Data is the lifeblood of any patient support program, but data access has been a challenge historically. With multiple entities providing or consuming the data needed to facilitate the patient’s care journey, each using different systems, ensuring that a hub can leverage that rich data has not always been easy.
Seamless digital integration has the power to remove these obstacles and revolutionize how hubs operate, whether it’s an external hub like CareMetx or a manufacturer’s internal hub. Thanks to a major initiative at CareMetx, effective integration of all the services and entities involved in delivering an exceptional patient journey is becoming a reality.
Why the Traditional Integration Approach Falls Short
When a drug manufacturer’s internal hub or external hub partner performs patient services such as program enrollment, benefit verification, prior authorization, or patient consent capture, the resulting data is valuable to multiple downstream or complimentary business processes and disparate systems across multiple entities. In the past, data sharing has been enabled by developing point-to-point integrations to and from a single system or entity. This approach greatly slows the implementation process by requiring new development work each time a new entity or system needs to integrate with the hub—for example, if an additional provider begins prescribing the drug and is using an electronic records management (EMR) system or specialty software solution which the hub doesn’t already integrate with.
The problem proliferates due to the many different entities that need to access and consume the data that flows through a patient support program, including providers, payers, manufacturers, other best-of-breed service organizations, and a non-dispensing pharmacy (NDP) or specialty pharmacy. The sheer number of organizations that interact with the patient support program and provide or obtain information through the hub makes the need for efficient integration vital.
Replacing Point-to-Point with One-to-Many
As a leading technology-enabled hub service platform and a provider of innovative patient support and engagement services, CareMetx continually invests in technologies that benefit patients, providers, and manufacturers. Digital integration is one of our areas of investment and the focus of a long-term initiative that will revolutionize hub operations, whether those operations reside within CareMetx or the specialty manufacturers we serve.
CareMetx is transforming how we integrate systems and data, using a gateway approach that eliminates the inefficient, time-consuming point-to-point approach and replaces it with a scalable process that facilitates two-way data exchange. The foundation of this model is the use of the FHIR (Fast Healthcare Interoperability Resources) standard for exchanging electronic healthcare data. By employing a standard that is widely adopted across the healthcare market, and is encouraged by regulatory standards, CareMetx is reducing the friction traditionally associated with integrating the many systems that must share or consume hub data. Exposing our gateway to disparate systems using an existing interoperability standard will enable us to build each type of integration once and reuse it with many different entities, for greater speed and efficiency.
For example, consider how this approach will facilitate two-way data exchange and efficient service delivery when a NDP is involved in the patient journey. The hub can easily pass the patient’s prescription and insurance information through the gateway to the NDP, while the NDP returns a fast, accurate electronic benefit verification back to the hub through the same channel. Additionally, the manufacturer’s customer relationship management (CRM) system or other third-party source can pass patient information through the hub to the NDP for use in communicating with the treating provider or the filling pharmacy. These are just several of the countless transactions that can easily flow through the gateway in this scenario. Now, every entity involved in enrolling the patient and initiating therapy has ready access to the information required to complete the process efficiently and accurately.
The CareMetx gateway will prove beneficial to manufacturers whether they operate an internal hub or outsource their hub operations to a third-party partner. For instance, manufacturers can contract with CareMetx for a patient support and engagement program and receive every completed transaction within their internal hub, in a clean and unified format, across every brand—without having to transform the data or create a new integration point. This single back end will support every manufacturer brand that uses any CareMetx service, such as our NDP and our patient engagement services.
The Benefits Become Exponential
By enabling manufacturers to leverage their initial investments, the gateway approach speeds the manufacturer’s time to market with services that benefit patients and providers. It offers better visibility into the status of the prescription at every stage, and for every stakeholder in the patient journey, including manufacturer field reimbursement managers and market access teams, which is crucial when high-value, life-altering specialty therapeutics are involved.
As CareMetx builds out the network of software providers we partner with, our gateway will pay additional dividends. Embedding our services directly into the provider’s native workflow already speeds the therapy initiation process, reduces administrative burdens for the physician and their office staff, and improves drug adoption. As we integrate with more EMRs, practice management systems, and solutions that support specialists like retina practices, a faster and simpler path to integration will become the market standard.
Of course, all of these advantages ultimately benefit the patient by reducing the time to start a new therapy and helping them adhere to and persist on treatment. By providing easier access to data, faster transaction completion, and better visibility into the entire patient journey, CareMetx is leading the way toward better health outcomes.