A Pivotal Role to Improve Patient Access: Field Reimbursement Managers

In the past year, tremendous consequences for the health and financial stability of the US healthcare system have been magnified due to the COVID-19 pandemic. And, while not a new trend, payers are tightening controls with the use of step-edits and stringent, complex prior authorization requirements. Because of high unemployment rates and the loss of or changes in health insurance coverage, many individuals find themselves unable to afford their medications. (The latter is not a recent development either, but COVID-19 has certainly exacerbated this issue.)

The field reimbursement manager (FRM) is an important extension of the healthcare provider (HCP) and their office team, and is a critical link in the continuum of patient care.

Every day on the frontlines, the FRM is focused on assisting providers’ offices in resolving (often complex) reimbursement challenges that can be barriers to patients accessing and receiving the full benefits of their treatment plans. They proactively identify patient access needs, manage reimbursement activities, help teams navigate product fulfillment, claim denials, appeals processes, verify accurate form completions, gather insights, and much more. To accomplish all of this, the FRM collaborates with several groups from field sales to the patient hub.

Of course, the COVID-19 pandemic has presented unique challenges for FRMs throughout the past 17 months; now, teams are smaller and have less direct access to HCP offices, while providers have more questions than ever about navigating the system and require more support.

The FRM acts as a liaison to enable providers and offices to spend more time providing quality patient care as they communicate and engage with provider offices throughout the product lifecycle. During the launch period, it is particularly important to convey proactive education and training regarding the reimbursement journey, which ensures accuracy and completeness of intake forms and reimbursement information required to submit claims and establish stable reimbursement paths.

Over time—and if payer policies and the competitive landscape are stable enough—this work moves to remote or virtual support of the office and practice managers. Nonetheless, providing the proactive education and required support has been particularly challenging during the pandemic. HCPs and offices have been overwhelmed enacting guidelines or safety protocols to reopen safely, while attempting to resume normal patient loads. These factors have added administrative and time burdens that only compounded overwhelmed offices that were already spending less time with patients.

COVID-19 has only solidified the need for FRMs to be advocates for HCPs and patients during the reimbursement journey, supporting complete and accurate filing of intake forms, ensuring patients are getting access to and on medically necessary treatments faster, and helping to communicate with other stakeholders to enable financial assistance. This type of guidance has proven to be increasingly necessary for patients to properly navigate healthcare and insurance, especially in terms of specialty medications.

Ultimately, FRMs can overcome these new hurdles while access teams can take steps to ensure that FRMs have the tools they need to carry out their critical roles. Arming your field reimbursement team with the right set of information and data—from real-time policy information to leveraging secondary medical and prescription claims information—enables FRMs to communicate the right information at the right time to the right stakeholders.

We know HCPs want positive outcomes for their patients. We also know that HCPs are always looking for ways to better support their patients. FRMs and any provider-facing teams should know their audience—their communication preferences, their needs, and their practice—and cater to each individual to create the appropriate educational materials that will be most meaningful to them and their patient population.

Learn more about IQVIA Dynamic Deployment for Access and Reimbursement here: https://bit.ly/3rtN7Rk