Your Hub Program Can’t Succeed Without Both High-Tech and High-Touch Support

In the fast-paced world of specialty drug access, you need both people and technology to give patients the ideal level of support. Too often, manufacturers make a critical mistake: choosing one over the other. 

Some go all-in on automation for programs they believe only need a light touch. Others opt for human-only support for programs perceived as complex. Both approaches have serious flaws. People-only programs are costly, and the process is manual and slow- even for cases that could easily be automated. Technology-only solutions lack the nuanced judgment of human intervention in complex scenarios, risking missed details that can lead to stalled transactions or errors—ultimately causing delays in patient support. 

The solution is clear: manufacturers need a patient services partner that seamlessly combines the best of both worlds. CareMetx’s flexible, comprehensive solutions are designed to support every step of the patient journey, strategically balancing technology and human expertise at each critical point. This approach accelerates patient access to life-changing treatments, benefiting both manufacturers and providers. 

The following real-world scenarios illustrate the value of this approach. 

Streamlining Medical Benefit Verifications for a Busy Ophthalmology Practice 

Imagine a bustling ophthalmology practice, handling a steady stream of patients with retinal diseases every day. The doctors here frequently prescribe complex therapies, requiring them to order medications directly from approved distributors and bill the health plan later.  

In a buy-and-bill environment like this, real-time benefit verification is crucial—not only to keep patient care on track, but to assure the practice that their prescriptions will be reimbursed. CareMetx’s electronic solution completes most verifications instantly, allowing doctors to prescribe with confidence and maintain their workflow. 

But when issues arise—such as mismatched insurance details or incomplete forms—CareMetx’s trained support team steps in without delay. They quickly resolve any problems, ensuring that patients aren’t left waiting for the treatments they need.  

This example illustrates why combining both technology and human support is essential for providing patients with the timely care they deserve. Relying solely on one or the other can lead to costly delays and errors, but a seamless integration of both ensures a smoother, more efficient process. 

Accelerating Prior Authorization for Timely Oncology Care 

Imagine an oncology practice where doctors are working to get critical cancer treatments to their patients as quickly as possible. Many of these costly therapies require prior authorizations (PAs), which often delay the start of treatment due to the time-consuming process of paperwork, approvals, and insurance communications. In oncology, these delays are particularly unacceptable, as patient health is at risk and time is of the essence. A survey by the American Society of Clinical Oncology reveals a troubling reality: nearly every oncologist surveyed has seen a patient harmed by the PA process, whether through therapy delays, denials, or increased out-of-pocket costs. 

To prevent these setbacks, providers can electronically send prescriptions to CareMetx’s non-dispensing pharmacy. Here, specialized pharmacists act as an extension of the provider’s team, handling the PA submissions on their behalf. These complex, time-sensitive scenarios require human attention and expertise to ensure both speed and accuracy, preventing any obstacles in the process. This partnership expedites the workflow, ensuring prescriptions are ready to dispense without unnecessary interruption. 

Data Analytics for Field Reps: Monitoring Practice Health 

Imagine a manufacturer field rep working to identify and resolve obstacles to patient access within a network of providers, payers, and manufacturers. It’s not enough to rely on gut instinct—field reps need accurate, real-time data to make informed decisions.  

For example, a practice might be taking three times longer than 80% of others in the territory to complete prior authorizations. With CareMetx’s data monitoring system, the field rep can quickly spot this issue and take targeted action. Armed with these insights, the rep can determine if the office staff needs additional training to speed up the PA process, ensuring patients aren’t delayed in getting the care they need.  

This is a perfect example of how high-tech solutions enable high-touch support, allowing field reps to combine data-driven insights with personalized, on-the-ground action to improve patient access. 

Patient Engagement: Personalizing Care for Chronic Disease 

Imagine a patient with rheumatoid arthritis, a chronic condition requiring ongoing treatment and regular support. For these patients, CareMetx’s patient engagement program automates reminders and delivers educational content through texts and emails, helping to keep them on track with their treatment plan. But while technology ensures that patients receive timely, relevant information, it’s the human touch that truly makes a difference. Nurse navigators and case managers are available for personalized coaching, offering support that addresses the more personal and emotional challenges patients face, like fears and confusion about their treatment. 

This combination of high-tech tools and high-touch care is essential to guiding patients through their long-term journey, ensuring they receive the right information when they need it and the compassionate support they deserve. 

At CareMetx, blending high-tech solutions with the human touch isn’t a nice-to-have—it’s a must-have. Our comprehensive approach reflects a deep understanding of complex patient journeys. While technology does the heavy lifting to simplify the path from access to adherence, it works in tandem with our people. Together, they form a powerful team, collaborating seamlessly to support our customers and enhance the patient experience. 

Use the sidebar to your right to schedule a meeting and learn how the CareMetx approach streamlines access to transformative therapies while providing patients with the perfect combination of technology and personalized support.