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Managed Care Profiling Solutions are designed to inform and validate the targeting efforts of pharmaceutical and biotech account teams. This market research suite of products provides plan-specific information on health maintenance organizations, preferred provider organizations, pharmacy benefit managers, employer coalitions, and Medicare Advantage and Prescription Drug Plans.
Key Measures
The individual components of Managed Care Profiling Solutions include:
- Two distinct Health Maintenance Organization (HMO) Profiling Solutions: HMO Demographics and HMO Pharmacy. These two solutions provide information on demographics, contact names, pharmacy benefit design, enrollment, and more for each HMO in the country. Additionally, Health Service Plans (HSPs) provide information on those organizations servicing the Medicaid population, but not licensed as an HMO. HMO and HSP information is updated semiannually; contact names are updated quarterly.
- The Preferred Provider Organization (PPO) Profiling Solutions are similar to HMO modules, and also include data on demographics, contact names, operations, ownership, utilization, and pharmacy practices. This service is updated annually.
- The Pharmacy Benefits Manager (PBM) Profiling Solutions track the growing and increasingly influential organizations that manage pharmacy benefits programs for HMOs, HSPs, PPOs, and other healthcare entities. Updated annually, the PBM Profiling Solutions provide current demographics, contact names, and pharmacy benefit profile data to help you successfully target this evolving sector of the managed care pharmacy market.
- The Employer Coalition (EC) Profiling Solutions, updated annually, contain demographics, contact names, pharmaceutical activity, and healthcare insurance coverage for ECs nationwide. This service helps you tailor your patient education, disease management, and preventive care programs to meet the needs of large ECs around the country.
- Medicare Advantage Plans (MAs) are updated annually, with quarterly enrollment updates. Information includes demographic and pharmacy data for the universe of Medicare Advantage Plans. Data elements for CMS-contracted plans include pharmacy benefit design, enrollment by plan category, service area, and contact name (names are updated quarterly).
- Medicare Prescription Drug Plans (PDPs) are similar to the Medicare Advantage Plans. SDI tracks the universe of PDPs.
Each individual profiling solution can be integrated with other managed care profiling solutions and internal sales databases for a complete managed care information and customer-profiling system covering HMOs, HSPs, PPOs, PBMs, ECs, MAs, PDPs, mail-order pharmacy, and HMO-affiliated hospitals.
Product Benefits
The Managed Care Profiling Solutions database can be used for business planning and targeting questions, market research, marketing, and sales. The data can also be augmented with managed care and non-managed care research audits and SDI’s proprietary patient-centric, longitudinal databases.
Methods
Telephone and mail surveys of key individuals at managed care organizations along with secondary research as needed. HMO and HSP information is also obtained from federal and state sources.
What business questions do these products answer?
- Assist in developing target lists of key accounts by providing easy access to information on demographics, relationships, key contacts, service areas, operational characteristics, and enrollment
- Offer guidance for optimizing sales force alignments
- Identify roadblocks to market share at the plan level, including generic-substitution policy, tier co-pay structure, therapeutic-substitution list, prior-authorization guidelines, and NDC locks
Deliverables
Information is delivered quarterly and can be accessed through InSite Next Generation® – a Web-based query tool that enables 24/7 interaction with everything clients need to manage their accounts and create custom reports. SDI also makes the profile data available in flat files.
For more information, please contact us.
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