Michael Zilligen, Market Access Practice Lead, Ogilvy Health
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“Repetition penetrates the dullest minds” was a common line I used to hear regularly from a former boss when I was a wet behind the ears product manager. The media’s consistent focus on prescription drug prices and the rising cost of healthcare has penetrated every news channel and stakeholder in the system, from employers, to payers, to providers and patients. Even in cases where true drug breakthroughs were emerging from bench to bedside, the headlines over indexed on the exorbitant cost of these emerging medications and financial burdens to the patient and the healthcare system. Overshadowed were the significant clinical advances, which in some cases were in disease states where no effective treatments existed (eg, rare diseases). Unfortunately, access service programs developed and funded by the manufacturers rarely make it into the conversation, much less the news.
Improving Patient Access
One common goal shared by all healthcare stakeholders is to improve patient outcomes. While the approaches about how to best improve patient access to care and outcomes varies and continues to be debated, patient solutions designed to achieve these important goals has evolved dramatically. Putting patients first includes ensuring patient access to the many new therapies and access services programs are a foundational way to ensure access to these much needed therapies.
Various elements of patient support have been around for years. More than two decades ago, copay programs emerged to help patients offset some of the cost of new high-cost branded prescriptions. Disease information became commonplace, and more white glove services such as nursing services and adherence support quickly emerged as new ways to assist patient care and improve outcomes. Fast forward to today, complex and comprehensive patient assistance programs help patients with much more than financial assistance and include important elements throughout the patient journey, beginning with benefit investigation/verification, billing/coding, prior authorization and appeals support — all the way through to foundation referrals (if appropriate) and adherence support.
While the specialty and rare disease segment has grown significantly, the importance of access support is more critical than ever. And the dynamics in the marketplace have led to a number of real-world challenges in delivering exceptional patient support. One such challenge is greater pressure on the patient resulting from the increased cost shifting. The weight of higher out-of-pocket costs is affecting patient affordability and ultimately prescription fulfillment. Another challenge is higher customer expectations. In an era of Amazon Prime, patients and providers expect more for less, and faster. So what patients expect and demand in their healthcare experience mimics what they demand in other areas of their lives. They expect to receive their medication quickly and affordably. A patient’s experience affects how he or she views your company and products, as well as your perceived reputation. Lastly, program affordability is a challenge for the manufacturers. Along with rebates, investment and costs associated with a comprehensive patient assistance program are the largest line items in the brands budget. Seeing a tangible and measurable return on investment is imperative given the significant resources allocated to these programs.
Building on the Amazon Prime analogy, understanding what is important to the customer, in this case the patient and provider, will help prioritize components of the program and align expectations to ensure a superior customer experience. Knowing what is important to the customer guides the operational configuration of the program. These insights are the genesis for leveraging technology to streamline the processes and improve time from prescription to fulfillment. By imbedding technology solutions in the EHR by automating many labor-intensive elements, the experience for providers (and support staff) and patients is enhanced.
Finally, providing visibility into the overall performance of the program will guide the access service team in identifying what program elements are performing well and potential program pain points. Establishing benchmarks aligned to your programs strategic vision by creating KPIs and measuring those over time, is an effective approach to validating if you have the ideal program in place, or you have work to do to exceed your customer’s expectations.
Example of Access Services Program KPIs:
Perception of quality of products
Ease of use of reimbursement services
Ease of attaining reimbursement of product(s)
Speed to resolution
Provider portal ease of use
Website ease of use
Call center knowledge and problem resolution
Access services programs don’t garner the attention of the media unlike drug prices, but they play an integral role in helping patients access the right therapy. Effective programs can have a positive effect on the patient experience, outcomes, and their perception of your brand and company. Monitor your program and take the pulse of your customers, your reputation is at stake.(PV)
Ogilvy Health makes brands matter by keeping our audiences’ health, healthcare and wellness needs at the center of every touchpoint.
For more information, visit ogilvyhealth.com.