In the last edition of PM360’s eNewsletter Panorama, Steve Mink of McKesson Specialty Health kicked off a three-part series on removing silos to integrating comprehensive hub services and adherence support for the creation of a single brand and patient experience. Part One focused on leveraging end-to-end reimbursement services to accelerate the appropriate access to therapy for patients.
Part Two builds on that foundation, expanding from access to overcoming multi-faceted barriers patients face once on therapy, including those that are operational, financial, behavioral, and clinical in nature.
Reimbursement Access is Just the Beginning
With the cost and complexity of specialty drugs, access is only the first step to impacting patient adherence and health outcomes. Hub services continue to evolve and help patients overcome operational barriers with brands wanting to consolidate services under one umbrella, provide integrated data, and create a seamless patient experience that supports adherence and reduce abandonment.
Financial barriers are vast as out-of-pocket costs increase. Despite the fact that their overall health and survival may be dependent on adhering to their treatment regimen, patients are often forced to make life and death choices. Leveraging a hub with integrated copay programs can help to overcome these financial barriers as well, highlighting program benefits and integrating patient support. However, at the end of the day, price is only a piece of the adherence equation. Simply addressing out-of-pocket costs is frequently not the only solution needed to help remove adherence barriers.
Brands benefit from supporting patients throughout their therapeutic journey, starting with access and minimizing financial barriers. From there, they build relationships with patients to delve deeper into behavioral barriers, which can often be complicated, deeper rooted, and more difficult to ascertain.
While cost and access will almost always play some role in medication decisions, patients frequently face multiple barriers that impact adherence and outcomes. Comprehensive programs also address behavioral barriers, such as medication concerns, low self-efficacy, or perceived importance. Brands can leverage copay utilization data and validated segmentation tools to offer personalized support.
Behavioral coaching encourages a two-way, patient-led conversation to uncover barriers to adherence, express empathy, and offer personal support to maximize adherence. Results demonstrate that frequent, personalized interactions with patients create opportunities to reinforce messages about adherence and allow patients to take an active role in managing their own healthcare. By using behavioral-based techniques, trained agents can help deliver impactful conversations with patients.
Integrating Coaching Across Delivery Channels
Behavioral conversations are designed to “meet the patient where they are.” This not only refers to where patients are along their treatment journey, but also the channels through which patients can be coached. Patients can be touched across multiple channels to enhance the overall patient experience and outcomes. Coaching can be conducted face to face in the pharmacy, in-home, and via phone by trained contact center agents.
Research shows that coaching patients can improve health behavior, self-efficacy, and health status, especially within more vulnerable populations. These coaching sessions can increase patients’ understanding of their disease and the role and function of their medication, leading to support skill development over time and increasing medication adherence.1 For example, the glaucoma patient population is primarily elderly, and patients are often not knowledgeable about the progression of disease or how the medications work to lower eye pressure. Cost is often a barrier, so patients typically weigh their perceived “need” for the medication when they decide whether to fill their prescription. Additionally, dexterity challenges with administering the drops lead to over and underuse. Pharmacy-based coaching of these patients resulted in a 33% increase in adherence compared to a control group that did not receive coaching, as measured through McKesson’s pharmacy dispensing data.
A phone coaching example can be found within diabetes. The life of a diabetic patient is a juggling act to maintain glycemic control: Blood-glucose testing, exercise, and diet. Many type 2 diabetics struggle with the condition from the point of diagnosis, and consequently have feelings of failure if they progress to an insulin-dependent state. Everyday decisions can be complex, often leading to feelings of being overwhelmed and even giving up. These issues create multiple challenges to medication adherence, and ultimately, disease and blood-glucose management. Phone support increased adherence through supporting individual patient needs. Results demonstrated that patients who were coached were 25% more adherent to therapy vs. control during a nine-month study. This 25% increase in adherence translated to an increased length of time on therapy of nearly 31 days (Symphony Health Analytics, 2016).
Additionally, McKesson’s U.K. division, Celesio recently completed a pilot program supporting more than 200 diabetes patients. The six-month program on behalf of manufacturer MSD, included in-home support through the deployment of out-bound calls and texts from pharmacists for ongoing education and adherence support. Results showed that patients enrolled with the lowest rate of adherence ended the pilot with the highest overall adherence, an improvement of more than 61%.
To effectively combat non-adherence, the pharmaceutical industry must explore patient-centric approaches that increase adherence rates and improve patient quality of life. However, these approaches take longer term investments and time, as do building relationships within our own lives. Leveraging behavioral coaching across a breadth of delivery channels, including face-to-face adherence coaching, hub services, and phone coaching, allows brands to support patients in overcoming operational, financial, and behavioral barriers to adherence.
Evolution of E-services
The final article in this series will discuss the evolution of e-services and how digital capabilities can help improve the speed, cost, and accuracy of reimbursement access services.
- (Aust Health Rev. 2013 Jun;37(3):381-8).