Case Studies >
Value & Access

U.S. Reimbursement Strategy to Enable Early Adoption of a Novel ED Diagnostic

image of pharmacy community engagement activities
Client Profile

Mid-size Diagnostics

Key Stakeholders

Commercial, Market Access, Medical Affairs, Finance

Asset

FDA-cleared, early commercialization

Disease Area

Infectious Disease Diagnostics

Join Our Newsletter

Subscribe to our newsletter to receive the latest case studies.

Client Profile

Mid-size Diagnostics

Key Stakeholders

Commercial, Market Access, Medical Affairs, Finance

Asset

FDA-cleared, early commercialization

Disease Area

Infectious Disease Diagnostics

Situation

A mid-size diagnostics company was preparing to commercialize a newly FDA-cleared diagnostic intended for use in the emergency department.

Early adoption depended on more than clinical performance. The team needed clarity on reimbursement feasibility, coding options, pricing strategy, and how to communicate value to hospitals and payers.

The client engaged Alkemi to validate reimbursement pathways, define the value story, and guide early commercialization priorities.

Approach

1. Assessed emergency department reimbursement pathways and how similar diagnostics achieved payment.

2. Identified relevant analogues and evaluated coding strategies, including PLA options and crosswalk pathways.

3. Interviewed decision-makers to validate real-world billing practices, documentation requirements, and adoption drivers.

4. Built an early value story and ROI model tailored to both clinical and administrative stakeholders.

The focus throughout:

Reduce reimbursement uncertainty and enable early commercial traction.

Deliverables

1
Landscape assessment outlining reimbursement pathways and adoption considerations.
2
PLA and crosswalk assessment to inform coding, pricing, and payment strategy.
3
Early value story and ROI model to demonstrate impact for hospitals and payers.
4
Evidence and commercial readiness report prioritizing next steps for adoption and reimbursement.
5
6

Impact

"The work provided us with much-needed clarity on reimbursement risk and helped us articulate a compelling value story as we move toward early adoption." - Commercial Leader

Stronger CMS Readiness:

Crosswalk and ROI outputs supported CMS discussions and helped defend pricing in CLFS discussions.

Accelerated Commercial Momentum:

The ROI model supported pilot-site engagement and helped build early interest.

Supported Growth and Investment:

Pilot outcomes informed commercialization planning and were used to support additional investor discussions.

Experience The Alkemi Advantage Today