Healthcare market research: how to talk to clinicians, administrators and payers

Healthcare market research is the work of learning how care organizations notice a problem, decide what to buy and use it day to day. Most of the useful answers come from interviews with three groups: clinicians who use the product, administrators who approve and run it, and payers whose rules shape what gets paid for. Healthcare adds two complications you should plan for before the first call: patient information must stay out of your notes, and if your company makes a drug or medical device, conversations can trigger safety-reporting duties.

A worked example: prior authorization in specialty clinics

Suppose you are building software that tracks prior authorization requests for independent dermatology practices. This example is hypothetical and used throughout the page.

You want to know how long approvals take today, who chases them, what they use to keep track, and whether a practice would pay to make it faster. No single person can answer all of that. The dermatologist feels the delay, the front-office staff do the chasing, the practice manager owns the budget, and the health plan sets the rules that cause the work.

Map everyone who touches the decision

Write down each role that uses, pays for, approves or constrains the product. For the example, that list might be:

• Clinicians: dermatologists and physician assistants who order treatments that need approval.
• Administrators: the practice manager, billing lead and front-office staff who submit and follow up.
• Payers: utilization management staff at health plans who review requests.

Larger organizations add formal buying steps. At UCI Health, for example, a physician's new product request is reviewed by a value analysis manager, a clinical budget director, the department chair and a multidisciplinary committee that weighs clinical efficacy, product evaluation and financial impact. UCI Health value management If you sell to hospitals, ask early whether a committee like this exists and who sits on it.

Ask each group what they actually know

Ask about recent, specific events rather than opinions about your idea. Our guide to interviewing B2B buying roles covers how to separate users, buyers and approvers, and expert interview questions for an unfamiliar industry helps when the vocabulary is new to you.

Keep patient information out of the conversation

The HIPAA rules apply to covered entities and their business associates. Covered entities include health care providers that transmit health information electronically in standard transactions, health plans and health care clearinghouses. HHS Many of the clinicians, practice staff and payer employees you interview will work for one of these, so they have reason to be careful.

You rarely need patient details to learn about a workflow. Say at the start that you do not want names, dates of birth or anything that could identify a patient, and ask about processes and patterns instead. If someone starts describing a specific patient, steer back to the process. This is a practical precaution, not legal advice; if your research needs patient-level data, get proper legal and compliance review first. If you record calls, see how to ask for recording consent.

If you make a drug or device, plan for reporting duties

Research sponsored by a drug or device maker can carry extra obligations. The Insights Association notes that participants can mention health effects linked to a drug or device during market research, and that any reporting obligations should be agreed between the parties before research begins. Insights Association The industry guidelines it points to, from EPHMRA, say adverse events mentioned in research commissioned by the product's license holder should be reported to that company within one business day, and that participants must be told about this at recruitment and at the start of the interview. EPHMRA guidelines

Payments matter too. Under the Physician Payments Sunshine Act, manufacturers report many payments to physicians. The Insights Association explains that research payments made through a third party are excluded when the manufacturer does not know who the physician is. Insights Association on the Sunshine Act If you are a manufacturer paying clinicians directly, check with counsel before you start. Both rules are aimed at drug and device makers; if you only make software, like the prior authorization example, confirm with counsel whether either touches your research.

Find clinicians and administrators to interview

Clinicians are busy and get a lot of requests. The usual routes are introductions from people you know, professional associations, direct outreach that names the person's experience, paid invitations and expert networks. In Instant Expert, you describe the experience you need, review the people it finds, and it sends your invitations; you pay for the calls that get booked. Directory pages such as finance professionals in hospitals, IT professionals in hospitals and operations professionals in insurance show the kind of administrators and payer staff you might shortlist.

Set any payment before you start and keep it the same whatever the person says. Our research incentive budget guide walks through how.

A plan for the first two weeks

1. Write the decision the research informs and the four or five facts that would change it.
2. List every role that uses, pays for, approves or constrains the product.
3. Decide whether drug or device reporting rules apply, and settle that before recruiting.
4. Book three to five conversations per role, starting with the people who do the work.
5. Group your notes by role and by fact, and note where roles disagree.

If you know the roles but not the people, start a search with a one-sentence description of the experience you need.