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Patient Support Vendor Directory 2018

The year 2017 was another one with more launches of specialty pharmaceuticals than conventional mass-market ones, continuing the shift of the branded pharma industry into the branded specialty pharma one. This shift has been generating more and more business for outsourced hub and patient-support providers, many of whom report rapid staff increases and expansion. The field is becoming more crowded—and more competitive.

“Patient support” means many things to many people. On the other hand, “hub services” is sometimes restricted in meaning to only the steps taken to get a patient through the prior authorization (PA) process and line up reimbursement support.

 has espoused the “hub services” term to encompass the full range of services—usually funded directly or indirectly by pharma manufacturers—to assist getting patients on therapy, and keeping them adherent in disease states that require chronic care. Also called “wraparound services,” these include education and counseling of patients (and physicians in many cases); case management that provides a person at the other end of the phone line to handle patient queries; refill reminders and adherence programs; the data repository that brings patient data together from hospitals, clinics, labs and pharmacies; as well as the PA and reimbursement support. Some vendors also provide third-party logistics (3PL) services to expedite deliveries of drugs. The hub concept is critical to all of this—it’s the only way truly coordinated care can be achieved.

Historically, hub service originated with an earlier wave of (then) new biologics that required diagnostic tests and more complicated means of administration (such as infusion)—and were provided by the biotech companies themselves. In recent years and with the rise of specialty pharmaceuticals, hub services are applied to many therapy classes, and to the orphan drugs that target rare diseases. Some bioharma companies retain some or all of the patient support services even today; but the trend has been to engage with outsourced providers that specialize in the practice. Such service providers provide economies of scale, a more varied range of services, and a degree of assurance that the patient support does not violate regulatory standards for improper inducements.

“Different manufacturers have different philosophies when it comes to hub services,” observes Richard Whittington, director of marketing at TrialCard. “Some want a full spectrum of services at a one-stop shop; others want to pick and choose what they consider to be best of breed individual services.”

“Pharma companies spend a lot in their supply chain processes; that’s the world we’re focused on,” says 

, a recently established hub services provider. “There’s a lot of opportunity to lower these costs through efficient patient support services, and when those lower costs pass through to the patient, it means access to therapies increases.”

Patient support services have important implications not just for the pharma companies that sponsor them, but for payers and providers. “Patient support is and will be an important component of value-based contracts,” says Dominic Galante, chief medical officer with Precision for Value, referring to the novel practice of tying pharma reimbursement to the outcome of a therapeutic regimen. “Payers and providers want to be assured that their funds and human capital are being allocated with the right objectives in mind,” adds SVP Maureen Hennessey. “With patient support, this includes psychosocial issues like providing transportation or shelter needs for patients undergoing therapy.”

 Fig. 2. BioSolutia’s consultative approach to hub design illustrates the complexity of the service.[/caption]

One indicator of the vitality of the hub services business is the accelerated activity around the financing of these businesses; the market has attracted sizable interest from the private equity world. The most recent of these is the sale of Dohmen Life Sciences Services in February to two ventures, Water Street Healthcare Partners and JLL Partners, for an undisclosed price. Water Street in turn is melding DLSS with two market research and data firms, Alliance Life Sciences and Health Strategies Group, and a communications agency, Access Group. DLSS’s approach has been to assist manufacturers in both the clinical research and commercialization realms, an approach touted as “molecule to market.” Water Street’s announcement also mentioned that the firm has “$3 billion to invest in life sciences and service businesses.”

In the latter half of 2017, RxCrossroads, then a unit of CVS Health, was sold to McKesson, where it will be combined with McKesson’s Specialty Health Solutions unit. (McKesson will be announcing a reorganization of this unit later this year, with the pharma-facing services united as McKesson Manufacturer Solutions, according to Shawn Seamans, president of the unit.) and in the first half of last year, McKesson ponied up an eyepopping $1.1 billion for CoverMyMeds, a firm specializing in automating the prior authorization process (more about that later).

One “demerger,” so to speak, occurred last year when AmerisourceBergen acquired H. D. Smith, one of the last large drug distributors that was still private. H. D. Smith’s parent retained the Triplefin unit, which was the core of its hub services offering. Triplefin’s business had been growing over the past few years (Triplefin itself was a H. D. Smith acquisitions several years ago), and Tom Doyle, EVP of the unit, says that it intends to continue that growth.

Also last year, TrialCard recapitalized as one private equity firm backed out, and another, Odyssey Partners, came on board. TrialCard’s Whittington says that the larger financial base of Odyssey will translate into more investment in the firm.

Finally, the newest entry in this field is PharmaCord, which came into being last year, now has pharmacy licensing in place in all 50 states, and is about to begin managing its first pharma contract. PharmaCord’s Sahney has a long history in this field, having founded RxCrossroads in 2000, sold it to Omnicare where he eventually became president, and then left that company after it was acquired by CVS Health. He’s now reassembled some of the original RxCrossroads team.

All these firms—and others—compete in a space dominated by the specialty services operations of the big PBMs—Express Scripts’ Accredo Pharmacy and Curascript distribution services; Coram, CVS Health’s specialty infusion business; BriovaRx, now owned by OptumRx; and Walgreens Specialty Pharmacy. Lash Group, a business unit of AmerisourceBergen, is 

 unit has expanded into hub services. Something of an outlier is Covance, a contract research organization (CRO) but one that has a Market Access business unit for comprehensive hub services.

Accredo, Coram and other PBM-associated specialty pharmacies are big enough to justify their own inclusion in the limited-distribution networks set up by some pharma companies to dispense their products; these limited networks enable pharma companies to exert some control over how their drugs are dispensed and followed up with services. Independent specialty pharmacies represent another option. A recognized leader in this channel is Diplomat Pharmacy, which went through the exercise of setting up a hub service, Envoy Health, that is “firewalled” (Diplomat’s term) from the rest of the company. The firewall enables Diplomat to present an option to manufacturers that want to keep hub services separate from pharmacy-based services. And, in an action that certainly makes sense from the Diplomat perspective of providing comprehensive services, but which blurs the distinctions between trade channels, the company acquired two small PBMs last year, and so can be involved in price negotiations with pharma companies even while fulfilling prescriptions.

Other specialty pharmacies are big enough to offer an alternative distribution channel to manufacturers; Avella Pharmacy is often mentioned in this context. ExceleraRx is a network of academic medical centers (primarily) that enables manufacturers to tap into that hospital segment. Another network is Kloudscript, which says it has brought together the independent pharmacies of 500 communities across much of the continental US to provide specialty care, including hub services.

The hub provider business—and the nature of patient support and its relevance to various disease states—is such that manufacturers can choose what area of expertise or skill the service provider offers.

Ashfield Patient Services is an example of this. Alongside a substantial (and international) contract sales organization, Ashfield offers trained clinical educators in a variety of disease states. “Originally, this service was for educating physicians and their office managers on specialty pharmaceutical requirements,” says Nareda Mills, president of the unit. “now, our work is dominated by providing assistance to patients themselves, including visiting the patient’s home.” The company also maintains a sizable call center for telehealth services; and a significant part of the service is sustaining adherence programs to keep patients on therapy.

A recurring theme among hub providers is the ability to tailor an adherence program to the psychological profile of a patient—more services for those judged likely to drop off, less for highly motivated patients. Dropoffs can occur for financial reasons (raising the importance of reimbursement support), and for predictable side-effect occurrences. All this can be programmed into an adherence program. (Fig. 1)

Mills says “I guess so,” when asked whether Ashfield actually is a hub services provider, but notes that the company does not perform benefit investigations and provide reimbursement support for patients. “We are actively looking at an acquisition in that area, or to build our own expertise internally,” she says.

Coming from almost the other end of the spectrum, TrialCard started out with managing copay programs, has built out is range of hub services over the past couple years, and expects to intensify that with the backing of its new private-equity investor, Odyssey Partners. “Our reputation was built on our success in managing copay coupon programs, and the high quality of data reporting we were able to provide coming out of those programs,” says TrialCard’s Whittington. Scott Dulitz, SVP, corporate strategy at TrialCard, then picks up the thread. “Along the way, we learned that 50% of hub providers’ calls had to do with reimbursement, so it was a natural evolution for us to build on that interaction.”

Credit: CoverMyMeds" alignment="center"/>

Whittington and Dulitz tout the value of their proprietary relationship-management technology, a platform called QuickPath, which, while continuing the reporting and analytics of copay programs, integrates with the workflow of other participants in patient health. “We have an open-source platform, built on a Microsoft technology stack, and including reporting tools from MicroStrategy,” says Dulitz. The technology enables TrialCard to integrate with multiple electronic health-record (EHR) systems, now in wide use among healthcare providers, so that the patient journey can be tracked throughout all the treatment steps.

In a somewhat similar manner, TripleFin started out in patient assistance programs (which, among other things, arrange for drugs at no cost for indigent patients) and in pharma samples distributed to physicians’ offices, and has since grown to include a range of patient support functions. The company is notable for having trademarked the term “Hub Lite”—a reference to the ability of Triplefin and others to scale down a hub program to a lower-cost but sufficient option for drug programs that only need, say, a refill reminder program.

Another direction comes from the intense strategizing that goes into a well-run hub program. Jim Long, principal and cofounder of Biosolutia, cites his and his partners’ experience at prior companies (including PBMs, health plans and specialty pharmacies) that led to their initial work as consultants to the patient support field. “When we decided to operationalize our expertise and provide actual hub services, we put an emphasis on our consultative process,” he says.

This emphasis is so established the company has trademarked it as CSDS—the Commercialization Strategy Development System (see Fig. 2). It comprises five “P’s” (patient, provider, payer, pharmacy and pharma), and 15 “C’s”, ranging from “clinical care setting” to “collection of data.” Only by going through the analysis and agreeing on common, achievable goals, can a client and BioSolutia arrive at a meaningful program. (If nothing else, the 15 C’s show the complexity and multiplicity of factors that go into a comprehensive hub program.)

Yet another factor—one sure to start debates among competing hub providers—is the business foundation of the hub service. As indicated above, they range from extensions of a PBM (a business that is usually negotiating discounted drug prices with a manufacturer) to wholesaler-based entities (whose parents’ business is to take ownership of drugs, although that is almost never the case with a hub provider), to specialty-pharmacy based. That leaves the truly independent business, with no other ties, in a distinct position.

“What we offer is a 100% commitment to the manufacturer client,” says PharmaCord’s Sahney. Specifically, he says, the company won’t take on as clients competing products in the same drug class—something that PBMs and specialty pharmacies, by their very nature, usually do. “We not saying this is automatically better than our competitors, but we want to be clear that we’re offering an alternative to those models.” Sahney’s push for independence even goes as far as how the company is financed: “The private equity firms have a clock ticking on their investments; they want to see a return and eventually to sell the business,” he says. “We can afford to take a longer-term perspective.” (Sahney says that the firm is starting out with financing from himself and his executive-chairman partner.)

PharmaCord is not the only firm with no ties to another player in the pharmaceutical distribution world, and there are probably others that began with self-financing. The downside of being exclusive with one drug in one disease state, potentially, is that the company might be limited in its expertise across that disease state. Shawn Seamans, president of McKesson Manufacturer Solutions, cites the breadth of capabilities his business offers, as a component of McKesson, the biggest drug wholesaler in the US.

McKesson Manufacturer Solutions, besides now containing RxCrossroads, also has Biologics (an earlier patient support provider acquisition), a 3PL service, and McKesson Patient Relationship Solutions, a longstanding business that manages patient communications. Plus the unit has ties to US Oncology, a practice-management business for community oncologists, a similar offering for ophthalmology, and an infusion-services business.

And besides, says Seamans, “McKesson Specialty can create an exclusive launch package with various commercialization services (e.g., distribution, specialty pharmacy, awareness and education, market insights, etc.) for a brand in one therapy class, if the client so chooses. In cases where we are handling competing brands, the service teams are kept separate and there is no cross-communication. The advantage to working with us is the scale we can provide nationally, and the breadth we can create around a brand’s hub program.”

A key part of Cardinal Health Specialty Solutions was its acquisition of Sonexus several years ago; Sonexus’ management had a background in patient assistance programs and so-called “fast start” programs to get a drug to a patient even while PA and benefit verifications are progressing. Tara Herington, recently appointed vice president of the unit, touts the quality of customer service the company maintains. “Our case managers, besides the medical backgrounding they need, undergo a training program in customer service,” she notes. The program, called Traub Hospitality, comes from a training company that specializes in customer service programs for prestige consumer brands. Herington says that this commitment to customer service pays off in better interactions with the patients whose care is being managed by Cardinal.

While there are all these variations in how hub providers position themselves, a universal claim is made for top-notch IT platforms to manage patient cases effectively, while generating vital information for both payers (who are tracking the outcomes of drug therapies) and manufacturers, who use the information in aggregate to monitor their marketing efforts.

Every vendor contacted for this report touts their platform: Asembia has Asembia1; Cardinal has ConnectSource; TrialCard has QuickPath; CareMetx has CareMetx Connect; Triplefin’s is branded as Rx365; BioSolutia’s is branded as BOSS (BioSolutia Operations Support System—company president Jim Long says that the it had to fend off a claim from Bruce Springsteen to own the trademark!). The big distinction among these is whether the company chose to use an off-the-shelf system, or to build one from scratch.

At this time, the most cited common platform is SalesForce.com, which is used by Cardinal Health, ConvergeHealth (an IT business of Deloitte) and Accenture, among others. Last year, Cardinal completed an extensive rebuild of its platform, ConnectSource. ConnectSource was built as a tailored adaptation of Deloitte’s platform, PatientConnect, which is Deloitte’s own configuration of Salesforce.com.

Ashfield’s Nareda Mills says that the company is in the final throes of a multi-million-dollar investment in Salesforce Health Cloud, a version of Salesforce software tailored to the healthcare industry with important features such as HIPAA compliance. Accenture has also made use of SalesForce Health Cloud for its Intelligent Patient Platform.

Most of the other platforms are home-grown; and this off-the-shelf vs. custom dichotomy is a common one in the world of business IT, with deeply committed proponents on both sides. While the trend in business IT overall is toward single, commonly applied systems (think SAP for enterprise resource planning), the custom-software proponents argue that those systems are too rigid, too expensive, and fail to meet user needs adequately. On the common-platform side, proponents argue that custom software is always difficult to maintain, requires building (and rebuilding) interfaces to other systems, and locks clients (in this case, the pharma company recipients of output data) to the service provider. The longterm trend in business software is toward standardized platforms, but in a field like hub services, where conventional practices are still evolving, that standardization might be a long way off.

One area where software and data standardization are trending now is in prior authorization and the benefit investigation/verification process. A leading firm here is CoverMyMeds (now owned by McKesson), which says that it has linkages to 700,000 providers (physicians and their employers), 80% of payers, essentially all of the EHR systems in the country, and over 200 pharma brands. PA forms traditionally have been filled out in physicians’ offices and faxed to payers or PBMs; CoverMyMeds has automated part of that process by creating online forms to be filled out.

According to Erica Conroy, VP of operations, CoverMyMeds is funded by the payer community and the pharma manufacturers; the former benefit from the reduced workload and better accuracy of PA filings, and the latter from reducing the obstacles to getting a prescription approved and dispensed. “We like to work with pharma companies throughout a product’s life cycle; pharma companies have found that having accurate PA forms even helps product marketing after loss of exclusivity, by keeping that prescribing option in front of physicians.”

CoverMyMeds has just issued an annual “ePA Adoption Scorecard” that assesses trends in adopting digital PA processes in the US. Among the data cited in the report, 10% of all prescriptions are initially rejected at pharmacies, and of those two-thirds required a completed PA. A third of rejected prescriptions with a PA requirement wind up as abandoned prescriptions (and that’s where the PA process can hit pharma markets hard).

CoverMyMeds has worked with the National Council for Prescription Drug Programs (NCPDP, a professional standards-setting body) on an ePA standard; this, in turn, has been put into force in a number of states. (Since the pharmacy profession is regulated at the state level, there is no national standard to be imposed.) Interestingly, ePA varies not just by the payer, and by the drug involved, but also by the state where the prescription is to be dispensed (see Fig. 3). According to CoverMyMeds data, 50% of PAs are now being processed with automation, and increasingly, the PA process can be an interactive one with the payer, such that the PA is completed in real time.

CoverMyMeds is not the only organization that has sought to standardize and automate the PA process; Asembia makes PA processing a part of its service; other vendors include AssistRx and ZappRx. Asembia has an extensive network of specialty pharmacies that work with it, and so is able to bring uniformity to how PAs are handled by those partner pharmacies. In September, CoverMyMeds announced a similar undertaking, where approved PAs could then be routed to specialty pharmacies that could fill the prescription.

Patient support (hub) services rise in lockstep with specialty pharmaceutical launches

The Hub Services Wheel keeps Rolling Along

Twenty years ago, the notion of data collection and intelligence on the scale common today was nearly unheard of. Predictive and collaborative analytics are used across almost all industries to target marketing efforts that increase customer satisfaction and build brand loyalty. An estimated 150 million Americans turn to their phones for health information, using websites like Google that are able to store and analyze their search data. [1] The output is data-driven applications that recommend products or actions, customized to each individual consumer to enhance their user experience. At the same time, these practices encourage a continuous exchange of information—data that are more relevant and analytics that are more impactful.

The healthcare industry is driven by innovation. According to a Forbes report, healthcare companies dominate among the 25 most innovative companies. [2] However, its expansive size and stakeholders, as well as regulatory challenges, have often slowed the implementation of new technologies. Recently, we have seen changes in the industry as patient-support service providers are putting the same data-driven and personalized tactics leveraged by more consumer-facing industries into place. These enhanced services have the ability to improve quality of life through better patient outcomes.

These innovations are driving new solutions that promise a seamless and tailored omni-channel experience for patients; an automated, streamlined workflow for providers; and promotion of information exchange that keeps manufacturers informed about their product and its patient population’s needs. While data-driven design is transforming patient engagement, there is still an absence of accurate, comprehensive insights from across all touch points of a patient’s unique journey.

This is further complicated by the complexities associated with each disease state and each patient within a particular disease state. These unique aspects underscore the need for data driven programs that get to the heart of what a patient needs. Through a smart program design and the right digital solutions, manufacturers can use data-driven hub services to boost confidence in their product and its patient services.

Historically, patient support services program-design decisions relied largely on industry tribal knowledge and best practices learned from partners. Today, data analytics give manufacturers a more calculated approach that, as part of a multi-pronged plan, can inform patient support programs. Big data in healthcare is, in many cases, still chaotic. Unstructured and structured data sources must be combined in order to create a comprehensive view of the patient’s journey. The right patient services partner uses data analytics from multiple sources to identify unspoken patient and provider needs and pinpoint a targeted approach that enhances outcomes and optimizes program spend.

In a particular example, a program that had been in place for more than three years had an unusual and sudden spike in patient drop-off after the benefit verification process was completed. In analyzing the program data and reasons for drop-off, the patient-support services company noticed that physician withdrawals also spiked significantly during the same period. From there, a deeper segmentation and targeted analysis led to a recommended change in field strategy and provider and patient communications to reverse the emerging pattern. As a result, the manufacturer achieved a 10% reduction in physician withdrawals, many of whom had a high number of patients on that specific treatment. This recommendation, born from a collaborative and comprehensive approach, ultimately helped more patients start and stay on therapy.

Differentiating with collaborative analytics

The differentiating factor in this patient service design is collaborative analytics. Collaborative analytics brings together people, processes, data, and tools into one cohesive ecosystem that is enabled by technology and by an open, adaptive and knowledgeable culture.

Over the past decade, the healthcare industry has shifted away from broad, general programs that serve massive, large-volume product launches. Patient populations today are smaller, targeted and personalized. Increased nuance in the types of data manufacturers are able to obtain and leverage is critical to combatting the increased scrutiny that has come from how manufacturers engage with patients and providers throughout the product life cycle. For example, patient interactions with a nurse via a telehealth call can be proactively and collaboratively shared with the manufacturer team. Collaborative analytics affords manufacturers the ability to leverage the combined knowledge of their analysts and our patient support services analysts to generate deeper insights about smaller, more niche populations.

Recently, Lash Group executed a project to better understand the impact of patient-support program utilization on prescriber behavior, conversations with patients and adherence rates. We combined master data from the manufacturer with collaborative data available through a physician service organization, ION Solutions (a sister company to Lash Group), to analyze prescribing behavior and payer data, and to identify provider channel preferences. Ultimately, this collaboration allowed us to uncover a list of providers who were using the services and those who dropped off. These insights became the basis of an updated service program design, which shifted the mix of services to include the manufacturer sales representatives, ultimately improving the physician experience. After implementation, physician attrition slowed by 10%—a significant improvement.

We must not forget that the basis of these services is to work as a support system that ultimately optimizes patient outcomes and helps treat disease. Improved data connectivity and aggregation will benefit all stakeholders in the healthcare system, and patient support services are only one piece of the puzzle. The industry must work together to aggregate data across manufacturers, providers, patients and third-party partners. As the depth of predictive and collaborative analytics grow, strategic and targeted recommendations on how to optimize patient services will come to fruition.

“Reach the growing majority of healthcare seekers on smartphones” Accessed at: 

https://advertise.bingads.microsoft.com/en-us/insights/reach-the-growing-majority-of-healthcare-seekers-on-smartphones?lipi=urn%3Ali%3Apage%3Ad_flagship3_pulse_read%3Bam4%2FplwmRpiS1lu9CotffA%3D%3D

“Top 25 Most Innovative Companies” Accessed at: 

https://www.forbes.com/innovative-companies/list/#tab:rank

Shishir Desai is Sr. Director, Client Analytics at Lash Group, an AmerisourceBergen company.

Data drawn from collaborating sources can benefit the patient journey

Improving Patient Services and Outcomes with Data-Driven Design to Hub Services

“Patient centricity” has been a popular concept in the healthcare industry for years, but due to changing dynamics, today the patient is truly becoming the center of care. According to a 2016 study, “consumers now directly control $330 billion annually in out-of-pocket healthcare expenses, and the choices they make have the potential to affect 61% of all healthcare spending.” [1] At the same time, there is growing recognition that when patients are active in managing their own care, outcomes improve and costs decrease. [2] These trends, coupled with dramatic changes in technology, reimbursement and culture, are leading the industry to rewrite the role of the patient—and to significantly expand its focus on patient engagement.

Three key trends affecting the role of the patient:

The shift toward value-based reimbursement is driving greater focus on importance of patient outcomes. Physicians who participate in CMS quality payment programs like MIPS (Merit-based Incentive Payment System) will soon find that a portion of their payment will be based on the patient experience, which is leading to a more patient-centric approach to care.

For pharmaceutical manufacturers, there is increased pressure to demonstrate that new drugs can deliver meaningful outcomes. In some new contracts with payers, the cost of the drug will only be reimbursed if the patient responds positively to treatment and achieves defined clinical thresholds. As a result, providers and pharmaceutical companies are increasingly focused on ensuring that patients not only get access to therapy, but also take the right steps during the treatment journey to enable optimal outcomes.

Patients, increasingly engaged and informed, are playing a bigger role in making healthcare decisions and managing care than ever before. And because patients are also savvy consumers, they are seeking health solutions that are coordinated, convenient, customized, and accessible. Patients are using digital tools and technology to manage their well-being, and are starting to expect an “Amazon-like” customer experience when interacting with physicians, pharmacists and other healthcare service providers. According to industry research, 80% of internet users have researched health topics online and 32% post about the health experiences of family and friends on social media. [3] In this environment, healthcare stakeholders need to be prepared to engage patients using the digital tools patients prefer and deliver experiences that are on-par with leading consumer brands.

Apps, wearable medical devices, home monitoring devices and even traceable medicines are playing a growing role in how patients manage their health. In addition to making disease management easier, they can also provide meaningful insights into patient journey. This rapidly growing collection of Internet-connected devices has the potential to connect patients, physicians, pharmacists and other care providers in ways that would have once seemed impossible. To date, adoption of wearables and other monitoring technology has been highest among young, healthy patients who are focused on fitness. It is unclear whether those who are managing diseases or struggling with complex health issues will embrace it with the same enthusiasm. Persuading the right patients to use these tools is the key to making the data meaningful.

The movement toward patient centricity, fueled by value-based care, consumerism and digital medicine, is impacting every aspect of healthcare. Hospital systems, which are increasingly competing for patients in complex specialty areas like oncology and neurology, are investing in improving their patient experience in the hopes of becoming a treatment center of choice. Physicians are increasingly focused on collecting and analyzing patient data so they better understand the outcomes patients are experiencing and use those insights to improve their clinical decision making.

Drug developers also want to build deeper relationships with patients so they can facilitate easier access to their products, drive medication adherence, and help improve outcomes. And patients are looking for more support from drug companies. Research among patients shows that 76% expect pharma manufacturers to provide them with tools and support services [4] and physicians believe these programs can help improve outcomes. [5] However, despite the growing availability of patient data, pharma companies often lack access to the information they need to fully understand the patient journey and support patients along the way.

Pharma has historically had little direct interaction with patients, typically relying on information provided by other stakeholders, such as providers, pharmacists and payers. In a patient study, Deloitte found that only 19% of patients report being aware of the services provided to them by the manufacturer of their prescription medication.

“For a long time, we have talked about who ‘owns’ the patient, which is a very paternalistic way to view health care,” said Chris Zant, principal, Deloitte Consulting, LLP. “Instead, the pharmaceutical industry needs to talk about how we collaborate to support the patient, and new digital health platforms actually enable us for the first time to make that a reality.”

For pharmaceutical companies, the answer to two key questions “How do I better understand my patient’s journey?” and “How do engage my patient in a deeper relationship with my brand?” can often be found in their patient services hub. Because hubs interact with and gather data from patients, providers and payers all at the same time, they can be ideal sources of data—and some hubs are investing in tools to help their pharma partners harness this data. The challenge is aligning pharma’s needs with the right hub services, technology and team.

“Driving value for patients requires end-to-end visibility into the patient journey.” said Dave Rosner, principal, Deloitte Consulting, LLP. “This is particularly challenging for pharmaceutical companies in the specialty segment. Hub services companies are uniquely positioned to help specialty pharma bridge that gap and improve outcomes by using digital tools to facilitate interaction between the company and the patient.”

Below are a few recommendations for optimizing patient engagement using hub services:

When evaluating how to use hub data to deepen patient engagement, pharma companies should start with their objectives. Are they hoping to improve access to their product? Drive adherence? Do they plan to use patient data to enhance their reimbursement strategy? Support future regulatory filings? Refine commercialization efforts? Defining objectives will allow drug companies to determine what data they need and whether their hub has the systems in place to achieve the goals.

Understanding the current gaps in the patient experience and how to fill them is another critical step. Are patients facing long delays in starting therapy because of a slow prior authorization process? Are patients falling off therapy at the same point in the treatment regimen—and if so, could more frequent touchpoints help improve adherence? Pharma companies should also look beyond clinical care when considering the patient experience. For example, could providing caregiver support programs or assistance with transportation help to improve the patient’s quality of life? Having visibility in the patient experience is critical to understanding how a pharma company can deepen engagement.

A clear understanding of the reimbursement landscape can help to determine what type of support patients will need. Will most patients be on government or exchange-based systems, or private insurance? Will a prior authorization be required? Will the drug be a 3rd or 4th line therapy? Will a significant portion of patients be uninsured? Will co-payments be a barrier for patients? Payers are constantly evolving their approaches to specialty medicines, so being nimble when designing assistance programs for patients is advised.

The ability to harness meaningful data and insights through the hub will ultimately enable the pharmaceutical industry to deliver better patient programs, which will result in better patient outcomes. And while these patient-centric programs are particularly relevant for specialty drugs today, in the near future, manufacturers of nearly all prescription products will need to adopt an increasingly patient-oriented approach.

https://healthcare.mckinsey.com/enabling-healthcare-consumerism

https://www.healthaffairs.org/do/10.1377/hpb20130214.898775/full/

https://getreferralmd.com/2017/01/30-facts-statistics-on-social-media-and-healthcare/

https://healthitanalytics.com/features/explaining-the-basics-of-the-internet-of-things-for-healthcare

Oncology Insights, June 2017, Cardinal Health Specialty Solutions.

Jennifer Fillman is VP/General Manager, Cardinal Health Specialty Solutions.

Hub services enhance relationships with patients

Patient centricity and the growing role of hub services

 readers with long memories might recall a cover-story interview with Nitin Sahney, then COO of Omnicare and the Omnicare Specialty Care Group, in 2013. Omnicare was acquired by CVS Health in 2015, and Mr. Sahney chose not to go along with the acquisition. After spending some time consulting and working with private equity groups, he has jumped back into the fray with PharmaCord, a patient support and hub services provider, which opened its doors in early 2017 and, as of today, has a team in place, pharmacy licenses in 50 states, and the first few manufacturer clients.

You’ve got a long history in the patient support field; tell us about it.

One of my earliest jobs was as a reimbursement specialist at Caremark in the 1980s. In 1993, I was recruited by Cardinal Health to help build a pharma portal business unit called Nexus Health. At the time Nexus was a small part of a $2-billion company; by 2000, it was an even smaller part of a $60-billion company. While the business I was running had tremendous potential, Cardinal was going in a different direction. At the time, the first few specialty products like human growth hormone and multiple sclerosis drugs, were coming on the market, and they needed reimbursement support, special handling and other complications. I left Cardinal at the end of 2000 and started RxCrossroads in 2001 to meet that need.

As president of the Specialty Care group, and between then and 2015, grew the business unit from $600 million to $2.4 billion. In 2015, CVS Health came knocking. Over these years the patient support space has grown and become very competitive, with the big PBMs and big wholesalers all jumping in. I still had the entrepreneurial drive and chose not to continue with CVS Health.

Now, with PharmaCord, I and my team—many of whom have been with me since the RxCrossroads days—have a blank slate to address patient support the way I believe it should be done. I feel passionate about this space.

What will make PharmaCord different from its competitors?

After leaving CVS Health, I’ve spent a good bit of time talking with people in the industry, and with manufacturers. Although there are many players in this space, my opinion is that they present limited options to manufacturers. Our approach is very straightforward: First, my partner and I own the company—there is no outside capital. That means that we will not be beholden to private equity investors, and can grow at our own pace. Second, we will serve manufacturer clients exclusively in the various disease states. The big PBMs and wholesaler-operated hub services are set up to handle competing products; we believe our clients are better served with exclusive arrangements. Third, we’ve built our company foundation to enable it to scale up and serve major products from top pharma companies; some of our competitors are well positioned to handle orphan drugs (which we plan to do as well) with limited patient populations—but scale up poorly. Finally, we have an experienced team with a proven track record; this is a business where it’s easy to perform poorly and we don’t plan to do that.

These characteristics are what differentiates us. At the same time, we will provide many of the standard hub services: a closed-door pharmacy from which we will deliver prescriptions daily; benefit investigation and verification; free drug and fast-start programs; copay coupons; and adherence programs. An intriguing possibility is to combine our IT capabilities with our patient engagement—it should be possible to service some patients, or some programs, with automated systems that lower costs to the manufacturer. We will not provide 3PL (third-party logistics) services; there are plenty of 3PL providers we can work with, and we don’t need to re-invent the wheel.

To sum up, I like to say that “We’re built to scale, and we’re not for sale.”

Isn’t scale simply a matter of how large the company’s call center and case management staff is?

First of all, I think everyone in this business needs to give better recognition to their case managers, because that’s where the high-quality patient service happens. In any case, we currently have capacity for 250 case managers, and are able to double that when business volume justifies it. While we’re currently in offices in downtown Louisville, KY, our plan is to build our own campus in the future.

But the key factor in being able to scale is to have the IT system that allows it to happen. We’ve invested millions in a proprietary It system, and it’s designed to address some of the current limitations in this field. Being able to aggregate and report data is critical. Many of the systems in the market today were built several years ago, and in my opinion, are not built for real-time reporting, and do no scale up easily. We’ve addressed both of those concerns; in addition, the system enables connectivity to obtain data from hospital electronic health systems, pharmacy automation systems and other sources. It is tailored to the workflow of our internal operations, and the reporting requirements of pharma clients.

Pharma clients will be able to get reporting, in near real time, of prescriptions and patient status, broken down by ZIP code or sales territory, and perform analytics on that data. And as the system is cloud-based, clients will be able to access data, based on permissions, with their smartphone or mobile device.

What do you see down the road for hub services?

In terms of the drug pipeline, we see lots of opportunity in coming years. Large-molecule biologics will continue to be introduced; biosimilars are coming along, as are orphan and ultra-orphan drugs. The major obstacle the entire industry is dealing with is connectivity—getting patient information to and from hospitals, pharmacies, payers, manufacturers and patients. That is the crucial role of hub services going forward. We all need better cost efficiency in delivering drug therapies to patients; lower cost will enable better patient access.

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A Conversation with Nitin Sahney, PharmaCord