Health Systems at the Crossroads of Access: Why Provider Insights Are as Critical as Payer Input
Market access strategy often centers on payers. Rebates, contracting, and formulary placement dominate the conversation. But in today’s environment, that view is incomplete.
Hospitals, Integrated Delivery Networks (IDNs), and health system leaders are emerging as equally critical stakeholders. They influence how therapies are adopted, how operational barriers are managed, and ultimately whether patients can access treatment in the real world.
As one payer recently put it: “Access doesn’t just live in spreadsheets, it lives in the system.”
Why Providers Matter in Market Access
When health systems weigh in, they bring a different lens than payers:
- Operational feasibility: Can pharmacy teams implement new coverage rules without slowing down care?
- Clinical practice alignment: Do treatment pathways and guidelines match real-world workflows?
- Resource constraints: Staffing shortages, prior auth processes, and infusion capacity often determine whether access exists on paper or in practice.
- Patient experience: Hospitals and IDNs see firsthand where delays, step edits, or reimbursement hurdles disrupt care.
Without provider input, manufacturers risk designing strategies that look strong on a payer slide but fall apart in implementation.
Provider + Payer = A Complete Picture
The best-performing access teams understand that payer and provider insights must work in tandem. For example:
- A payer might agree to step-edit removal if adherence data looks strong.
- But the provider perspective reveals whether pharmacy teams can operationalize that change.
- Together, these insights create a strategy that’s not only approved, but sustainable.
4 Ways to Incorporate Provider Insight
- Expand advisory panels to include pharmacy directors, system executives, and care coordinators.
- Leverage digital platforms like MAVA® to engage hospital and IDN leaders alongside payers.
- Validate real-world feasibility before finalizing contracting models or evidence submissions.
- Treat providers as co-strategists, not downstream implementers.
The Bottom Line
Market access doesn’t end with a payer’s decision. It plays out in hospitals, IDNs, and health systems where real-world constraints can make or break uptake.
Access isn’t decided in payer spreadsheets alone. It’s decided in the places where care is.