process. Payer liaisons were trained to customize payer-perspective budgetary impact models for payer-specific presentations. TTi developed the models and associated PPTs (with detailed talk tracks) and conducted web-based and in-person training on the use of the models. TTi is currently updating the client’s existing clinical dossier with supporting evidence for the product’s clinical benefits. TTi also updated the design and “look” of the clinical dossier to enhance presentation to payers. The updated document supports a more persuasive value message to potential payers. As a result of TTi’s efforts, the client was able to demonstrate and communicate the value of their technology to both facilities and payers, resulting in improved coverage and increased adoption.

Our team was demanding and threw out all kinds of objections even before initiating work with TTi. We didn’t get any easier after the project work began. The facility tool required a very complex user interface while the payer tool required an extraordinarily simplified one. The model itself was necessarily complex, incorporating data from disparate sources. TTi met all our challenges and exceeded our expectations with two tools that proved very useful to us in improving market access and expanding coverage.

Shawn Becker, MD, iRhythm