Bridging the Evidence-to-Access Gap
A strategic blueprint for Market Access and HEOR teams to accelerate coverage, optimize reimbursement, and secure market penetration in an AI-driven healthcare ecosystem.
The New Era of Evidence Scrutiny
Traditional value communication is failing. Payers are leveraging AI to scrutinize claims at scale, creating an "AI arms race" where manufacturers are at a distinct disadvantage. The era of submitting a static value dossier and hoping for the best is over. Your meticulously crafted HEOR models and clinical data are now being fed into systems that identify any discrepancy with ruthless efficiency.
The AI Capability Gap
Payers are outpacing providers and manufacturers in deploying artificial intelligence, creating a significant challenge in evidence communication.
The Payer's Core Dilemma
The global healthcare ecosystem is straining under three compounding pressures: an aging population, escalating costs, and high-cost precision therapies. This forces payers into a defensive posture, where they must reconcile improved patient outcomes with immediate budget impact, leading to risk-mitigation strategies like conditional reimbursement and Managed Entry Agreements.
Relentless Financial Pressure
Health spending continues to rise, squeezing budgets and making payers resistant to new expenditures without overwhelming proof of value.
Plummeting Margins
2.1%
Average U.S. hospital margins in 2024, amplifying resistance to adopting clinically superior but more expensive technologies.
The Evidence-to-Access Gap
The evidence that secures regulatory approval is not the same evidence that secures market access. Payers demand "access evidence"—proof of value to the entire ecosystem. Bridging this structural divide requires supplementing clinical trial data with Real-World Evidence (RWE) and device-specific data demonstrating tangible benefits in clinical practice.
AdVids Warning: The Fallacy of Linear Evidence Generation
"Viewing the Evidence-to-Access Gap as a one-time hurdle is a costly, outdated mistake. Access is a dynamic position that must be continuously defended. Evidence generation must be a perpetual, strategic function throughout your product's entire lifecycle."
Systemic Friction: The "Innovation Tax"
The system is riddled with misaligned financial incentives. Pre-existing reimbursement formulas often penalize providers for adopting clinically superior but more expensive technology. This, combined with escalating regulatory complexity and falling hospital margins, creates a system biased against disruptive innovation.
The AI-Powered Paradigm Shift
It's no longer enough to present data; you must bring it to life. The new paradigm is AI-powered visualization—translating complex HEOR models into clear, engaging, and interactive visual narratives to accelerate comprehension and build trust.
AdVids Defines: AI-Powered Evidence Visualization
The strategic application of AI to transform complex, multi-source health economic and clinical data into dynamic, interactive, and personalized visual narratives. It’s a capability designed to accelerate comprehension, withstand algorithmic scrutiny, and build stakeholder trust.
From Static Models to Dynamic Tools
Transform the traditional Budget Impact Model (BIM) from an opaque spreadsheet into an interactive, digital toolkit. Engage payers in collaborative "what-if" analysis in real-time, allowing them to adjust inputs and instantly see the projected budget impact. This shifts the conversation from a defensive justification to a collaborative exploration of value.
Visualizing the Invisible
AI-powered animation makes notoriously difficult HEOR concepts tangible and intuitive for non-economists.
Markov Models
Instead of static diagrams, dynamic animations show a patient cohort moving between health states over time, making disease progression clear.
Kaplan-Meier Curves
AI can extract data from published curves with 95% accuracy and create interactive versions where stakeholders can explore survival probabilities.
Probabilistic Sensitivity Analysis (PSA)
Translate a dense scatterplot into an intuitive tornado diagram, clearly ranking the variables that have the biggest impact on outcomes.
Markov Model Flow
PSA Scatterplot Clarity
The Future of Simulation
Generative AI video models will unlock new frontiers, creating hyper-realistic simulations of a device's impact. Imagine showing a VAC a simulation of your new surgical device reducing OR time, or visualizing a product's Mechanism of Action with cinematic, scientific accuracy. Understanding these emerging capabilities is key to creating evidence that sets a new standard for impact.
Strategic Application: A Tailored Approach
True success lies in execution—deploying visual assets effectively in high-stakes engagements with Health Technology Assessment (HTA) bodies, payers, and hospital Value Analysis Committees (VACs). Each audience has unique priorities, requiring a tailored, multi-channel strategy designed to build credibility and accelerate alignment at every stage.
The Digital Dossier for HTA Submissions
Evolve the core value dossier from a static document into a dynamic "digital dossier." Embed interactive elements and visual summaries within HTA submissions to enhance clarity, demonstrate transparency, and facilitate review. Submitting evidence in a format that is both human-readable and machine-ready will become a significant competitive advantage.
Case Study: The HEOR Specialist
Payer Negotiations & Value-Based Contracting
In direct negotiations, interactive tools transform the dynamic from confrontation to collaboration. This is critical for Value-Based Contracts (VBCs), where visualizing the mechanics and modeling financial outcomes demystifies the arrangement and builds the trust needed to reach an agreement.
A Core Competency, Not an Option
45.2%
Of all US healthcare payments now flow through value-based arrangements. Your ability to clearly communicate and model these contracts is essential for market access.
VAC Acceleration: Aligning Hospital Stakeholders
Accelerate VAC approval by creating targeted, personalized communications that solve key pain points, such as the time it takes to gather evidence and the lack of physician engagement. A digital toolkit with tailored video summaries for the CFO, Clinician, and Administrator builds credibility and speeds the path to a positive decision.
Case Study: The Market Access Director
The Global Challenge
As of January 2025, the new EU HTA Regulation (EUHTAR) harmonizes clinical assessments, presenting a monumental opportunity and a new strategic challenge. The traditional Global Value Dossier (GVD) model is no longer viable.
The Joint Clinical Assessment (JCA)
The centerpiece is the Joint Clinical Assessment (JCA). Manufacturers will submit a single evidence dossier for EU-level assessment, raising the stakes of the initial submission and requiring unprecedented cross-functional collaboration to satisfy the needs of 27 different member states.
JCA Phased Implementation
The new regulation will be rolled out over several years, starting with high-priority therapeutic areas.
AI-Powered Localization: From Adaptation to Generation
The GVD must evolve into a dynamic, modular content platform. AI-powered localization is the critical capability to rapidly generate culturally and economically relevant value arguments at scale.
Automated Evidence Synthesis
AI tools rapidly screen data sources for country-specific inputs essential for adapting global economic models.
Narrative Consistency
Ensures core value messages and brand voice remain consistent across all markets and translations.
Visual Content Adaptation
Streamlines localization of visual assets, generating new voiceovers and text in dozens of languages.
AdVids' Ecosystem Perspective
"Your goal should be to create a 'smart' GVD—a centralized, modular evidence platform where AI can be deployed to rapidly assemble compliant, locally-resonant value propositions, freeing your affiliate teams to focus on strategic engagement rather than content creation."
Navigating the "Last Mile" of Access
True market access is only achieved when providers can effectively adopt, use, and get reimbursed for your technology. This final step is fraught with challenges, primarily a significant education gap regarding complex coding requirements and medical necessity documentation.
AI Video for Provider Training
Expecting time-constrained providers to master new codes from a PDF is unrealistic. Personalized, AI-driven video training offers a scalable solution. Short, targeted videos can provide clear, visual instruction on specific coding and documentation requirements, delivered directly into provider workflows.
60% Reduction in Denials
A targeted AI video campaign dropped the claim denial rate for a new diagnostic test from 25% to 10% in a single quarter.
Case Study: The Reimbursement & Coding Strategist
Compliance, Integrity, and the MLR Imperative
While the 21st Century Cures Act created a "safe harbor" for sharing Health Care Economic Information (HCEI), this freedom demands a "compliance-first" mindset and seamless integration with the MLR review process.
AI Integration for the MLR Workflow
The traditional, manual review of static documents is too slow. The solution is integrating AI-powered compliance tools directly into the MLR workflow. Systems using Natural Language Processing can analyze materials in real-time to flag issues and suggest compliant alternatives, significantly accelerating review cycles.
AdVids' Human Element Emphasis
"If you layer AI on rotten processes, you end up with rotten results... An AI can check a claim against a library, but only a human expert can validate the scientific nuance... This human-in-the-loop model is non-negotiable."
The Contrarian Take: The Static Dossier is a Liability
In the age of AI, the traditional, static AMCP dossier is a strategic liability. Research shows dossier receipt does not improve the likelihood of attaining preferred formulary placement. It's a one-way tool in a two-way world. Resources must shift to building dynamic, "living evidence" platforms that foster dialogue.
Implementation Strategy: Integrating AI into the Evidence Workflow
Adopting AI is an organizational transformation. A successful strategy requires a deliberate, phased approach to de-risk investment, build momentum, and ensure each phase generates tangible value.
AdVids' Strategic Prioritization: The "Crawl, Walk, Run" Approach
"This strategic sequencing de-risks investment, builds organizational momentum, and ensures that each phase generates tangible value and key learnings that inform the next. Attempting to 'run' before you can 'crawl' is a recipe for costly failure."
Crawl
Months 1-6: Achieve a Quick Win
- High-Value Use Case: Pilot an interactive digital BIM for one product.
- Data Foundation: Create a centralized "evidence library" for the pilot.
- Pilot Team: Form a cross-functional team (HEOR, Access, Legal).
Walk
Months 6-18: Build Momentum
- Expand Tools: Develop a "Digital VAC Toolkit" and provider education videos.
- Upskill Team: Train market access teams on collaborative value conversations.
- Secure Buy-In: Use pilot success metrics to build a business case for wider adoption.
Run
Months 18+: Achieve Scale
- Integrate Workflows: Make AI-powered tools the default, integrated into MLR systems.
- Leverage Analytics: Use tool analytics to inform global evidence generation strategy.
- Explore Next Frontier: Experiment with predictive personalization and generative AI video.
Measuring Impact: Advanced KPIs for a New Era
To justify investment and optimize performance, you must adopt KPIs that connect communication activities to tangible commercial outcomes: accelerating access, optimizing reimbursement, and driving provider adoption.
AdVids' ROI Methodology Nuance
"The AdVids ROI framework focuses on three core pillars that reflect actual business value: Access Velocity, Commercial Efficiency, and Stakeholder Influence. A successful strategy must demonstrate a quantifiable improvement in all three."
Pillar 1: Access Velocity
This measures the speed at which your product achieves key market access milestones. Key metrics include Time to Positive Coverage Decision and Pipeline Velocity, which tracks movement between key stages of the access journey.
Shortening Timelines, Accelerating Revenue
Pillar 2: Commercial Efficiency
This pillar quantifies financial outcomes and internal operational gains. Key metrics include Reimbursement Rate Adequacy, Marketing-Influenced Revenue, and a reduction in MLR Review Cycle Time.
Operational Gains with AI Compliance
AI-powered pre-screening significantly reduces the number of review cycles and accelerates content approval, freeing up resources.
Pillar 3: Stakeholder Influence
Measure how your communications shape perceptions and decisions using a mix of qualitative and quantitative data.
Stakeholder Influence Score
Track changes in sentiment over time, moving stakeholders from "Resistant" to "Supportive" through surveys and engagement analysis.
Evidence Displacement Rate
Track how often your data is cited by payers relative to competitors. An increase indicates your value story is becoming the new standard.
From Resistance to Advocacy
Effective, targeted visual communication demonstrably shifts stakeholder perception, building the support needed to win formulary placement and drive adoption.
Future Outlook & Final Arguments
The lines between evidence generation, communication, and negotiation are blurring. Your role will evolve from a generator of static reports to a strategic conductor of real-time, adaptive value dialogues.
The AI-Powered HTA
HTA bodies and payers are also leveraging AI, raising the bar for submission quality. Soon, you will need to provide evidence in a structured, machine-readable format to meet new digital standards for transparency and reproducibility.
The Evolving Role of the Market Access Professional
AI augments, not replaces, expertise. By automating manual tasks, AI will free up human experts to focus on high-value strategic thinking and human interaction. Your role will shift from producing evidence to strategically interpreting and communicating it.
"We've moved from digital products and infrastructure to digital distribution and Web strategy to now into more holistic transformations."
- Saul Berman, IBM
Your First Steps into the New Era
1. Crawl: Audit Bottlenecks
Identify the single biggest point of friction in your current communication process and design a focused pilot program to address it.
2. Walk: Invest in Data
Begin creating a centralized "single source of truth" for your evidence. Good data governance is the non-negotiable foundation for any successful AI strategy.
3. Run: Upskill Your Team
Start a dialogue about the evolving role of the Market Access professional and invest in the training required to prepare for the future.
AdVids' Concluding Strategic Statement
"The fundamental currency of market access has changed. It is no longer the volume of evidence, but the velocity and clarity with which you communicate value. The ability to visualize complex data is the core strategic competency that will separate market leaders from laggards, ensuring innovative technologies reach the patients who need them most."