“Embracing the patient-centric mindset”

(upbeat music) - Welcome to the Patient Centricity, a ZS podcast. We are the industry leaders within the health and health technology space. For over 40 years, we've been bringing patient-led business models to life. We're also the authors of a new book called Reinventing Patient Centricity. Our vision is to transform global healthcare and drive toward a more connected ecosystem. In this series, we will focus on how to incorporate the patient's voice into the decision-making process across all healthcare systems, from pharmaceuticals to managed care to life sciences companies, and thus improving health and business outcomes for all. I am your host, Victoria Summers, principal with ZS in the Patient Health and Equity Practice. I am thrilled to have two of my colleagues with me here today, Tanya Shepley and Dan Ogletree. They're principals in our digital patient experience services area. And Tanya is one of the co-authors of a chapter in our new book, Reinventing Patient Centricity. I have worked alongside both of you. It's been exciting to kind of have this opportunity to talk more with you about this topic that I think is near and dear to all of our hearts around helping patients be successful on their therapies and providing them support and solutions that will help. So welcome, thank you so much for joining us today. And I was just wondering if you could maybe start out by just talking a little bit about what drives your passion about patient experience services and patient centricity. And maybe Tanya, maybe I'll start with you. - Yeah, thank you for having me. I'm excited that we get to talk about this topic today. For me, consumers today, consumers, not patients, consumers have been accustomed to digital first experiences in all of their transactions. And health should be no different, but unfortunately when it comes to patients managing their conditions, they're left with a very frustrating experience from binding physicians, getting a diagnosis, all the way to starting medication. And so for me, I am passionate about bringing better experiences to patients. Health is, if nothing else, it's personal. And so we should have that degree of personalized experience and reducing that frustration for patients, and that's where my passion lies. - Excellent, that's awesome. Thank you so much, Dan? - Yeah, this is an interesting question. For me, the passion comes from being able to create disruption. If you think about the brokenness of the consumer and patient journey, there's so many steps that are not connected, they're not integrated, they're silos. And so as a patient is going through care, they can go to a myriad of different places to get support. But a lot of times they just don't know, and they don't know where. I've seen some personal experiences within my own family where the care has been disrupted because the patient services model was broken. - Oh, that's great. You know, when you think about that, kind of now near and far about the patient experience and from your perspective, Dan, where do you think the patient experience evolution is going? - Yeah, I think you gotta look back a little bit, right? So if you look back and retrospectively, a lot of our clients in the pharmaceutical industry are really scared to talk to patients directly, right? There were letters from the FDA, there was issues with misinformation. And what that caused is a massive move to outsourcing and pushing patient engagement, especially post-Rx patient engagement, out into vendors and suppliers where it became a bit more of a commodity, right? You call the call center, they perform a function and you move on. And unfortunately, that's not the experience our patients deserve. And you know, Tanya mentioned, right? Our experiences are driven by our consumer life. And so how do we help our clients start to create more of a consumer feel? And that includes things like digital first and digital only experiences that I could have as a patient. You know, one of the biggest issues too is this is a massive area that's increasing in spending, right? Over $9 billion, I think it was in 2019. You know, it's probably a $20 billion area this year. And so when we think about our patients, well, they don't know, right? About 60% don't have any awareness of programs that are available to them. And utilization is still, you know, in the basement, right? We have sub 8% utilization. And so those are really important is how do we connect the consumer and the patient experience as well so that I'm creating awareness of what's available before you make that decision, before you make that product choice and treatment choice. - Well, that's interesting. You know, Tanya, when you think about creating awareness for all of those, you know, services and support, how do you make that inclusive? - You know, the poor patient experience has a staggering cost to society and patients struggle with many social economic factors. So we do have to consider an inclusive experience. Even before COVID, as Dan was mentioning, some stats on a national scale, patient non-adherence caused over 125,000 deaths annually. And then that has a byproduct of the cost related to our healthcare system. Failure to maintain treatment protocols was estimated to have somewhere near $500 billion implication on our healthcare system. So being more inclusive in our experience has to start with thinking about that strategy on how to help patients and inclusion over time too, right? So programs need to focus on not only initiating or the service offerings, initiating patients on therapy. A lot of what we do is focused on access and affordability, especially in the US healthcare market. And we are more focused on commercial covered patients than non-commercial patients either. So there's a failure already in who we're looking to service instead of looking at the total patient population. And some of our research showed that patients with household incomes under 20,000, we're half as likely to leverage financial resources than higher household incomes. So the structure in it of itself is somewhat backwards. So we need to kind of really start from the beginning and look at the social economic restrictions of some of the patients have today. - It sounds like you have a lot of deep insights and understanding what role does data play in this whole kind of life cycle of a patient's support and helping to kind of build programs that patients can access. - I think that's one of the unique opportunities for manufacturers, for pharmaceutical organizations in this space is to look at that model, being data-led in order to support the patients in order to embrace their kind of role in the ecosystem, because it truly is an ecosystem. And manufacturers have a lot of both the engagement level data with patients, so how patients are consuming those services, but also what is being most effective towards patient outcomes. And that's what we should actually be oriented to. I know I made mention of a lot of cost stats just now, but we really should be focused on patient outcome data and what is making that experience better for them and that they are achieving those outcomes. - Interesting. Dan, do you wanna add anything to that to what Tanya just described? - Yeah, you know, it's really interesting. I know we're very US-centric patient services and the US is a massive amount of spend. I had the pleasure of speaking at a conference in Jamaica at the end of last year and met some of the folks from the Ministry of Health. And one of the things that they're looking to do is disrupt their healthcare market by bringing in digital and be able to leapfrog where they are from a maturity and service delivery of healthcare into the future, which will be a digital-first, digital-only type of experience. They're doing some pilots with telemedicine and so it's really interesting to see what's happening outside of the US in these what I'll call maker markets where you may be less regulated. You may be able to move with faster efficiency as long as you have the right controls in place. And so I thought that was a really interesting thing. The other is around the data, what Tanya said was spot on. There's a value for our clients. There's a value in the data that you have within your patient services ecosystem that's unique. Nobody else has it. And so if you're not mining and getting insights on how to improve care, how to improve starting therapies, how to improve staying on a therapy, how to understand when a patient may need to stop a therapy, that mining that data is so important and so much uniqueness to the intelligence you're gonna gain. If you can action that, you're gonna be much better off and the patients themselves are gonna be much better off. - No, thank you for that, Dan. You know, Tanya, when you think about the collaboration that has to happen to make these programs come to life, how should pharma be rethinking that collaboration model? - That I think is one of the linchpins certainly for making true change. Manufacturers, so life science organizations, payers, providers and advocacy groups have a common interest in facilitating positive patient outcomes. To build trust and achieve this collective goal though, the stakeholders need to start partnering effectively. So not just within individual organizations, but across that ecosystem. More organizations we see are embracing this kind of this patient-centric mindset across their culture. And these firms are earning more trust in that ecosystem. We need to break down those silos. What manufacturers, life science organizations put out in the marketplace? Our research shows that 50% of that is actually duplicated from others in the ecosystem. So really understanding what you're providing, what is your core competency, what else is out there potentially directing patients to that, which may be more of their first source, actually patient advocacy groups in local markets. Patients tend to turn their first. Individuals who are seeking information about certain disease states. And then breaking down the silos internally. Again, some of our own research noted that only 5% of patient-focused marketing and service teams feel that they have an insight and have a strategy for meeting the end-to-end needs of patients throughout that journey. And so that's where we see we kind of need to tear down silos. And there are certainly other parts of our book that goes into more depth around that kind of transformation of organizational structures. The partnerships outside of our own walls is important too. - Oh, I think that's great. Dan, I wanna ask you, when you think about the partnerships angle or even just kind of examples or best practices, what should pharma be looking at or learning from outside the life sciences industry? - Yeah, I think there's a lot within the CPG area, right? So when we think about consumer products and us as consumers, I mean the speed of information and the speed at which you're able to go online on your phone, order something, get suggested something else, order something else, cancel your order, return your order. It's all so fast, right? And that Amazon experience, what you get with places like Zappos and Home Depot, there's a massive amount of interconnectivity within the experiences you're creating and I ask Alexa what the temperature is and she tells me that I need to reorder something that I might have forgotten about and that I'm due to get, right? So there's this interconnectivity and I think just me being a little bit of a geek, right? My home is a very smart home. I have Google, I have Alexa, I have everything connected together. And so I can unlock my front door because it recognizes your face when you come to visit me. And so there's so much that we can do nowadays with how things are interconnected. And so one of the things I think, when you think about pharma and how do we learn from these models? Well, how did Amazon do this? They didn't do this because they went out and got wholesalers for every product. They integrated the supply chain, they integrated the real-time connectivity, they integrated the backend data layer that allowed them to gain the intelligence. And so by doing these things, they were able to create a differentiated experience. And I think for pharma, it's no different. You know, I'll take an example for you. You know, embedding things in EHR, patient services enrollment is still one of the biggest pains in the, you know, and let me use a different phrase. It's not just a pain, it's literally keeping fax machines in business. We wouldn't have fax machines anymore without patient services enrollment forms, I swear. And so because of that, you know, looking at digitization, looking at how do I make it so simple for you to enroll so that I'm not having to fill out a seven page form that half is me, half is my doctor, half I don't know who does it. And so, and then I have to fax it in, you know, my handwriting personally is awful. So how do we get that over in a legible way where people can, you know, process faster, right? Increase my start. And the other part of what we can learn is interconnectivity. You know, EMRs are very hard still to connect to. And even with things like fire standards, which are coming out, and I think they're due in 2024 as well as, you know, some of the other standards like smart on fire, which is like a 2026 objective, they're still not that interconnectivity. And, you know, I was with a client not too long ago and he was telling me about a ride along he did with Rep up in, I think it was Washington state, up in Washington state. And he went to three different hospitals within the same network. Every single of one of them was on a different EMR, a different version of the EMR, and they had customizations that created difficulty connecting to each other, not just connecting outside. And that's where I think that fundamental interconnectivity we've seen from CPG needs to come together. - You know, when you talk about the interconnectivity though, and I hear Tanya talking about silos, it sounds like there is a piece of the interconnectivity that is that data, that is that technology, but isn't there more than that? I mean, what other capabilities do pharma companies pay to invest in? - Some of those capabilities are rooted in their ways of working too. So as I mentioned, you're bringing together this whole ecosystem. Life Sciences has the opportunity to be at the forefront and powering that. But also the experience that they're setting out that differs by, you know, the therapy area that that organization is focused in. So it does go beyond the data and technology to be thinking about how do you support shared decision making moments between patients and physicians, right? Especially if you look at a product that maybe has a titration period or needs certain diagnostic scans throughout that treatment, you want the physician and the patient to be having a productive and both ends in powered conversation. And so that goes into more of the experience realm. It can be powered by data and technology but sometimes just even the simplest discussion guide to sit down and have a conversation about that or track what they're doing from a medication perspective goes a long way in creating that collaboration. And then again, as I mentioned, I don't think that we can, you know, overlook the other types of support that are needed. You know, there was a lot during COVID too around the need for mental health support. Regardless of what therapy you were on or what disease that you may be battling. So finding partners outside of the manufacturer to provide those services to connect patients to that. A lot more was definitely pushed forward. I think during COVID with the remote nature, kind of thinking about digital first connectivity for patients. So we see a lot of those areas now bubbling to the top as well. - Oh, that's great. Thank you, Tanya. Dan, what are some of the innovations you've been seeing? - Yeah, I think, you know, it starts with that enrollment, right? The ability to scan a QR code and instead of putting the burden on the healthcare professionals office and in the staff, just leaving it with the patient, right? Just if you're a patient, you say you're a patient, you're gonna enroll in my services. At some point I might need to validate you, but why don't I just start by asking you your first name, last name, email address or phone number so that I can contact you, get your consent to talk and offer up a value exchange. Show you that I have a wealth of resources and financial support, you know, educational materials, peer connects, community, and things where you're gonna be able to get value out of what I'm providing to you. And then when you may say, okay, well, I wanna sign up for a copay program and I believe I'm eligible, I might ask you for more information. And I might need at some point, the physician to validate that you're on the script. But why have that be the front end of the experience instead of when I've created the value exchange already and you wanna trigger an event. I think scanning a QR code, I've heard of organizations that are working towards NFC chips on their injectors and the packaging. And so being able to quickly immerse into a digital experience where we put the power in the hand of the patient or the caregiver to enroll, I think is really significant. Other places is in the, you know, you hear us talk about data and analytics and we wouldn't be as we didn't, right? Is the ability to predict, you know, can I predict that you're likely going to be afraid, right? I have a family member, definitely afraid of needles. So moving from an oral treatment to a biologic for her, it's not gonna happen. She will stay away from it for the rest of her life because that injection is such a fear factor. What about, you know, costs are so high. If I'm on, you know, an immuno-oncology or immunotherapy and it's $200,000 a year, my cost out of pocket is still fairly high. What's the burden I'm gonna create for my family? You know, and I have to really think about those factors. Also, how can I use things like lookalike modeling to give an experience to someone that worked for somebody like them in the past? And, you know, getting proactive and predictive within the entire patient engagement ecosystem is a huge, you know, stepping stone for where our clients are going and where the industry is headed. - Thank you, Dan. That's really interesting, especially around, you know, all the different ways to use some really advanced, you know, data and analytics. That's a pretty significant investment, though. Tanya, how should pharma think about assessing the impact of some of the investments they're making? - Yes, that is a big topic to undertake and actually one of those change elements to within organization. We see in the industry often conflate activity measures as the same as experience or impact measures. And they're not. While those are leading indicators, activity measures, you know, Dan made mention of enrollment or call volume, click through rates, they're really self-serving. It means your technology is on. It doesn't actually give you more of a, it's really a diagnostic. What it doesn't help us understand is measures around the effort it took the patient to comb through that information or achieve the next step, the satisfaction of that experience. Did it actually reduce the time to therapy and improve outcomes like adherence or symptom reductions? Those made mention getting to patient outcomes, getting to patient impact is really what we should be measuring. Taking in those activity measures, again, as leading that we know things are working, it can give us certainly some signals that patients are reaching our information, but impact on investment need to be going to the outcome that it's really creating. And I think that the future of healthcare exists between two polarities. You know, highly advanced technology that will enable speed, efficiency and customization, even as human-centered care, which is a critical differentiator, you know, drives long-term adherence. That's where getting to those measures, impact measures can help us inform, did we make the right investments? Are these investments that we'll be making a difference for patients and for the industry? - Excellent, excellent. - Yeah, I think-- - Yeah, Dan, did you wanna add anything to that? - Yeah, what Tanya said is great. And, you know, I think one thing for our clients in the industry to think of as a whole, if you're a brand that has 30% of your patients that never start and 40% that drop off between first and second fill and 50% overall that drop off in the first year, there is a business case they're already made, right? If you can just help the patient support. And one of the challenges that we get, right? Well, very few patients enroll in my support program. That's great. Now we need to integrate more, right? How do I take those learnings and actions that I've learned about you as a particular type of patient who's in my support program and then take it as messaging that goes to the doctor, messaging that goes to the office staff, messaging that goes through my FRMs or my field reimbursement teams to go help message and support patients who may not be directly in my ecosystem, but I can use my intelligence and insights to action with other channels and other people that are involved in the ecosystem. And again, it comes back to that integrating and connecting and breaking down those silos. - This has been so fascinating you guys. Thank you so much for sharing your insights with us. Any last thoughts as we wrap up? - I think understanding first the experience that you aim to create for people on your medication and those customers, HCPs and office staff is critical. We see many organizations may have a support program and they lift and shift it to the next product, right? These are a core set of services and it's gonna be the same that I'm offering. A lot of centralized solutions are like that. And it really does leave the patient and customer experience to the end. And I think we have the opportunity to do better, to bring all of the data technology and outside of industry learnings to uplift of what we are delivering to the healthcare system. - Wonderful, Dan, any last thoughts? - I think the biggest one is a vote of confidence, right? You can do it. To our pharma clients, you can do it, right? Oftentimes there's concerns over compliance. Historically, we haven't been able to do things in a disruptive way here. We haven't been able to innovate. But now is the time, you can do it, right? You can really create more patient impact and the return on the investment is there. There's no reason that you can't create a transformational opportunity to do more and impact more patient lives. - Wonderful. Well, thank you both for joining us today. - Thanks, Victoria. - Thank you, Victoria. - This has been the Patient Centricity podcast by ZS. You can find our book "Reinventing Patient Centricity" on Amazon in hard copy or audio. You can also find us at ZS.com. Executive producers, Samantha Keys and Georgiana Moreland. Until next time. (gentle music)