Jim Banigan, Conduent

After a newly diagnosed illness or chronic condition, a patient may find that navigating the healthcare system can be bewildering. And making sense of how to begin a complex drug therapy without help can present them with a steep learning curve at an emotional time. Hub services can alleviate a host of anxieties related to starting, and adhering to, a complex drug regimen. From prior authorizations and copay assistance, to logistics and communication with the patient and their care team, the most effective hubs seamlessly remove barriers to a patient’s access to life-saving drug therapy. But all too often, the patient can feel lost in the process.

For specialty drug manufacturers, high regulatory pressures make it natural to view the hub program from the inside, out through the lens of compliance, performance, analytics, and reporting. The ability to control costs with an efficient operational model drives business performance but does less to illuminate where along the patient journey an individual struggled to navigate a confusing or complex process. It is time to look at the effectiveness of your hub program from the outside in, through the lens of the patient’s journey where a five-star hub experience translates to patient satisfaction, treatment adherence, and better health outcomes.

Specialty drugs account for 2% of total medications prescribed, yet over 50% of the total prescription costs in the US, according to Evernorth’s 2020 Drug Trend Report.

 The report predicts that specialty spending could increase 10% to 15% over the next few years. Given the expense and the known risks of incorrectly using prescription medications, a patient’s lack of adherence and persistency due to movable barriers within your hub program is a non-starter.

To create a more individual-centric experience—and reveal the not-so-obvious sources of frustration—every interaction that involves the patient should consider their journey, experiences, and their emotions.

These four considerations provide the framework to rethink a hub program from a patient’s perspective:

Understand the consumer’s choice: Self-service or high touch

Consumers have grown accustomed to the convenience of technology—whether they’re ordering produce or purchasing a new car. And in a world with same-day delivery, suggested purchases, and personalized ads, consumers expect more information and choices than ever when making buying decisions. Smart retailers are studying all these preferences to cater to the individual’s preferences in how they learn about a product and the information (what and how much) they want before making a purchase.

It should not come as a surprise that the consumers have the same expectations of their interactions with the healthcare ecosystem. The hub program is no exception. Even though they are engaging in an experience that may not be of their choosing, the consumer-become-patient wants ready information to understand their disease state and tools to view progress at every step of the hub experience. Pharma manufacturers can look to retailers for effective practices to quickly become the trusted, go-to source for accurate information that patients can rely on to help them manage their condition, learn more about therapy, and discover ways to stay adherent.

On the other end of the behind-the-scenes activities to ensure a hub is cost-efficient and compliant, is a patient who is expecting a personalized, real-world experience—much like the one they get from an Amazon or Instacart.

Drug manufacturers can affect individualized experiences through the power of self-service. Patients want instant answers about their journey to therapy at their fingertips. They’re thinking: Where can I find out more about my medication? For quick-start or bridge drug shipments, what is the status of my medication delivery? Where am I in the process of payer approval to start my therapy? The accurate and easy flow of information can help to create trust and to improve patient satisfaction. And, considering all of an individual’s touchpoints—which may include family, friends, patient support groups, and more—creating a rich and immersive personalized experience can create positive ripple effects that may generate goodwill for your brand.

As it is with retailers, there is value in pharma organizations asking the patient to rate their experience. In addition to gaining valuable insights, a patient’s input about an experience that is essentially not of their choosing can help them feel visible in a fragmented ecosystem and save their healthcare providers from an earful. A strong feedback loop can also motivate patients to have more of a role in managing their care and understanding their condition.

And with tools like artificial intelligence (AI) and machine learning (ML), we’re able to pinpoint how to best reach patients based on their data—and personalize it. Maybe it’s a phone call, text message, or email. Even motivational text messaging. Based on their personal health trends and behaviors, we’re able to pinpoint how much hand-holding they likely need to stay adherent, even predict which questions they might ask. That’s what truly individualizes the experience. And it makes the process all the more seamless and efficient.

Let’s stick with this shift in mindset of viewing the patient as a consumer. To give patients the experience they want and need, take a page from luxury retail. Upon entering the store, you may choose a highly personalized shopping experience where a highly attentive salesperson is on hand to offer suggestions, answer questions, and tend to your comfort with all the accoutrements. Or you may say, “Thanks, just browsing,” and be left alone knowing that you can switch to the high-touch experience at any time. You drive the interaction and dictate how your experience is curated with the expectation of impeccable, white-glove service in either scenario. The patient is seeking the same power to choose.

When we lay the groundwork for an engaging, educational hub program, the patient’s choice on how they want to shape their journey must be top of mind. Do they prefer self-service, or do they need a high-touch approach to care? To determine this, a good hub program leverages its data and understands how to use it—via the best channel at the most important time—to give the patient the best experience possible, which, in turn, will drive the best outcome possible.

As hub programs evolve, drug manufacturers will increasingly become part of the conversation about a patient’s holistic health. Can we advance health equity as part of the patient’s extended 

care team? The focus on social determinants of health (SDOH) is prompting the industry to look beyond cost as a likely driver of a patient’s struggle with persisting on therapy. Major manufacturers are making headlines for investments and partnerships with community organizations to advance health equity with dollars to provide access to care, education, and support to underserved patients. Direct investment is one pathway to build a bridge to whole-person care.

However, what if an enrolled patient is hungry or doesn’t have a way to the hospital? What if they don’t have safe housing in their neighborhood? Through regular interactions, you may learn more about the unmet social needs of the patient, but, today, it is not the role of the hub to address these issues.

As information becomes easier to share across silos, drug manufacturers will be called upon to take a greater role in collecting and sharing insights that factor into whole-person care for the patient. In this sense, an inside-out look at the hub can drive something greater and more sustainable to the program than a five-star review.

A patient’s journey is personal, unique, and full of distinct interactions that can influence whole-person outcomes. Viewing your hub program from the outside in will help illuminate barriers and points of frustration that can derail efforts to improve adherence and persistency, and damage brand goodwill.

Creating a mind shift away from viewing your hub program as a process-driven exercise for efficiency and cost-control will not happen overnight, but there are rewards for evolution. Disruption is the order of the day to create a more individual-centric hub experience from the patient’s POV.

Jim Banigan is Director of Patient Access Support HUB/PAP for Pharma and Life Sciences at Conduent, Inc.

https://www.evernorth.com/drug-trend-report/year-in-review#main-content

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Disruption is the order of the day to create a more individual-centric hub experience from the patient’s point of view

Hub Programs from Patient Perspective

Pharmaceutical executives are well aware of the disruptive potential of technology. Their organizations, once slow to innovate, are now rapidly adopting new use-cases for automation and artificial intelligence (AI) that expand empathetic touch points to better understand the issues and attitudes of their customers. Technology transformation, both in the context of delivery of reimbursement access solutions and customer engagement, is a core component to customer centricity. This realization is prompting leaders to give their hub/patient assistance program (PAP) customer relationship management (CRM) platforms—and their vendor partners—a closer look.

For many drug manufacturers, owning a hub/PAP CRM platform is part of a larger enterprise initiative, one that embodies all things patient centric, including R&D, wearables, mobile and real-world data collection. For others, it is more narrowly targeted to standard hub and PAP capabilities. Regardless of the scale or scope, motivations leading to full ownership generally fall under four categories:

Controlling delivery processes across vendors.

Swapping under-performing vendors more seamlessly.

If you have ambitions of owning the hub/PAP CRM platform and in-sourcing customer engagement, you will do well to realize that remaining nimble to keep pace with emerging technologies and expanded use cases for automation and AI is not for the faint of heart.

When going it alone, leaders should be clear-eyed about the sizeable investments in talent, technology and time that will be required to deploy and sustain a wholly owned hub/PAP CRM platform.

Let us start with the most obvious investment—people. But not just any people. Transformative, tech-enabled customer engagement will require the mobilization of your most resourceful in-house talent.

Many pharma companies already have experienced staff (formally hired from hub/PAP vendors) overseeing current vendor delivery. To incrementally reimagine and advance solution design, your rock-star contributors should have a deep understanding of dimensional shifts in the channel, government policy, payer landscape and your competitors. Some advances may arrive via your technology vendor, but true transformative change will be more tailored, nuanced and specific.

To keep up, pharma companies need to move past practicing innovation theater (i.e., workshops and design-thinking classes) and shift their mindset to become generators of new ideas and new methods that focus on the issues. There is no “innovation process” 

, as both the problem and the solution are not yet known. Moving operations and engagement experiences forward calls for highly trained talent with sharp problem-solving skills, deep industry experience, insatiable curiosity and time-tested solutioning within this segment.

Whether your transformation is attributable to the integration of emerging technologies, or new capabilities, it will be colored by your investment in the best people.

Modular tech does not equal ‘meh’ tech

From more intuitive workflow processes to harmonization around data schema, there has been a sea change of advancement in technology platform design. Yet for all the progression, hub/PAP CRM platform capabilities have coalesced. Perhaps these platforms seem undifferentiated because they are underpinned by the same CRM application: Salesforce.

If the basic framework is the same, what does a quality hub/PAP CRM look like? In posing this question, you will do well to remember the adage, “appearances are deceiving” before jumping to conclusions that lead to skimpy technology investments.

At a high level, your hub/PAP CRM system architecture and design should be:

Supportive of a wide range of business rules.

Accommodating to the latest in data and third-party payer capabilities.

In addition to AI and automation, your CRM platform should also demonstrate an active use of orchestration logic. Orchestration logic should be capable of triggering parallel processing while provisioning workflows and looping in agents. Reporting packages should be robust and workstreams should be segmented in a way to support visualization of operational performance and coverage dynamics at various stages of the workflow. Moreover, CRM software applications that underpin your hub/PAP platform should be market leading and, if possible, common to your organization’s CRM platform for sales.

As it is with people, technology to advance your hub program will require a significant investment of time and money if you are to realize value. A hub/PAP CRM platform that can use data sources from everything from electronic health records (EHRs), payer systems, identity-proofing and billing and claims records to genomics data and Fitbits® can provide plenty of scale to support the customer engagement strategies devised by your best talent.

Tomorrow’s hub/PAP CRM platforms will reenvision the patient journey with efficiency and precision. The micro-segmentation of tasks will produce outcomes that inform downstream workflows and trigger parallel tasks. Better sensors will be embedded within more micro segments to identify bottlenecks, making it possible to isolate issues with pinpoint accuracy, thus enabling quicker diagnostics. And layered within these micro segmented journeys are more robust guiding elements and dynamic business logic to orchestrate tasks more deeply and to guide the agent more fully.

Sensors will also serve a dual purpose of monitoring an agent’s time and motion to provide performance standards for each step in the process while also making it possible to measure the impacts of process changes in real time to increase productivity.

These early-warning buoys will help prevent the disruption and collateral damage that abandoned prescriptions can cause.

Arguably, the future state of hub/PAP CRM tech is not dissimilar to what some platforms have achieved today. The next generation of platforms emerging from the current nascent state will be far more intelligent and guided.

Full on in-source or shared delivery model?

Any proper hub/PAP CRM platform will require full interoperability with health information exchanges (HIEs), payers and EHR systems, to name a few. Pharma companies that elect to go it alone are likely opting out of many of these connections.

Given the limited data use rights and payer connections, pharma companies would be wise to consider contracting with hub vendors to perform payer sensitive front-end tasks of eligibility, coverage investigation and prior authorization.

The same can be said of PAPs, where eligibility determination may be a PAP vendor, in part to leverage payer connections and in part to maintain an arm’s length from the distribution of free goods.

Bridging applications or middleware will be required to enable live connections between the hub vendor and the pharma company’s hub CRM platform. These connections should exchange patient/task-specific progression, as well as overarching status indicators that, when triaged for follow-on work, will provide a stepwise access journey and next steps.

Keep in mind that this shared delivery strategy, by its very nature, will require that two operating systems function in parallel, as well as two distinct data warehouses being maintained by your hub vendor—one data warehouse containing contractually available patient data, and the other containing the restricted data to be used by the hub vendor to process the work and then destroy restricted data upon completion.

Whether you choose full-on insourcing or a shared delivery model, the speed of innovation will only accelerate. If you are evaluating the best path to move your hub/PAP CRM platform farther and faster toward tech transformation, then a hybrid approach is worth consideration.

The shared investment in talent, technology and time can reduce risk while helping your organization keep up with the pace of innovation.

Jim Banigan is Director of Patient Access Support HUB/PAP for Pharma and Life Sciences at Conduent, Inc. He can be reached at Jim.Banigan@Conduent.com.

Their promise is prompting pharma leaders to give their hub/PAP CRM platforms a closer look