Most of the time, when you think about patient support programs (PSPs) you think of financial assistance programs. But in reality, patients want more than that. In fact, in a survey conducted by Health Perspectives Group and presented at eyeforpharma Philadelphia 2018, patients actually rated financial assistance as the eighth most beneficial aspect of programs they have participated in after such things as peer-to-peer mentor programs, apps/tools to manage diseases, online health communities, and one-to-one education programs. So, PM360 asked 11 experts:
- What services do patients find to be most beneficial from pharma beyond financial support?
- How do you determine what are the best services to offer patients?
- How do you move programs through the MLR review process faster so they are still relevant to patients when they come out?
- What qualities do the best PSPs have? What is lacking from current programs?
- How should you measure the success of PSPs?
When it comes to patient services, the thing that patients desire the most is individualized support. This requires a thoughtful approach to program design and vendor partner selection. I firmly believe you “get what you give,” and for me, authentic patient engagement has to start with listening to patients to gain their perspective and getting a full understanding of their needs. Once you have done that, then you can build flexible solutions that are meaningful and actionable to the patients you seek to support.
The Problem with Most Patient Support Programs
Too often vendors offer standardized platforms and programs that are not capable of meeting patients on their terms. Not only is each disease unique—each patient’s journey is unique! Don’t fall into the trap of journey mapping, picking a program, and just thinking you are patient centric—the odds are you are not satisfying your customers! The easiest and hardest thing you can do as a pharma partner is choose to meet your customers’ needs. You must: LISTEN, LEARN, BUILD, LISTEN, and MODIFY.
Patient support programs (PSPs) were originally created to support patient access to complex medications and to assist patients with navigating through the complex healthcare system. Today, PSPs provide a more holistic approach to patient, caregiver, and HCP support services when specialty medications are prescribed, including: Reimbursement navigation; clinic and nursing support (infusion and injection administration/training); patient education and counseling; risk management and adherence; specialty pharmacy, drug delivery, and logistics services; and connection to other social support services. Pharma-supported PSPs have the ability to fill gaps in services not readily available in the current healthcare system.
For instance, offering access to nurses who provide personalized infusion, injection, and take-home therapy education services for patients and caregivers. They could also provide such customized services as disease education, dietary and social plans, and diagnostic/genetic test coordination specific for each condition and tailored to patient and family needs. The key is to develop a PSP that allows the patient to live in a state of normal—they can still go to school or work and the PSP provides the tools to help them maintain their life while still treating their chronic disease effectively.
The Importance of RWE
An integrated model is essential for a successful PSP. As a manufacturer, it’s important to think about real-world evidence (RWE) and how you can leverage the PSP to generate data insights and inform commercialization strategies. For example, tracking health-based outcomes to inform payer decisions, or reporting trends about a payer who has listed the treatment, are data points from a PSP that can inform a manufacturer’s decisions on the market and impact to the patient’s treatment experience. These insights can lead to more informed strategic decisions that ultimately benefit the patient and improve health outcomes.
Measuring the success of a patient support program has multiple facets, but the fundamental metric measuring set has to be deep-rooted in minimizing the time it takes to get patients to start and stay on therapy. In order to know if the program is successful, organizations should have a way to measure compliance and persistency by comparing patients in-program versus those patients not in a program. Forward-leaning organizations have developed appropriate relationships with their providers to create longitudinal linkages of their patient support data with claims to create appropriate compliance and persistency curves.
To drive success in compliance and persistency, organizations should have the ability to evaluate metrics including:
- Prescriber, field support, and patient relationship patterns.
- Payer trending and behavior.
- Patient engagement and satisfaction.
- Speed to engagement and therapy.
- Age of cases by stage of support.
- Prior authorization and appeal process metric steps.
- Policy adherence.
- Prescriptive patterns to support the best course of action for the patient.
Measuring success is not only based on static measures, but also explored through dynamic visual analytics. This provides program leadership with targeted, concise dashboards focused on continual improvement of patient outcomes. Creating a data-driven operation focused on the optimization of performance for the metrics above is the key to running a successful patient support program.
One of the biggest challenges with designing great programs is the sheer variability of healthcare in the U.S.—in terms of the networks, how care is delivered, and what patients need and want. This makes any “custom solution”—as great as it may be—inherently only applicable to a small slice of the pie. And, it makes designing and rolling out patient-centric programs and services very challenging, given that there is no uniform or common system/data/standard underpinning how patients navigate the U.S. system. When designing programs, this translates into a tension between customization versus operational uniformity/consistency—which means it’s difficult to give lots of meaningful choices and to adapt for various customers, but that’s exactly what HCPs and patients want and need.
Increasing Adoption of Technology
The most important thing we can do as companies and as an industry is to really embrace technology and take bold steps to drive adoption. Technology has revolutionized so many other industries; now it’s our turn to disrupt the status quo. The fax machine should absolutely not be driving so much activity in our space. We must strive to do better for HCPs and patients—by working to drive 100% electronic enrollment for services, push adoption of EMR/EHR enablement, make ePA/eBV the standard, and design 100% e-tools and platforms across the industry.
Measuring the “success” of patient support programs should actually be fairly straightforward. There are many other relevant measures—such as patient and HCP satisfaction, efficiency of spend, etc.—however, once the HCP has made the decision to start an appropriate patient on a particular therapy, true success must be measured as what percentage of patients end up on that therapy, how long it takes them to get started, and if they are staying adherent to the therapy/regimen.
Why invest in a Patient Support Program if it doesn’t offer patients what they really want?
This is why we always recommend performing a landscape assessment before launching new programs. The biggest challenge is what to do when the research tells you that patients want something new and they want it NOW.
We know that the MLR review process can take so long that by the time you’re ready to launch, patients have moved on to wanting something different. Another risk is that your competitors have the same idea and beat you to launch, enticing patients to switch treatments.
To ensure the review process moves rapidly, develop the key components of new PSPs by modeling those of previously successfully deployed programs. This includes items such as policies, procedures, forms, and messaging. Therapeutic areas and value offerings may differ, but there are universals when it comes to the underlying design of compliant, patient-centered programs.
Working with Reviewers
You also need to know how to initiate an effective dialogue with reviewers in advance of the actual review submission. This means reaching out to vet ideas and ask questions so that you ensure you understand all major concerns and how to address them.
Particularly with novel programs, reviewers are much more likely to consider submissions with an open mind if they’re confident in how thoroughly you’ve thought through risks and outcomes. The goal is to go into the initial submission with a comprehensive set of plans and materials that addresses all identified questions and concerns, making it easy for reviewers to provide approval.
Finally, make sure to inform reviewers about your experience with patient programs across brands within the organization. A timely review hinges on effective planning and attention to detail, but a trusted reputation can mean the difference between weeks and months.
The age of patient consumerism is upon us: “Patients are demanding more sophisticated, convenient, transparent, affordable, and personalized service,” according to a PwC consumer survey. With this shift in demand, digital services are the expectation. In fact, “more than 75% of all patients expect to use digital services in the future,” according to a McKinsey & Company report.
When designing patient support programs, too often the focus is based upon the services that can be provided to the patient, rather than how the patient wishes to receive those services and what channels are most effective. Adding digital channels is key, but understanding the patient must come first:
- Know their preferences: When an interaction with a patient is timely, relevant, and received as the patient desires, the patient is likely to be more engaged. The first step in this process is understanding the channel preferences of the patient and ensuring they’re applied. Confirm preferences during your welcome call, and even if your program supports limited outbound channels, ensure your agents adhere to the patient’s choice.
- Different service, different tactic: I spend considerable time working from home. With email and an array of digital communication tools, I can be highly effective. When it comes to meeting with a prospect or discussing complex topics, I’ll change tactics by picking up the phone or hopping on a plane. Patient engagement follows a similar pattern. Patients expect a different experience based upon the service being offered. An SMS may be appropriate for an appointment reminder whereas a face-to-face meeting with a nurse for injection training is more effective. Patient support programs must map communication preferences to those services being provided.
Seeking to understand and being able to apply these preferences must occur before those digital channels become truly effective for the patients you serve.
Successful patient support programs begin and end with the patient in mind. They demonstrate a sensitivity to the patient’s needs and offer partnerships with the patient to help them navigate the complexities of getting their prescriptions filled. They demonstrate a deep understanding of the patient’s journey and work to quickly find solutions that can assist the patient with obtaining therapy as quickly as possible. The best solutions in market today take into account the healthcare provider and patient user experience and build their program from the ground up around those experiences, instead of merely adapting their process to fit a particular patient service program.
Measuring Success of Patient Support Programs
A program’s success should be measured on the satisfaction of all the stakeholders involved, including patient, healthcare provider, and manufacturer. Patients want their medicine with the least amount of effort necessary and in a timely manner. Healthcare providers want a solution that doesn’t impact them or their staff’s time in treating their patients: It must be simple to use and reliable in assisting patients. This requires an easy way to enroll, track, and verify patients started on therapy. And finally, brands want to build equity with patients by delivering a high level of service for patients, which in turn brings goodwill for their brand and may help drive adherence. The key to ensuring all those are taking place are clear detailed metrics for all touchpoints in the patient journey, which can be used to measure the success and efficiency of the program as well as to diagnose areas where the process can be improved.
The only way to create a service that is fit for purpose is to see the problems from the outside in—from the patients’ perspective. This means collecting insight from your target audience to identify the triggers and drivers of behavior, as well as needs and challenges.
Insight is essential to understanding the underlying problems that your service will address and get to the heart of them, rather than just addressing symptoms. Services can be thought of as logistical, independence or confidence building, lifestyle management, adherence, or the delivery of treatment at home. However, one isn’t necessarily better than another.
Patients’ have a variety of needs, which can differ depending on therapy area, treatment type, demographics, environment, and context. For example, a patient with little emotional support but finances for care and logistics will have different needs to one who has difficulty traveling but has a network of emotional support.
Determining What Patients Need
Personas, developed by analyzing your customers, can help you empathize with different patients and group them together in a simple and memorable way. This is helpful for clearly identifying who you are designing for.
Mapping the patient’s journey helps you identify where, when, why, and what type of a service is most needed and for whom. It also helps to drive innovation, facilitate behavior change, and ultimately achieve better health outcomes and an improved patient experience. To create an effective visualization of your patient’s interactions, gather insight not only into the patient and carer, but also the HCPs and other stakeholders within their journey, along with their environment and context.
Rather than becoming tempted by shiny new technology or jumping to a list of assets, instead ask yourself who are your customers and what do they really need? Only then can you create an innovative service that transforms patients’ lives.
In the simplest terms possible: Don’t assume you know what patients need—work with them as partners to create innovative solutions together. First, recognize that the relationship that patients have with a particular brand does not only include taking the medication. It is an end-to-end experience from diagnosis to resolution (or maintenance). A parallel example is a passenger’s perception of a flight. Their experience does not only include what happens in the air. It starts when they purchase a ticket and ends when they pick up their luggage at their destination, and it includes all the touchpoints in between. The same holds true for a patient grappling with a diagnosis and the related treatment decisions.
We know that through understanding the patient journey and the emotional forces that come into play along the way, it is possible to uncover the unmet needs and value opportunities that exist within that ecosystem. Once you see the experience through a holistic lens, you can develop agile services that evolve to meet the changing needs of patients and physicians.
Getting Through MLR Faster
At Bridgeable, we have an offering known as “co-creation,” which is a multi-day workshop where we bring together both internal (legal, medical, marketing) and external (patients, caregivers, physicians, nurses, subject matter experts) stakeholders on a business challenge to create an optimal solution. By engaging people from all sides of an experience to work collaboratively, you can build empathy and consensus on the right way to forge ahead. Including key personnel from the Medical, Legal, or Regulatory review processes allows them to understand the patient position and therefore increases buy-in and ease of approval.
An effective PSP is critical to a drug’s success and requires significant resources to develop and manage. Therefore, organizations must make the right investment decisions with a focus on the patient’s needs, especially as patients play a stronger role in their treatment decisions. Executives must also identify elements that create exceptional value for patients and meet the needs of healthcare offices.
Developing a robust strategy for a patient support program begins with assessing the current environment. By benchmarking existing programs and pinpointing their areas of improvement, companies can leverage insights to refine their approach and create a competitive advantage. While all programs tend to include the same basic elements, there is no one size fits all approach, as experiences differ by indication. However, some success criteria Fuld + Company has identified for all patient support programs are:
- Companies must have a firm understanding of the characteristics and demands voiced by the target population.
- Patients need access to drugs through services such as benefits verification, prior authorization, and financial support including co-pay or insurance gap coverage.
- Empathy is an intangible but an essential element of a program—the need for emotional support is consistent throughout the patient journey.
- For example, Shire and AbbVie programs have a similar approach undervalued by some—patients enrolled in their programs have a dedicated representative throughout the entire process. Patients suffering from a disease can find it difficult to cope mentally and emotionally with the treatment process and dedicating personnel to guide them can leave a long-lasting impression.
A truly effective PSP requires these three elements but also relies on an understanding of the external environment including customers, competitors, and market trends to ensure the program meets the unique needs of its constituents.
Use qualitative and quantitative research to explore the features and services that patients want from your support program. Ideally, support programs should offer more than mailings, co-pay assistance, and refill reminders. The most comprehensive programs include features such as personalized communication, caregiver support, and patient networking communities. Remember that every patient is different. Patients crave personalized solutions.
During physician visits, patients can be overwhelmed by stress, especially when the physician is delivering a new diagnosis or other challenging news. The emotions of the moment can limit the ability to process new information. Successful support programs enable patients to access important material on their own time in a more comfortable setting.
Speak to patients using everyday language. SKIM’s research has shown that patients may not understand the dense clinical terms and acronyms that are sometimes used in support program materials. Keep it simple.
Don’t Forget the Caregiver
Caregivers can play a vital role in the treatment decision-making process. In such cases, the creation of a caregiver component of your support program is essential. While caregivers share many of the same information goals with patients (knowledge about the condition, clear understanding of the medications that are used to treat it), they have their own unique needs and challenges that are distinct from those of patients. Caregivers can struggle with balancing the needs of the patient with the necessity of managing other aspects of their lives. Support programs that help them achieve this balance perform a valuable service.
Keep the mindsets and goals of patients and caregivers at the center of your thinking. Successful support programs can produce greater patient satisfaction and adherence—leading to better patient outcomes.