Field Reimbursement Managers: Evolving to Meet Patient and Provider Needs

When David Bowie wrote the song “Changes” in the spring of 1971, it became an anthem to the ever-changing nature of things. This is certainly true in the world of Field Reimbursement Managers (FRMs), where organizations that deploy FRMs need to continually evolve how they measure and perform their role in the face of a continually changing healthcare landscape. 

Subject matter expertise and reimbursement competency are foundational for any successful FRM, but more is needed to truly move the needle on impact. FRM organizations will need to overcome significant obstacles in evolving how they measure success in a compliant environment, directly engage patients, and become strategic partners.  

Measuring Success in a Compliant Environment 

FRM organizations are a major cost center in the gross to net (GTN) calculation, which determines profitability reflecting the costs and rebates for branded products. Therefore, measuring the impact of FRMs is a very valid expectation. However, the challenge arises in that these roles are non-promotional and cannot be tied to activities which drive demand in any way. This creates an internal organizational dilemma that can lead to a constant push-pull relationship between the sales and FRM teams. 

Accordingly, how do we measure this valuable resource so important in assisting with patients access journeys?  

• Measure The Team: You can measure overall team impact on hard measurements such as completed cases, time to triage or fill rates. This rewards the results of the collective team while minimizing the risk of an individual adopting non-compliant behaviors to achieve individual performance. 

• Measure Specific Phases of a Patient’s Access Journey: There are specific phases of a patient’s access journey that can create frustrations for both the patient and the health care provider. By addressing these phases such as complete enrollments and payor first submissions by the HCP office, FRM teams can have a very positive impact on how smoothly a patient’s access journey goes. This proactive education to HCP offices of payor requirements will generally lead to a patient beginning treatment sooner, a win-win. 

• Measure Provider Experience: Recently more organizations are using quick surveys of reimbursement staff to assess FRM impact. The FRM provides a quick two-three question yes/no survey to a specific staff member involved in a patient’s access journey to obtain feedback at a case level. This information can help the FRM make needed adjustments to smooth the patient access journey. 

Measuring FRM success requires a partnership between the FRM team and the compliance team, with alignment across the manufacturer organization. This, along with thoughtful metrics will help organizations understand and measure FRM impact from both a provider and patient view.  

Engaging Patients Directly 

In recent years there are more access organizations engaging patients directly. While this is a good start, it is important that this direct patient engagement becomes standard practice for complex products with titrations or coordination of care. The reasons for this are three-fold: 

• Patient Empowerment: In 2002, the respected psychologist Edwin Locke outlined that through self-efficacy, knowledge and competence, people can achieve individual empowerment. Patients with complex diagnoses are now demanding the ability to make their own informed health care decisions through advocacy groups and direct engagement. 

• Patients Are Their Own Squeaky Wheel: Patients have a significant amount of power with payors. The star rating of a health plan can impact its marketability, and with some plans, a patient-initiated prior authorization carries with it an expedited timeline.  

• The Impact of Setting Expectations: Being able to directly set expectations with patients on their access journey and advise them on additional actions that they could take, can greatly improve the patient’s experience.  

Engaging patients directly can be a major shift for an FRM organization, and it will be paramount to gain alignment with your legal and compliance colleagues, but it can reshape your ability to serve your patient’s needs. 

Strategic Partnerships 

FRMs hold a unique position across a matrix field team and can provide valuable insights to key stakeholders within the broader commercial organization. The challenge lies in the fact that many organizations do not take the time to encourage or train their FRMS on forming strategic partnerships.  

Key stakeholders who could benefit from FRMs being a better strategic partner include: 

• Payor Account Teams: Although somewhat of an obvious consideration, there are many companies who do not foster collaboration between FRMs and payor account teams. Yet, the feedback from FRMs to payor account teams has already produced dramatic impact on payor policy changes. FRMs will be the first to recognize the impact of a payor’s policy on patient access and this first-hand knowledge should be shared with those in a position to effect change when needed. 

• Managed Care Marketing: Managed care education is critical for any field team. FRMs will learn from customers what is working and what isn’t. Many times, FRM teams will identify needs for managed care education and can help develop and launch the necessary resources. 

• Field Sales Leadership: From understanding an account’s reimbursement competency to identifying a problematic employer plan, the FRMs can help field sales leadership identify obstacles and opportunities.  This will allow for better resource allocation and strategic planning. 

Evolving for the Future 

FRM organizations who can align their leadership with legal and compliance to evolve the FRM role and make these changes in their go-to-market models, can make a profoundly positive impact on the patient access journey, especially in rare and specialty diseases.  

Compliantly measuring impact, directly engaging with patients and establishing strategic partnerships will evolve an FRM organization from “case managers on wheels” into a meaningful organization that not only gains patient access to therapy but also strengthens market access.