Challenge

The desired price of this new inpatient surgical technology was twenty percent of the reimbursement amount under the related Diagnostic Related Group (DRG) formula; the plan was to petition the Centers for Medicare and Medicaid (CMS) for a new technology add-on payment and the development of an economic impact analysis requiring evidence demonstrating cost savings of this device. 


Solution
Triage understood that this new technology would be best supported by demonstrating improved outcomes and a positive financial impact to Payers. We developed a three stage research approach; conducted an inpatient data mining of hospital data sets identifying financial impact of these surgeries; conducted a cost-effectiveness analysis and created a budget impact model.  

 
Results and Impact
The outcome provided the manufacturer with the economic evidence to support potential cost savings for this technology, the key value messages for the value story and tools for negotiations with hospitals and Payers.  


  • Development of a budget impact model and published results 
  • Rationale to obtain a new procedure code to support the price 
  • CMS-driven economic analyses were used in turn to support access and reimbursement efforts in the commercial sector
  • Conducted negotiations training for sales representatives 
  • Developed a “center of excellence” program at key teaching hospitals 


Our work qualified the clinical and economic value of this device which has become standard surgical practice in most US hospitals.

Budget Impact Model 

A new hospital use medical device for treating lung surgeries required an economic impact analysis demonstrating cost savings of this new technology to support reimbursement 


Evidence Development Support