Authors: Vinayak Gupta, Saurabh Gupta, Asif Ghatala
Meet Michelle, a 66-year-old senior citizen living by herself and diagnosed with Type 1 Gaucher disease. She needs consistent support through Enzyme Replacement Therapy (ERT).
Patients like Michelle, who are suffering from rare diseases, and their caregivers often struggle to manage their condition for several reasons – lack of appropriate training, medication non-adherence, fear of side effects, or missed appointments, to name a few. With recent advancements in data analytics, Pharma companies are bringing ‘Patient Services at the center of the organizations’ by developing a Patient-centric ecosystem to support patients through their therapy journeys. As soon as a patient has been prescribed a certain therapy, they generally have access to the relevant Patient Services resources and can start engaging with the organization.
Primary Objectives of the Patient Services Organization
1. Assist patients (and their caregivers) with education on insurance options, insurance access, or coverage issues,
conduct benefits investigations, and provide information about financial assistance options.
2. Coordinate with nursing and infusion services or additional educational channels to ensure adequate training
and support patients and caregivers.
3. Coordinate with specialty pharmacies to ensure seamless drug shipment.
4. Provide information about educational programs, advocacy groups, and events; connect patients and caregivers
with community resources.
5. Ongoing product support throughout the patient’s journey, including access to financial assistance programs, as
6. Ensure patients have the necessary means to complete the therapy program by enhancing patient engagement and
alleviating any roadblocks.
What does this mean for patients like Michelle?
Michelle was prescribed an ERT therapy manufactured by a multinational Pharma company by her Health Care Provider (HCP). This company is known to have a successful Patient Services Program with a dedicated Patient Support Manager (PSM) who will help Michelle at every stage of the therapy.
Therapy engagement starts with Michelle meeting Rachel, her dedicated PSM, on a Welcome Call and continues with ongoing support.
As far as Michelle’s needs are concerned, Rachel will be her single point of contact through all her interactions with the pharma company. However, for Rachel to be successful in her role (as a PSM), she is supported by different entities and business functions that assist her for different patient needs – thus delivering a seamless experience to patients (and their caregivers) in meeting their therapy goals. Some of the key entities supporting Patient Services include:
● Resource Hub:
The resource hubs are responsible for helping providers and patients to help navigate the process of obtaining permission for the usage and reimbursement of the drugs. In certain cases, the hub also enables bridging the supply of medication while the preauthorization is pending, supported by Patient Access Managers (PAMs). With the help of Clinical Educators (CEs), resource hubs provide education about the therapy, resources available to patients within and outside patient’s insurance company, and/or the pharma company to fill the medication.
● Specialty Pharmacy (SP):
SPs are external entities dispensing drugs on behalf of the pharma companies and play a vital role in capturing dispense data which pharma companies can use to monitor the success of the therapy.
Insurance companies play a vital role in drug accessibility for eligible patients and also participate in Copay assistance programs as part of financial assistance provided by Pharma companies.
Operations team helps with managing a range of day-to-day functions: patient onboarding, benefits & claims approval/processing, drug shipments, managing nursing vendors, managing pharmacy and related turnaround SLAs, etc. Analytics is pivotal in tracking adherence to SLAs, predicting program benefits utilization, and budget planning.
● Nursing Support Services:
Nursing support services team helps with the training needs of the patients and their caregivers in case of infusions and other care support needed during the therapy. Analyzing training requests helps forecast the demand and allocation of nursing support across different therapeutic areas.
● Marketing & Outreach:
This team (as the name describes) is responsible for facilitating communication with patients and managing flow of information between the patients and the pharma companies via surveys, campaigns, and outreach programs. The engagement with patients provides an opportunity to analyze and segment patients in various support requirement categories and optimize patient support plans.
Role of Advanced Analytics (AI Solutions) in Patient Services Ecosystem
With the help of advanced analytics and AI, it is now possible to provide actionable intelligence to the Patient Services team to meet every patient’s unique needs (as part of patient journeys) at the right time, thus driving optimal therapy outcomes. For example:
● AI can help identify key drivers of therapy discontinuation and never-start patients – and using those drivers, AI can identify ‘at-risk’ patients enabling Patient Services team to drive early interventions.
● AI can identify segments/micro-segments of new patients with high degree of accuracy – allowing patient services to personalize the outreach strategy ahead of time.
AI-driven insights generated at every stage of the Patient journey (Pre-onboarding, On-boarding, and On-Therapy) helps in driving personalized, accurate, and timely interventions by Patient Service Managers to ensure patients remain on-therapy and lead healthier lives.
Patient Services: Use Cases Across Patient Journey
At Tiger Analytics, we’ve partnered with a major multinational Pharma and Lifesciences company to enable them to become a more Patient-centric organization. Through our bouquet of AI interventions, we helped create a 360° view of patient experience to enable the leaders in Patient Engagement & Experience teams to keep a pulse check on every patient’s need and curate interventions to ensure each patient is able to benefit from the latest available medical advancements.
The analytics support provided by Patient Services organizations greatly benefits Patient Service Managers, Account managers, Therapeutic Area leads, and other associated functions like Patient Engagement, Vendor Management, etc. With the help of our team of Data Engineers, Data Scientists, and Industry experts, we’ve developed capabilities and roadmaps for the analytics journey for Patient Services and other associated functions.
With the foundational pillars and analytical capabilities in place, any Pharma company can therefore make a shift from just being a drug provider, to providing an integrated support system and being a true care partner, offering patients like Michelle and their caregivers much-needed support during their difficult patient journey.