Impactful Payer Engagement is a Persistent Challenge for Global Access Teams

Impactful payer engagement is essential to accelerating appropriate patient access. It depends not only on robust evidence, but on understanding how payers think and what shapes their decisions. Value communication tools play a vital role in supporting payer engagement: When aligned with payer priorities, they translate evidence into compelling narratives that support access, from national reimbursement to real-world use.

To engage payers effectively, market access teams must first appreciate the belief systems driving payer behavior. When it comes to shaping how a medicine’s value is perceived, accepted, and rewarded, it is often assumed that payer decisions hinge solely on a rational trade-off between clinical benefit and budget impact. While cost containment remains a critical driver, payer decision-making rarely operates in a purely rational vacuum. Payers are, after all, human, guided not only by data but also by underlying beliefs, perceptions, and social influences. Beyond the core domains of clinical, humanistic, and economic value, payer judgments can be shaped by broader considerations: perceptions of disease severity and unmet need, implications for the wider healthcare ecosystem, and notions of fairness, equity, and societal value. Payer perspectives are also influenced by the views of other stakeholders—clinicians, patient organizations, policymakers, and the general public—creating a complex network of beliefs that ultimately shapes access outcomes. 

Recognizing this, global market access teams can strengthen payer engagement by incorporating additional value drivers into payer engagement tools. Doing so may not only increase the likelihood of securing favorable reimbursement but also advances the ambition for global access teams to enable timely and meaningful real-world patient access.  

Belief Mapping: A Powerful Tool for Market Access Teams 

Value communication aims to differentiate a product through impactful, evidence-based narratives grounded in clinical data. Belief mapping is a complimentary approach that considers the rational and emotional beliefs that influence payers decision making within the broader therapeutic area. This approach enables market access teams to identify possible payer beliefs that may shape decisions across the therapy area and the belief shifts needed to enable real-world patient access to a product.  

Grounded in behavioral science, belief mapping is a structured, hypothesis-driven approach that has long been used in marketing to uncover, cluster, and operationalize the belief shifts necessary to change stakeholder behaviors. While belief mapping is currently underutilized in market access, it is a powerful tool to unlock a deeper, more durable layer of payer insight, grounding teams in a shared understanding of the likely belief shift needed to drive the desired payer behavior towards a disease area and product, supporting optimal and equitable patient access, faster. 

As payer decisions are influenced by a range of value components beyond clinical and economic value, belief mapping can help market access teams move from what payers say to why they hold certain views about a disease area and product. Belief mapping can uncover: 

• Payer beliefs tied to different healthcare system archetypes:  For example, the statutory health insurance system in Germany is based on principle of solidarity, whereas the United Kingdom is focused on cost-utility. 

• Emotional and value-based drivers: These include beliefs such as “innovation deserves reward,” “surrogate endpoints cannot be trusted because they lack scientific rigor,” and “reimbursing the only disease-modifying treatment in this disease gives hopes to patients who previous only had symptomatic treatments.” 

• Implicit barriers: These can block access to treatments even when the evidence is strong. Such barriers are often tied to entrenched clinical dogma and beliefs about precedent and fairness.. 

• Shifts in beliefs over time: Mapping these allows anticipation of payer resistance across launches, not just a single health technology assessment (HTA). 

 Additionally, for access teams under pressure to secure not just reimbursement but sustained patient uptake, belief mapping helps bridge the gap between national market access and real-world access. Belief mapping shows where the beliefs of different stakeholders (e.g., national payers, regional- and hospital-level payers, patient advocacy groups, clinicians, policymakers) diverge, as well as enables mapping of how the beliefs and behaviors of different stakeholders may influence one another. 

Using insights from belief mapping, market access teams can: 

• Develop a high-impact, healthcare system-wide value proposition that acknowledges stakeholder concerns and reframes them with evidence and empathy. 

• Curate messaging tailored for different stakeholder groups, ensuring relevance and resonance. 

• Plan the sequence of messaging across the product lifecycle.  

By conducting belief mapping early, market access teams can shape stakeholder engagement well in advance of launch. Such early engagement is particularly valuable for novel modalities, where beliefs may be unsettled, underdeveloped, or require adjustment to support timely and meaningful patient access.   

Figure 1 provides examples where access teams may have benefited from using belief mapping to uncover payer beliefs, anticipate access challenges, and develop value communication materials. 

Figure 1. Illustrative Examples: Applying Belief Mapping to Payer Engagement Strategies  

ALK: Anaplastic Lymphoma Kinase; ICER: Incremental Cost-effectiveness Ratio; SGLT2: Sodium-glucose Co-transporter-2 Inhibitor. 

At Avalere Health, we understand what it takes to optimize meaningful multi-stakeholder value engagement and develop messaging that aligns and galvanizes internal cross-functional teams around a shared communication goal. To learn more about how Avalere Health can support your efforts to achieve timely and meaningful in-market patient access, connect with us.