Patients is a Virtue

Providers of patient service solutions for pharma companies share insights on the nuances of the "consumer" connection and the shifts taking place in making patient-centric programs and tools more alive for patients

Who better to talk patient centricity in pharma than with experts at patient services providers? In this article, we speak to professionals from EVERSANA, Cardinal Health, ICON, IQVIA, McKesson, and PharmaCord that have been offering solutions for pharma to deliver to patients for many years. Here, they offer their take on the shifts that are bringing these programs more alive for patients. From new ways to target patient populations, to new approaches for training and customized programs for brands, understanding patients’ needs is at the forefront of the providers’ focus. 

When speaking about patient services on the commercial side of pharma, the discussion is around hubs or specialty pharmacy services for patients. From pre-authorization services, to co-pay advice, medication questions, and more, traditional hubs are call centers that can handle a speed up the process of getting patients on medications post-prescription. Those were, again, traditionally set up for large-population, blockbuster drugs with a competitive treatment landscape. Alleviating the burden on both the physician and the patient in regard to the supply chain remains the ultimate goal.

But with personalized and precision medicine, the landscape has shifted and now includes small patient populations prescribed a complex therapy, which may be very expensive with very few suppliers. 

Then factoring in social media and the internet, where there is information overload, exponential opportunities for patients to find and interact with each other, and a growing influence of a “consumer” mindset on the “patient” experience, this is where we find the patient services industry today.

David Hileman, chief operating officer of patient services provider PharmaCord, says there is a definite evolution in trying to deliver existing patient services, shifting from what has become a commoditized approach

David Hileman

to a more tailored, individualized approach. Hileman says that when PharmaCord was launched in January 2017, its intent was to take advantage of newer technologies, as well as a broad spectrum of talent and experience, and apply them to the traditional way of conducting patient services. Hileman himself has been in the industry for over 20 years and has seen the patient-centric movement take shape.

“Today, the [patient] engagement aspect starts with technology," he says. "How do we on behalf of our manufacturing partners engage with the patient population and how do we configure our tools and services to meet the patients where they are? For example, we know that millennials access information differently than other patient populations, so we’ve decided to use technology to structure that connectivity and pull data from different places, so we know where the patients are on their journey.”

Further, Hileman noted that many manufacturers are seeking providers who bring forward new approaches rather than focusing on task execution.  They are looking for partners to help with the development of solutions. “We are taking a much more consultative approach with them to leverage expertise for the best solution in design, development, and deployment,” says Hileman. 

Matt McCarty, global head of patient engagement commercialization and outcomes at ICON, noted that patients are increasingly using digital and social media as part of their consumer behaviour in other areas of their lives and expecting a similar quality of experience, convenience, and digital enablement in their healthcare.

Matt McCarty

 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.

While the internet and digital influence on consumers cannot be understated, another important trend is an increase in patient involvement in their own health or conditions. Tara Herington, vice president, Cardinal Health Sonexus™Access and Patient Support, says that patients’ needs have definitely shifted over the years. “As they take on a greater financial responsibility for their drugs, they are asking more questions and demanding more information,” she tells Pharm Exec.

This, in turn, has influenced how Herington's company interacts with and incorporates patients into its practices. Examples include town halls that include patient speakers who share their stories living with chronic or terminal diseases, which Herington calls “powerful.” She says, “They tell us how their medications and the patient services support make a positive impact on their lives; that keeps our vision in line with the patient.”

More recently, Herington says her company changed the name of the “call center” to a “patient engagement

Tara Herington

center.” Sonexus regularly, in a de-identified way, shares insights learned from patients and providers to offer a deeper view into the patient journey for manufacturers. This includes things like pinpointing why uptake may be decreasing due to patient transportation difficulties, to patient comments regarding a media story. This information, says Herington, is qualitative. Sonexus is also beginning to use a quantitative process-natural language processing-that can go through thousands of call recordings to glean insights for brand teams. 

Sonexus has also incorporated more of the “consumer” touch in approaching patients on the other side of the phone through its training. For that, Sonexus' engagement employees have been trained with programs developed by Zappos and former Ritz-Carlton trainers. Herington says their “white glove experience” approach to customers translates very well to what patients expect from service interactions today. 

Similarly, Kathi Henson, chief patient service officer at EVERSANA, notes that her company regularly incorporate what its employees are hearing from patients into insights for their Patient Conversation Workshops. These insights translate into tweaks and fixes into current patient programs, such as frequency in contact or additional education. 

EVERSANA, like the other patient services providers, offer customizable programs that transcend large populations in chronic disease states, to smaller rare diseases. “We have definitely seen a lot of energy around rare diseases," says Henson. "For the patients, we seek to understand the smaller populations and their needs. We have found that the reimbursement side is one of the most challenging for them.”

Kathi Henson

Another challenge, notes Henson, is that in some of these smaller populations, these therapies provide treatments where none had existed before.  For example, for some metabolic diseases, where prognosis in infancy was grave, these advances and treatments have led to patients living relatively normal lives into adulthood.

“This presents a whole set of new patient services as you transition from childhood to adulthood. Mom and dad took care of you and now you are going off to college and this is a huge transition for them emotionally, as well as from a financial or reimbursement standpoint," says Henson. "And comorbidities that come along as they get older-how do we direct them to the best services? Not to mention the adherence issue. If the parents were making sure their kids take the medicine, what happens when they are on their own? They need support in many areas. In building a best-in-class care team, we recognize that each patient is unique in order to provide value across the patient lifecycle.” 

Support around the patient

Hileman says, “You have to meet the patient where they are and that evolves over time.” He used epilepsy as an example, where nearly 500,000 children have the active form of the disorder. 

Devon Womack

Devon Womack, VP of sales and customer engagement for RxCrossroads by McKesson, says patient interactions, especially in the chronic disease space, as expected, can last for years. Patients with chronic diseases not only need support in navigating initial insurance coverage and co-payment support, but with ongoing adherence management as well. Where support services become increasingly helpful for the chronic disease population is when patients change insurance, or another round of verification is required, or they reach insurance caps and need financial guidance.

In the future, Womack sees the need to meet these patients not only where they are in their treatment journey, but in the way they choose to interact with access, adherence, and affordability programs along that journey through technology or contact center support. “We are seeing a rise in requests for online services,” says Womack. “We think it’s because patients are more comfortable online, but they are asking for more virtual support.” Think telemedicine, where nurses can describe or instruct over the web how to use an injector or inhaler to patients or caregivers. Womack says those services, too, are tailored to the patient population.

“Patients in their 30s or 40s, who don’t have the time to wait for an in-home visit, are very likely candidates for virtual services," she says. "Also, caregivers or parents. We see an increase for online instructors where it makes sense."

Heather Gagnier, senior director, offer development, patient engagement at IQVIA, observes that many patients today are on information overload and require advanced engagement programs to gain access to therapy and remain on therapy. “Technology or digital approaches alone do not engage and motivate patients," she says. "A

Heather Gagnier

combination of personal interactions and digital approaches provide patients with the best possible support and drive better patient outcomes. The most successful patient support solutions are a combination of multiple services and offerings that the patient can customize to create a personalized continuum of services.”

And while keeping in mind that technology alone may not be a motivator, Gagnier notes that more patients are embracing technology and are expecting more interactive, mobile health tools to help manage their disease. “We design our technology tools to reduce barriers to adoption for patients," she says. "This is a critical guiding principle as we engage with our clients on the development of new solutions.”

Support for pharma

For ICON, part of its role is to consult and inform manufacturers on how to better structure and initiate patient-facing programs. Kelly Franchetti, RN, CCRN, VP of global patient insights and engagement at ICON, says, “We work with the manufacturers to discover what works for their company and how to navigate the patient voice and within patient advocacy.”

Kelly Franchetti

For years, the assumption has been that in order to develop successful branding and advertising strategies, marketers only need to engage in creative concept testing via traditional market research. Whether through surveys or focus groups, the belief was show potential consumers the imagery/concepts and get their reactions. This assumption is built on the belief that marketers already understand the consumer (in this case a patient) and can identify what will resonate and motivate them. In recent years, it has become clear that developing branding and advertising strategies for consumer products is not the same as developing one for the pharmaceutical industry. As a result, more and more companies have begun to recognize the value of engaging directly with patients and including the patient voice as the foundation of a successful brand strategy. 

Change is slow and not all companies recognize the importance of developing and nurturing high-value advocacy relationships on the commercial side. For many, patient advocacy and patient engagement are seen as a means to an end or a way to quickly access and leverage a database of patients. However, to truly understand the value of direct patient engagement and advocacy, companies need to take the time to understand how to grow successful, mutually beneficial relationships.

Gretchen Goller

Gretchen Goller, global head of patient recruitment with ICON, says that while pharma companies are increasingly putting the title of chief patient officer on their payroll, it may still only be a transactional motivation. “What they need would be an entire group of people that involve the patient every step of the way," she says. "They could grow that role into a department, and that’s what they look to us for.” 

In Franchetti’s experience, many times her team is brought in in to “sell the concept up” to the C-suite. “For example, in medical affairs, they see the need to bring the patient-centric concept in because they see the benefit," she says. "They want to get the buy-in from their senior and executive leadership to adopt it.” Goller agreed that patient centricity needs to start at the top. 

Where they do see successes in breaking down the silos that exist in large pharma, and in regard to patient-centric initiatives, is in the rare disease space. “Those companies really are driving the industry with their patients and family relationships on the clinical side, and the ability to leverage that transition to the commercial side,” says Franchetti.

The pharma industry is largely made up of internal silos where the clinical teams are firewalled from the commercial teams. In order to create effective change, the two sides need to share insights. A patient who enrolls in a clinical trial will be a consumer of the drug post-approval. Why not share the information internally, rather than have each team reinvent the wheel and lose time later.

Lisa Henderson is Editor-in-Chief of Pharm Exec. She can be reached at lisa.henderson@ubm.com. Follow Lisa on Twitter: @trialsonline