Every brand faces opportunities and challenges—a unique set of circumstances that creates the brand’s biosphere. Based on the multitude of factors creating the brand’s biosphere, brand teams may choose different levers to add value to patients and caregivers, healthcare providers, and other influential stakeholders. These factors include:
- Patient Profiles: What are the specific characteristics and needs of patients based on their demographics, symptoms, and needs?
- Disease Characteristics: What are the aspects of the disease or the treatment of the disease that make it unique? Acute or chronic illness, rare vs. prevalent conditions, etc., and how does this impact the needs of customers?
- Product Differentiation: What is the product profile and how do our customers see us differently from other treatment options? How competitive is the marketplace?
- Patient Journey: How do patients receive care today? Where in the patient journey are needs that cannot be addressed through traditional means?
- Decision Makers and Influencers: Who are the stakeholders involved—patients, caregivers, healthcare providers (HCPs), payers, specialty pharmacies, employers, advocacy groups, etc.? Does one stakeholder carry a disproportionate burden?
- Buying Process: What challenges or opportunities exist in the buying process. How can payer/reimbursement channels and distribution models be optimized?
- Company Capabilities: What are the organizational expertise, commitment, and core competencies?
Cost of Entry Rises For Support Services
The bar is becoming ever higher in terms of wrap-around services to drive value for customers and differentiate brands from the competition. Offerings to improve access, such as co-pay cards, reimbursement hotlines, and insurance verification services are relatively standard across the industry. Services to streamline fulfillment—starter kits and direct-to-patient shipping—are also common in rare diseases/specialty markets. Even education, appointment support tools and patient-physician discussion guides have become cornerstone tactics to drive patient adherence. However, there is still room to improve on many of these, by making the services easier for patients to find, understand, and learn how to apply for them.
Due to concerns of quid pro quo, physician-oriented services have been slower to gain broad traction, although here too, some customary offerings around physician and nurse education and coding/billing assistance in specialty markets are available. Increasingly, the lines are blurring between patient and physician services. For example, support tools are needed to monitor and drive patient adherence and to provide those insights to HCPs to help them better manage the patient.
Services Must Address Clearly Defined Objectives
To effectively develop value-added services, one must deeply understand customer needs and define services that truly address them. The needs are defined by the product biosphere, but the brand team will determine how to provide incremental value to the customers. Some of the more innovative services we’ve seen emerging are described below.
1. Mobile Pharmacies
These technology platforms connect patients to their pharmacies via apps to manage fills/refills and track medical prescription expenses—a real value-add for multi-therapy patients or families. Companies such as mScripts and ZappRx represent an opportunity for medication delivery at great convenience and ease to both the patient and the pharmacy. Partnered with national chains, health systems, and specialty pharmacies, mScripts also connects patients to educational videos, dosage reminders, surveys, and financial assistance. ZappRx, funded in part by the corporate venture arm of GSK, aims to streamline the refill prescription process for specialty medications, which is often cumbersome for patients with rare diseases.
2. Remote monitoring
Leveraging the Internet of Things, numerous services are emerging to help HCPs and caregivers manage patients remotely. This includes monitoring activities, treatments, symptoms, and outcomes through a number of different avenues. Bayer and Biogen have both partnered with Fitbit to offer activity trackers in Pulmonary Arterial Hypertension (PAH) and Multiple Sclerosis (MS), to motivate patients to be more active, provide HCPs with access to patients’ daily trend data, and to conduct studies that link activity to patient outcomes. Dexcom and Google have partnered in the development of smaller continuous glucose monitors (CGM) that can be flexible, disposable, and low-cost for diabetes patients. This next-generation monitor will likely communicate with a smartphone app to make glucose monitoring more user-friendly.
3. Personalized Treatment Plans
Predictive analytics tools can help physicians risk-stratify patients based on their likely adherence/persistence to therapy and develop individualized intervention strategies. Companies such as AllazoHealth and GNS Healthcare leverage EMR records, lab, and claim data to identify predictors for drug initiation, persistence and switching, and better match treatment plans and intervention strategies for specific patient populations.
4. Patient Transitions
Following a highly complex and often times very costly surgery, such as a total knee arthroplasty, a patient may incur incremental costs due to a re-admission or a less than optimal outcome requiring a revision. The Z23 Outpatient Knee Program provided by Zimmer creates a wrap-around treatment protocol that addresses many stakeholders and leverages proven approaches to engage patients and providers around a product-specific solution and process. This process not only improves the quality of the product offered but it also inherently expands the market by creating treatment opportunities for a broader range of patients.
5. Smart Product Packaging
Boehringer Ingelheim, in partnership with AdhereTech, uses smart pill bottles to monitor patient adherence to therapy, and then supplies personalized interventions via case managers to understand and overcome barriers to adherence. If a dose is missed, text or phone call reminders are delivered in real time to get patients back on track. This technology is also fueling clinical trial design and refining assessment of outcomes based on actual therapy.
6. Caregiver Collaboration Tools
“It takes a village,” applies more and more to the need for care provided to family and loved ones. Companies such as Janssen with their Care4Today app and Medisafe offer the ability to provide insight into patient behaviors and therapy adherence to multiple stakeholders in real time. Patients can upload their specific regimen (medication, dosage, frequency) and sync family members, friends and/or caregivers to send push notifications when doses are missed. Medisafe has been shown to increase adherence rates by 26% compared to general medication rates for long-term therapies.
7. Teletherapy and Telehealth
With more people living longer with chronic illnesses including cancer, and as more patients suffer from degenerative diseases, one burgeoning area is around therapy services. Companies such as Talkspace, Betterhealth and Lantern offer teletherapy through multiple digital channels to support patients dealing with illness. Through text, audio, and video messaging, patients can be paired with therapists in real time. Additionally, Teva has invested in telehealth company American Well to connect patients with doctors for live, on-demand video visits via mobile or Internet. This will allow physicians to reach their patients more efficiently and collaborate with other providers to provide a higher quality of care.
8. Case Managers
While case managers have become standard fare in some therapeutic areas, such as PAH, they are relatively nascent in other disease states. Case manager portals simplify the process for HCPs to stay current with patient paperwork and coverage status, and proactively alert them to any action necessary to ensure uninterrupted access. Companies such as Celgene, Shire, and Vertex are offering these services or in some cases partnering with Access Solutions to provide this support.
9. Virtual Communities
Most pharma companies have largely overcome social media hurdles, and we see organizations such as Novartis building online communities for Cystic Fibrosis patients and Biogen for MS patients. As they become more common, these communities can differentiate brands by offering personalized support, including: One-on-one interactions with nurse educators and support coordinators; activity trackers and apps that capture and communicate mood; energy and memory levels, and symptom progression to care teams; and proactive, personalized communications around local events and lifestyle tips. Patients are looking for community-based health information in places like Google Hangouts, while products like Shire’s Firazyr use social media updates and blogs to bring patients back to the community for frequent updates.
10. Operations Services
Medtronic has begun to expand its offerings beyond medical devices into hospital management. Medtronic Hospital Solutions (MHS) provides operational efficiency services, such as catheterization laboratory management. MHS provides the latest medical technology and infrastructure, optimizes laboratory operations, and develops the local cardiac services market. Initiatives such as these enhance a company’s presence in a disease area, increase operational efficiency, and create a rich stream of data to analyze and identify cost concerns or unmet patient needs.
Measuring Incremental Value
Measurement is an art, not a science and can be a big hurdle for evidence-based pharma companies to overcome. The benefits that these or other services can bring to patients, HCPs, and other stakeholders will vary based on the brand’s biosphere. The value that offering these services can bring to your organization will depend on your strategy and your organizational ability to execute. Understanding how to appropriately measure the impact of any value-add services is as big a challenge in determining which services to offer in the first place. The key is to link back to your strategic objectives and develop composite metrics that consider both activity and impact, and to evaluate how these services are advancing you towards your goals.
Navigant staff contributors: Marie Cassese, Travis Helm, Julia Mahieu, Sha Sha, Elena Stavrakas, Martin Trautmann, Todd Waldman, Sebastian Wegieleswki