Specialty care is traditionally high-touch. With patients, caregivers, nurses, case managers, field reimbursement managers, and more, there are a lot of stakeholders involved to help ensure patients get the medication they need.
At the same time, patient access and support are becoming increasingly complex. Rising prices create affordability issues for patients, with nearly 20% of US adults abandoning a prescription in the past year because of cost. High costs also result in additional scrutiny from payers, who then add more access barriers like prior authorization requirements and step therapy. Complex treatment regimens involving multiple medications and devices further complicate patient access.
You might think this would create a need for even more boots on the ground. But by using a high-tech approach, you can convert manual, disconnected processes reliant on old technology into an automated, streamlined hub. This allows you to direct the human touch to the patients who need it most.
The result? Greater access to your specialty therapy and better outcomes for patients – all at a lower cost. Here are the top features of technology-enabled hubs.
Real-Time Automated Transactions
Administrative transactions like benefits verification, prior authorization, and claim inquiry cost the healthcare industry more than $40 billion annually. Automating these transactions can help cut down on paperwork, improve communication, accelerate time-to-fulfillment, and create efficiencies. Real-time automated transactions include:
- eEnrollment: Lack of patient awareness and the need for signoff from multiple stakeholders can slow down hub onboarding. Help eliminate manual processes and increase the number of patients enrolled in your hub by using manufacturer- or brand-specific eEnrollment forms and capturing consent via eSignature.
- eBV: eBV does more than check eligibility. It provides a comprehensive view of coverage and can help prevent prescription abandonment due to unexpected costs, reduce human error, and increase efficiency. Automated medical benefit investigation reduces dependency on paper, phone, and fax – and could reduce time spent waiting for results from several days to several seconds.
- ePA: Prior authorization is the most costly administrative transaction for providers. 64% of physicians report waiting at least one business day and 30% report waiting at least three business days for PA. 84% say that it puts a high or very high burden on their practice, with an average of 14.6 hours spent on PA each week. It’s so time-consuming, some providers are hesitant to even prescribe a therapy that requires PA. A high-tech hub can provide a fully digital process for PA request, submission, and response that alleviates this burden.
- ePAP: Patient assistance programs (PAPs) are more vital than ever. The ability to accept enrollments and render real-time eligibility decisions based on income, LIS status, and other brand-specific criteria can streamline the process. A tech-enabled hub that digitally integrates candidate assessment for PAP into existing workflows saves even more time and effort.
- Copay: Copay cards help ease the financial burden on patients, but the physical cards and manual processes involved can be cumbersome. Virtual copay cards with electronic claim adjudication and settlement have the ability to electronically accept enrollments, render real-time eligibility decisions, and deliver copay auto-adjudication, making the whole process easier on patients and encouraging them to fill their prescriptions.
Many patient support hubs offer these services, but not all eServices are created equal. Look for a hub that leverages proprietary data and logic in real time and has rules to off-ramp transactions that fail to auto-adjudicate so that support can be provided. In addition, API gateways that unify and streamline third-party apps can help drive connectivity and speed-to-therapy.
Robust Data and Analytics
Quality data means you can not only track the success of your program, but also create better market access strategies and help get more patients on therapy, faster, improving outcomes and improving lives. Data can also help you create a better experience for existing patients and demonstrate the value of your therapy to payers to support favorable reimbursement.
The latest technology-enabled hubs use an enterprise-grade data lake rather than a traditional data warehouse, which allows for greater data interchange. And they leverage enterprise business intelligence tools and real-time API-based data interchanges to drive detailed patient journeys and program performance analytics.
What about reporting on all that data? No one wants to waste hours finding the information they need or piecing together analytics. Robust dashboards will provide both aggregated data and the ability to slice, dice, and create a more detailed view. You should also be able to easily understand program performance, patient journeys, and calibration of automation, to ensure you’re getting the most from your hub.
The hassle of administrative transactions like PA can prevent providers from prescribing medications that require them. Embedded workflows help standardize core patient access service requests, reducing hassle and increasing convenience – so providers won’t hesitate to prescribe your therapy.
With embedded workflows, providers don’t have to leave their own portal to separately engage with the patient support hub after issuing a prescription. These workflows embed with EMRs so that providers can issue prescriptions from their preferred technology. The system helps eliminate the need for manual processes by automatically initiating the process.
Hubs can also link partners in other ways, for example unifying processes across third-party apps and facilitating information sharing. The most tech-forward hubs have powerful API connectivity and configurable modular technology that embeds directly into partner workflows. But they won’t forget about user experience: intuitive navigation, single-sign on, and log-in support help ensure providers use the workflows to the fullest.
Field Reimbursement Support
Technology-enabled hubs leave staff more time to focus on the specific patient access challenges that require the most support. Thus, while technology can help to eliminate paper-based enrollment functions and manual data entry, the human touch remains a vital element in patient support. One common high-touch area is reimbursement.
Additional patient access barriers like prior authorization requirements and step therapy can mean an increased need for high-touch field reimbursement teams to resolve complaints and provide education. Hubs with field portals can deliver brand-specific benefit and usage intelligence around key metrics, empowering field sales with actionable reimbursement insights and timely data.
Technology is transforming the entire healthcare industry, but there is still a need for the human touch. When you strategically leverage both existing and emerging technology and integrate it with personalized support services, you’ll end the wait for patients and end high costs for your program.