Practices HCPs should follow to ensure patient confidence and success.
The need for patient centricity is ubiquitous, yet the patient journey is still daunting for most and impossible for some. Many patients fail to reach an accurate diagnosis for their condition, or if diagnosed, fail to adhere to their prescribed treatment. The factors that can stymie a successful outcome along the patient journey are as diverse as they are plentiful, but not insurmountable. The challenge to do better has never been greater both in human potential and healthcare system cost.
Obstructions Along The Way
A patient’s journey starts when a patient or care partner recognizes something is wrong. Depending on what the illness might be, the journey to diagnosis and treatment can be an uphill battle with many hurdles to overcome. This is particularly true for those suffering with rare or specialty diseases that are hard to diagnose and treat. The attending physicians may lack knowledge about the disease, which can lead to misdiagnosis. Diagnostic testing may not be available, or when available, not covered by insurance. The specialists treating the condition may be inaccessible due to geography or cost. Multiple diseases might be present in the patient, obfuscating accurate diagnosis and treatment. Biases on gender and race may also exist within the healthcare system that predispose certain symptoms to be overlooked.
Once the patient is properly diagnosed and prescribed treatment, they enter the next leg of the journey to access the prescribed medication. Many medications require pre-authorization by the insurance company, which in turn necessitates significant paperwork and the potential of rebutting rounds of denials. If approved, the out-of-pocket costs for the patient may still be prohibitive due to high deductibles, and the patient may need to seek manufacturer assistance programs. It has been reported these assistance programs offering coupons, e-vouchers, and co-pay assistance can cover most, if not all of the patient costs, yet only 10% of these dollars are actually used by patients as they are unaware or not able to access them.1 Even when the treatment costs are manageable by the patient, many of these medications are available only through specialty pharmacies or specialty distributors, which can present yet another hurdle to access based on their location.
Once patients have gone on to receive their medication, it would seem that they should be closer to meeting their goal of an improved health outcome. However, for many, adherence to and persistence with their medication is an issue—one leading to an estimated 125,000 preventable annual deaths in the United States and generating $100–300 billion of avoidable healthcare costs annually.2,3
The Path to Doing Better
There are some basic steps the industry can take to address and begin to resolve issues facing patients and their care partners along the journey to diagnosis and treatment.
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Education
An important step in improving the patient journey is to provide accurate and understandable disease state education to physicians, patients, care partners, payers, advocacy groups, pharmacy benefit managers (PBMs), and pharmacists. Essentially every touchpoint within a disease journey should be educated about the disease, in language appropriate to them, in order to understand it and how it impacts their particular role.
Clinical Educators can work with physicians to provide the necessary disease state information they might need to more readily identify symptoms in patients. These educators can also work with patient advocacy groups providing them with the disease state education they can share with patients, to provide them with options for managing their disease.
Patients should be aware of or able to easily find information regarding their condition, be it through their physician’s office, the Internet, advertising, patient advocacy groups, or their pharmacist. This information should be provided in language easy to understand for the average individual and recognize the crucial role played by the care partner along the patient journey. Only in being as educated as possible on the disease, can the patient and care partner be in a position to avoid potential misdiagnosis and properly weigh the options for treatment benefits.
Education on medication access is also critical to aid the patient journey. Field Reimbursement Managers and Treatment Navigators can play a vital role in keeping the physician’s office staff abreast of the ever-changing insurance reimbursement policies and administrative hurdles to be faced.
Keeping abreast of these policies, the office staff is able to jump-start patients on their journey to medication access with prior authorization submissions, saving valuable time and keeping patients motivated.
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Support
Support of the patient, and many times even more so the care partner, is critical throughout the patient journey. Such support works to help maintain the patient on the path to optimized outcome and also to realize full product launch potential. To be effective, a patient support program should recognize the individual patient and care partner experience throughout disease discovery, diagnosis, and treatment; identifying the critical points throughout this journey; and recognizing where support is most needed.
The real-world data available to drive today’s patient support programs is massive, but for the most part, existing within organizations’ operational silos. Only by breaking down these silos and sharing disease and patient data with internal stakeholders of market access and HEOR teams, brand teams, medical teams, and pharmacovigilance teams, can an organization create truly impactful, individualized patient engagement. Each patient touchpoint within the organization should be aware of where patients and potential patients are finding information, as well as how they are behaving. Technology to support this data sharing across the organization and with external stakeholders and partners is paramount to success. As more companies adopt data sharing technology platforms, they can better connect the dots in the patient journey to meet the individual needs of patients, how and when needed, to deliver the support that will drive better outcomes.
Patient support can begin with pre-treatment diagnosis and program enrollment. Treatment Navigators can educate the patient on insurance pre-authorizations and appeal processes, co-pay availability, and triage with the specialty pharmacy. Clinical Educators can support adherence with dose titration, injection, or infusion education as well as provide vital information on adherence strategies.
Pharmacies, HUB providers, and relevant patient associations and advocacy groups can also be leveraged to increase patient support program awareness.
To be most effective, a patient support program should take into account the whole patient, basing its approach on an understanding of the clinical, functional, behavioral, and psychosocial needs of individual patients. Behaviors are tough to change, and patients resistant to adherence are not likely to change their behavior simply by being educated on the fact that it is good for them. Clinical Educators must be trained in using a behavioral science approach to empower and motivate patients, helping them to cope and reduce their anxiety, fatigue, and depression so they are more likely to continue on their journey.
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Promote Your Support Programs
Providing excellent support only works when your targets are aware of the support you offer. According to the 2023 Nuvera PURE Report based on a survey of over 2,000 providers in oncology, neurology, and immunology, about 40-50% of these HCPs had a high awareness of patient support programs from pharmaceutical companies, yet over 70% of patients seeking treatment in these specialties primarily rely on their HCP to learn about such support. This is a lost opportunity in providing support on the patient journey.
HCPs and their staff can be valuable partners in the patient support program, but they need to be aware of the program and how it benefits the patient. To best address this, it is necessary to discover what will motivate individual HCPs and their office staff to enroll patients, and then use those insights to tailor clear patient benefit statements to engage them in the patient enrollment process. Showing evidence of positive patient outcomes should also be used to support the case.
It is important to remove any considerations of patient support program enrollment being a burden to the HCP’s office. Enrollment actions for the HCP should be minimized, and patients should be provided with multiple channel options to enroll with an easy consent process. Such channels as branded/unbranded web sites, QR codes/SMS enrollment, phone, along with traditional fax should be among the channels offered, and enrollment messages and imagery should be tailored to the individual patient being targeted.
Pharmacies, HUB providers, and relevant patient associations and advocacy groups can also be leveraged to increase patient support program awareness. To make sure that all of these touchpoints are aware of the patient support programs serving a specific disease population, the education on this program should be embedded into the brand strategy. Sales representatives and Clinical Educators calling on physician offices, pharmacies, and patient groups can then be directed to provide the necessary education and support materials.
There is much to be done to improve the journey for all patients. As the healthcare landscape continues to change and be impacted by governmental agencies, healthcare systems, payers, technology, and disease itself, the pharmaceutical industry and its partners can work to support the journey to ensure that patients achieve the positive outcome medications are designed to produce.
