How to Successfully Mitigate Risk and Dissatisfaction in Patient Service Programs

February 26, 2020

Pharmaceutical Executive

High customer satisfaction and low risk is the goal for patient service programs and is possible with focus on solid service delivery and quality.

Introduced 20-some years ago, hub service suppliers are meant to make it easier for providers and patients to access and use critical pharmaceutical and biotech therapies. However, even with multimillion-dollar contracts at stake to provide a range of services focused on access, affordability, and adherence, many of today’s hub suppliers miss the mark.

From benefit verification delays to unsubmitted prior authorization forms, unfilled orders, unmade calls to initiate therapy, and more, manufacturers increasingly find themselves scrambling to mitigate service risks and find better vendors. What’s going wrong? And, more importantly, what can manufacturers do to put reliable hub service partnerships into place?

Evolution of hub services

Originally, hub services focused on facilitating reimbursement, and over time expanded opportunistically to include adherence, financial assistance, patient assistance, and data aggregation, among other services. Nowadays, a variety of “one-stop-shop” hub service vendors handle everything from distributing products through servicing providers and patients. Frankly, some of these vendors have grown too fast or focused more on growth than on execution. So, while these vendors sell a “one-stop-shop” efficiency and immediate cost-savings to manufacturers, they often fail to holistically deliver on their promise. As a result of their broad approach, and based on experience, often program design, performance, and quality lack the necessary elemental foundations for success, which is the root cause of dissatisfaction among manufacturers (and in turn their customers and patients). 

Meanwhile, boutique hub service vendors that specialize in one area, such as financial assistance or adherence services, are gaining some ground. Some of these specialized service providers tend to deliver better quality overall than their “big box” hub competitors. However, they tend to add cost and management complexity since manufacturers must contract additional specialists, while striving to provide a consistent customer experience.

Despite their inherent advantages or disadvantages, hub service model can-and often does-falter without strong program design, performance, and quality. By design, a hub service program should facilitate patient access to therapies with services targeted to support the product journey and coordination with both providers and payers. Likewise, by design, a strong program will help patients learn about and receive the care they need. They also will ease the related stress and systemic barriers to help ensure the smoothest patient experience possible, fully considering issues of access, affordability, and adherence that must be overcome in the process.

Primary program risks

Program design

Program design starts with mapping services rendered to the patient and provider’s respective journeys to address potential access roadblocks. For providers, that means creating a program that fits into the clinician’s workflow, making it as easy and convenient as possible for the physician to refer appropriate patients to the program. Depending on the therapy, this might include implementing pre- or post-service reimbursement support, as well as ongoing patient support in terms of re-verification, re-authorization, or feedback from adherence activities, among other services.

For patients, a well-designed hub service program makes it as easy and convenient as possible to learn about and understand service offerings. Patients should come away understanding what to expect from the program, how it will verify applicable insurance benefits, and help them understand access options, including details about financial assistance offered, education or resources about the product, and guidance on adherence services.

In addition to anticipating and addressing the access needs of providers and patients, a well-designed service program needs to be tailored to the treatment option-or risk creating unintentional access barriers. For example, in a recent case of a new cardiac drug, the hub service provider applied a program design best suited for a medical benefit product or in-office procedure. In this scenario, the hub included a pre-service component for initial benefit verification and prior authorization support. But the cardiac drug was covered under a pharmacy benefit, and the pre-service program component created an extra step and a backlog of service requests, resulting in access delays for patients.

Program performance

Vendor capacity must meet service demand for a program to perform well. The best way to ensure that is to align anticipated volumes and expected service levels-such as based on projected sales targets, historical program volumes, or some combination of the two-and then monitor volumes regularly and adjust accordingly. This helps mitigate the potential for service request backlogs.

In addition, manufacturers need to monitor incoming service requests against outgoing service requests to manage program performance and excellence in execution. To do this, manufacturers should be familiar with anticipated turnaround times and aligned with the service provider on how the patient will ultimately be treated. This will help eliminate delays and support patient access.

In general, processes should be in place to consistently document the procedures being executed, regularly audit and monitor their effectiveness, and be prepared with outlined remediation steps to drive ongoing quality improvements as a matter of practice and as necessary.

Program quality

Program quality boils down to the patient and provider experience. Are they getting the support they need to access the product in a timely fashion? Do they have a good customer experience? Without a positive experience-or a remediation plan to correct course-access is jeopardized, and patients are put at risk.

Consider this case example: Despite having a hub service program in place, the manufacturer of a new ophthalmology product received numerous complaints from customers and field team members, citing a lack of support. An investigation into the complaints revealed that service demand exceeded vendor capacity, resulting in the perception of “no response” or “a black hole” at the vendor. With input from the manufacturer, the vendor developed an action plan to add resources, train and re-train team members, and establish a quality program for ongoing management of the support services. Fortunately, they were able to turn around hub performance within three months, improve customer service perceptions and the product launch rebounded.

Customer service and data management are at the core of a well-designed hub support program. Quality customer service must support all stakeholders-including smoothing access for patients and providers, guiding and assisting field teams to knowledgeably engage customers, and providing in-house manufacturer partners the information needed to make business decisions.

Robust data management is critical to maintaining the quality of customer service. Focus on data management from three perspectives: compliance to ensure data is protected and shared appropriately; operational to ensure data is driving efficient program execution; and, insight-generation to make sure data is managed and harvested to provide accurate and actionable information.

Mitigating risks, ensuring compliance, and improving satisfaction

In order to implement and execute a successful hub service program, vendors and manufacturers need to be aligned, communicative, and disciplined.

Manufacturers need to be clear about what is needed, what ongoing expectations are, and what is possible. Vendors need to be clear about what they will provide, as well as to whom and how the services will be administered. From there, once a product has launched and the hub program is live, performance must be actively managed and monitored-by the manufacturer and the vendor.

Ensuring compliance is the responsibility of both the manufacturer and vendor. Manufacturers must clearly communicate their requirements from a compliance perspective, including sharing policies and business rules. Vendors must work to implement those requirements, as well as monitor to ensure that all of these requirements are being met. Additionally, manufacturers should routinely audit and monitor vendors to make sure requirements are being implemented in compliance with their policies. This includes listening to actual calls with patients, as well as reviewing documentation to make sure that all the proper patient consent and confirmations have been retained.

“I have some manufacturers where they’ve outsourced their program to us, and they don’t ask what’s happening with the program until the end of the year, or until they get an invoice,” explained one consultant. “I’ll get a call, ‘This is a little high, what happened?’”

That is not a program being actively managed for quality to ensure a robust and positive customer experience.

Conversely, in a successful case example, a manufacturer with a broad portfolio of products conducted regular audits of its hub vendor on a set schedule including: financial audit, program process, compliance, and technology audits. Each year the manufacturer targets a specific area, conducts the audit, and works closely with the hub vendor to remediate and monitor going forward. This kind of active vendor management is how manufacturers can support ongoing quality.

As a best practice, well-designed, quality hub service vendors-whether large or boutique-will:

  • Establish written standards in Standard Operating Procedures (SOPs)

  • Implement ongoing key performance indicators (KPIs) that are shared with the manufacturer on a regular basis

  • Perform audits and regular monitoring to ensure operations adhere to standards and perform in line with expectations

  • Implement diligent course correction when an audit reveals discrepancy between standards and operations

  • Regularly review processes to identify areas for improvements

If the vendor and manufacturer are aligned on those pieces, then ultimately the program will be better, giving patients better access to the therapy, in a timely fashion, not compromising treatment and improving adherence, which in turn will improve sales. It all comes down to quality. High customer satisfaction and low risk is the goal for patient service programs and is possible with focus on solid service delivery and quality.

 

Dana Edwards is a Director in Life Sciences at Guidehouse (formerly Navigant). Dana.edwards@guidehouse.com

Casey Horton is a practice leader in Guidehouse’s Global Life Sciences Governance, Risk Management and Compliance practice. Casey.horton@guidehouse.com