Three of the main factors currently influencing patient support services are population health management, patient engagement, and shifting perspectives in biopharma, Tracy Foster told a roomful of attendees recently at the 2015 Patient Assistance & Access Programs meeting held in Baltimore, MD.
In her presentation, Ms Foster, President of Lash Group and Premier Source, a part of AmerisourceBergen, walked participants through these key factors and how stakeholders within the healthcare system, from patients to manufacturers, play an important role. She also recently spoke with Oncology Practice Management regarding the topics that were part of her keynote address.
“Some of the key trends in the industry—the growth of population health management, trying to curb costs and improve quality—are really requiring providers to develop new capabilities related to coordinating care and referral management,” Ms Foster said. “For oncologists, it’s continuity of care with primary care providers and other specialists, and a key to that is patient adherence and engagement. We see that as a win-win-win-win with providers, patients, insurers, and manufacturers: adherence and engagement is a critical success factor for all of those constituents.”
Population health management is a solidly established trend, with providers, government, and private payers intensifying their focus on value-based payment, Ms Foster said. Medicare shared savings programs (SSPs), a major driver in population health management, remain rooted in fee-for-service reimbursement, she noted, and have not produced the level of value share among participating accountable care organizations (ACOs) that is needed to drive confirmed growth of this model.
The program is being adapted, however, and ACOs are continuing to focus their business models on integrating high-quality, low-cost providers and establishing streamlined care pathways. This focus requires improved data sharing between all healthcare partners, Ms Foster said. It also involves coordinated care transitions, the alignment of quality targets, and leveraging worksite wellness programs to supplement patient support programs.
“[This means that] patient support programs are really going to need to be positioned in a way that they work in these coordinated-care networks,” Ms Foster said. “Patients receiving a certain product will not only be seen by their oncologist, they’ll also be seen by their primary care provider. So the patient support program has to address the patients’ needs as they work across the program, starting in the inpatient setting to transitioning to the outpatient setting.”
Within population health management, there also is the challenging element of gathering all patient-related quality metrics required by the Medicare SSP, said Ms Foster. As manufacturers are thinking about patient support programs, she suggested that they question whether the programs are designed to help and complement an oncologist’s tracking of quality, or if they add to the complexity.
Maximizing patient adherence and engagement is also widely recognized as being essential to optimizing healthcare. She cited in her presentation a survey of pharmacy and medical directors conducted by Xcenda, a part of AmerisourceBergen, which was originally fielded in April 2011 and then repeated in May 2013, with 59 and 60 respondents, respectively. The majority of respondents indicated they are willing to work with pharmaceutical companies to provide services to high-risk patients and, in return, to report on and improve the patients’ compliance and adherence. A total of 7% of the 2011 survey respondents and 17% of the 2013 respondents indicated a willingness to consider a pharmaceutical company’s oncology product for their formulary if the manufacturer also offered an adherence program.
Ensuring ongoing success of patient support programs also involves a patient-centric approach throughout the patient journey, noted Ms Foster. For example, a patient using an oral oncolytic starts with an initial visit to his or her primary care provider, where the path to diagnosis starts and where personalized health-coaching interactions can be used to optimize patient engagement. Similarly, said Ms Foster, through diagnosis, treatment, and aftercare, there are many points at which the patient’s team can work to coordinate care such that they understand his or her experience, maximize engagement, empower the patient, and work with him or her to achieve optimal care planning, clinical support, adherence, compliance, and, ultimately, treatment efficacy.
Adherence is the linchpin for much of this work, and in order to make a difference in this area, it is essential to take a broader approach and think about the patient more holistically, Ms Foster said. One of the key challenges—which is also an opportunity—is to unite adherence strategies with other efforts to engage patients, she said.
“In the past, manufacturers have partnered with oncology practices to provide patient support programs that were educationally oriented, a ‘one-size-fits-all’ approach to the patient,” Ms Foster said. “And really the opportunity is to ensure that their offerings address the full patient experience from diagnosis onward, with more patient engagement, so the patient is really a part of the program.”
To this end, pharmaceutical companies have shifted perspectives and developed ways to segment patients based on their risk of noncompliance (Figure). Patients can then be provided services based on where they are along the adherence risk spectrum, said Ms Foster. More and more of these services are being delivered via patients’ smartphones. This includes everything from enrollment of patients in patient support programs online or via an electronic medical record to text or e-mail alerts about the next clinic appointment. However, patients and physicians will still expect some high-touch communication, she added.
“There is always going to be a need to troubleshoot a patient issue, and providers want a professional, knowledgeable, high-quality customer service experience when they need to connect in a live, direct fashion,” said Ms Foster. “That’s why manufacturers are investing in higher-quality customer service models, which means hiring oncology-certified nurses and former practice managers to support patients in their call centers and working with patients’ adherence.”