Reservoir Health helps organizations shape the policy, narrative, and market environments to enable health care innovation to reach patients.
We integrate policy, market enablement, and communications to shape how health care innovations are understood, valued, accessed, and adopted. We work with organizations developing new therapies, devices, diagnostics, digital health solutions, and models of care.
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Corporate Reputation Starts with Demonstrating Value
Companies invest considerable resources in being liked, respected, and trusted. These are worthy ambitions, but on their own they may not offer companies sufficient specificity to build a proactive corporate reputation plan. They don’t answer the question of what a company should actually do.
Reservoir’s value model begins with a practical question: How does your company create value for the people whose decisions matter to its success?
Brand and reputation are often used interchangeably. A brand encompasses a broad range of associations, both cognitive and emotional. Reputation is more specifically what people think of your company based on their understanding of its conduct and contributions.
That distinction matters because reputation programs are often built around broad goals like increasing trust, without defining what a company needs to do to earn it.
Understanding what stakeholders value gives a company a better basis for choosing where to invest. It also makes research more useful. A company may discover that people do not recognize the benefits it delivers, or that the benefits it emphasizes matter less than management assumes. Sometimes, the company simply needs to improve what it does.
Each finding calls for a different response.
An approach rooted in value connects reputation work to business priorities. A pharmaceutical company needs to understand what patients, clinicians and those paying for care value about its work, and where they see shortcomings. Those judgments affect the company’s ability to bring treatments into use and build support for future innovation.
The challenge is to communicate consistently while recognizing that stakeholders have different priorities. Helping people manage illness might mean greater independence to a patient, better treatment options to a clinician and fewer costly complications to a payer. These benefits can support the same corporate story, with evidence that matters to each audience.
Emotional storytelling can help people understand why those benefits matter. But a strong initial response to a story does not establish a lasting change in how people view the company. Reputation is built when the company continues to demonstrate that value through its communications, its decisions and, ultimately, people’s experience with it.
That is why reputation work belongs close to the business. Much of the work involves helping people understand contributions they have overlooked or taken for granted. It also requires knowing the business well enough to recognize when performance needs to improve and being candid about what the company needs to do.
Reputation is built by creating value that matters to the people important to the success of the business, demonstrating and communicating that value consistently, and improving where the company falls short. Understanding what stakeholders value is where that work begins.

Reservoir Health: Shaping the Policy Environment
Over the last decade, advocacy has evolved.
While ultimate success may still be passing a favorable bill, preventing a harmful policy from advancing, or influencing a regulatory decision, the path to the result has changed.
Increasingly, organizations recognize that policy decisions are shaped long before a vote is cast or guidance is issued. Evidence generation, patient engagement, coalition building, stakeholder relationships, and communications all influence how issues are understood and ultimately how decisions are made. Advocacy brings these disciplines together to shape the policy environment.
Organizations that invest early in relationships, evidence, and infrastructure are better prepared to advance their priorities as Washington changes.
The same is true at the state level, where legislative sessions move quickly, and stakeholders may not recognize a policy’s implications until implementation is underway. Major policy shifts, from Medicaid changes to new coverage requirements, ripple across providers, patients, employers, and health plans.
An integrated approach creates stronger advocacy
Organizations today are increasingly asking not only What policy outcome do we want? but What conditions need to exist for that outcome to become possible?
That means ensuring evidence answers policymakers’ questions, engaging stakeholders to test assumptions, aligning coalition partners, and developing communications that support policy objectives. These efforts are most effective when they inform one another.
Why Reservoir Health
Our new name reflects this integrated approach.
For years, we've helped clients connect policy, communications, stakeholder engagement, and evidence.
We help organizations shape the broader policy and stakeholder environment surrounding the issues that matter most. By bringing these capabilities together, we help clients anticipate change, build alignment, and advance their policy objectives.

Why CBO-Style Scoring Is Getting Harder and More Important
Congressional debate often reduces a policy’s fiscal impact to one number: how much it is expected to save or cost over ten years.
That number can determine whether legislation advances, how it is designed and how stakeholders advocate for or against it.
But a score is not a fixed prediction. It is an estimate based on the policy language, available evidence and assumptions about how stakeholders will respond.
Recent Congressional Budget Office (CBO) revisions involving Medicare drug policy show why these estimates are becoming more difficult to produce and why understanding what sits behind the headline number is increasingly important.
Why it matters: The score can shape the policy
CBO scores influence whether a proposal is considered politically and procedurally viable, which provisions are changed or removed, what offsets lawmakers need and how stakeholders frame the policy’s potential benefits and tradeoffs.
The challenge is that health policies rarely operate in isolation. A change in one part of Medicare can alter incentives and behavior elsewhere, sometimes in ways that cannot be fully anticipated before implementation.
A score may be a critical input into policy and advocacy strategy, but the number alone does not reveal which assumptions drive the result, where uncertainty is greatest or where unintended consequences may emerge.
Zooming in: Two recent revisions, two sources of uncertainty
Technical details can change the estimate
In July 2025, CBO estimated that changes to the Inflation Reduction Act’s (IRA’s) orphan-drug exemption would increase federal spending by $4.9 billion over ten years.
After outside experts raised questions about additional products that could be affected, CBO conducted further analysis and revised the estimate to $8.8 billion. CBO also found that the cost could range from $6.7 billion to $10.9 billion, depending partly on how the Centers for Medicare & Medicaid Services (CMS) treats different formulations of affected products.
What this shows: Understanding a proposal’s effects requires more than interpreting its statutory language. It also requires detailed knowledge of the products, programs and markets the policy would affect.
The market may respond differently than expected
In 2022, CBO estimated that the IRA’s major Medicare Part D drug provisions would reduce federal deficits by $129 billion through 2031. CBO now projects that those provisions, taken together, will increase deficits over the same period because:
What this shows: Policy can change behavior throughout the health care system: patients may use more medicines when out-of-pocket costs decline, plans may adjust bids, formularies and utilization management, and manufacturers may change pricing and market strategies. These effects are difficult to isolate and even harder to predict before a policy takes effect.
The takeaway: One score is not enough
The lesson is not that scoring has become less useful. Rather, a single point estimate may provide false precision when a policy depends on uncertain implementation decisions and behavioral responses.
A more decision-useful analysis should identify:
Instead of relying on one estimate, policymakers and stakeholders should examine a central scenario alongside credible higher- and lower-impact scenarios. Sensitivity analysis can show how the result changes when critical assumptions shift.
The goal is not to predict the future with perfect accuracy. It is to understand the conditions under which a policy is likely to achieve its objectives and where it could produce unintended consequences.
From scoring to strategy
CBO-style scoring can inform strategy well beyond the headline budget impact.
A thoughtful analysis can help stakeholders identify major cost drivers, test policy modifications, anticipate questions from policymakers, strengthen the evidence supporting a proposal and prepare for alternative implementation approaches.
It can also support advocacy messages that acknowledge uncertainty while clearly explaining the policy’s rationale and likely effects.
The bottom line
As health policies become more interconnected, scoring them will become more difficult. That makes rigorous analysis more important, not less.
The most useful CBO-style analysis connects the number to the policy choices behind it. It considers multiple plausible scenarios, makes uncertainty visible and gives policymakers and stakeholders a stronger foundation for deciding how to design, defend or improve a proposal.
Go deeper:
To learn more about Reservoir's CBO-style scoring and other analytical capabilities, contact Ashley Flint at aflint@reservoirhealth.com.