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  • Writer's pictureAventria Health Group

Recognizing the Impact of Payer Transformation on Provider Access and Brand Performance

Pharmaceutical market access vice presidents, executive directors, market access marketing, and brand leads:

We are experiencing an unprecedented acceleration in the pace of change of the US health care ecosystem. Payer evolution to gain scale through vertical integration continues, resulting in a concentration of buying power with a small number of influential customers. Their motivation comes from the growth and profitability of specialty drug management focusing on lives, data, and outcomes across pharmacy and medical drug management of spend and trend.

At the same time, payers are quietly transforming their business model to protect revenue and strengthen their provider footprint and member engagement experience by developing controlled provider networks.

As part of your integrated business planning process, have you assessed the impact of these transformations and connectivity to your brand access strategies across payers and local market ecosystems?

Impact of Payer Transformation—Next Frontier of Payer Influence

As a market access or brand leader, you’re highly engaged with payers aggressively intensifying drug cost management and utilization by:

  • Managing formularies with stricter prior authorization and significant growth of drug formulary exclusions (without grandfathering)

  • More onerous requests for price concessions and protection

  • Increasing requests for outcomes guarantees

  • Shifting cost to members (co-pay liability, premiums, coinsurance co-pay accumulators/maximizers)

At the same time, have you allocated time to assess the impact of almost stealth-like payer transformations to enhance provider services by building and expanding integrated networks and capabilities in local ecosystems to include primary care, behavioral health, urgent care, and specialty medicine, as well as captured populations of patients? The following chart provides an illustration of the growing payer/provider footprint.

Anticipate the Impact on Your Portfolio

Building “winning” brand business plans requires a rigorous assessment of transformational payer dynamics to develop sound brand strategies by anticipating the impact of payer-controlled networks in local market ecosystems and their effect on provider access, patient engagement, and brand financial performance.

Aventria can help ensure your success to effectively execute in this new ecosystem.

Presenting Aventria Health Group’s Market Access/Brand Business Planning Workshop Series

The proven and proprietary Aventria PASS Model® (Product Assessment Success Strategy) provides a strategic framework for virtual workshops with your leadership teams to confidently develop robust brand/market access business plans with a focus on tactical execution to drive financial results.

“I thought the workshop was fantastic. Allowed the team to interact and share perspectives from individual functional areas. I think we came up with some great ideas and opportunities.” —Workshop participant, senior market access leader

Assessing Payer Transformation—“Market Access (MA) Quick Check” Webinars

This may be a perfect vehicle for Aventria to help you with a customized virtual workshop to assess and align on the impact of payer-controlled provider networks.

These “MA Quick Checks” are an agile, fast way for your teams to ensure that market access insights are methodically collected and evaluated. They begin with a single trend that your leadership team sees emerging in the marketplace and necessitates an aligned understanding and strategy.

To learn more about Aventria’s Market Access/Brand Business Planning PASS Model and how we can help you strengthen your market access/brand business planning process, please reach out to:

Dave Dierk, Co-President, 30-year sales and marketing thought leader in pharmaceutical diagnostics, biomedical, long-term care, managed care, employer, and pharmacy communications, at

Paul G. Pochtar, RPh, 25+ years of experience in leading the successful commercialization of both primary care and specialty pharmaceuticals throughout their life cycle, including several landmark oncology products and other specialty therapeutics, at

Making a difference in patient care by helping patients, providers, and payers collaborate on shared priorities


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