Improving Workflows to Impact Patient Access

 |  Erica Conroy, Ph.D., VP, Specialty

Specialty continuity hero contained

Specialty Support Gets a Boost from Technology

Patients can face a great deal of barriers when it comes to accessing and staying adherent to their medications. These barriers include prior authorization (PA), out-of-pocket cost and clinical complexity.

Add a crisis into the mix — hurricanes, wildfires and the COVID-19 pandemic, to name a few — and these challenges can be exacerbated. Interruptions in the medication fulfillment process, loss of healthcare coverage and trouble getting to the pharmacy are all issues we’ve seen surge since the virus reached the U.S. this past spring.1

In fact, a patient survey conducted by CoverMyMeds in the wake of COVID-19 found that 43 percent of patients were concerned about disruption to their treatment routine, while 39 percent reported that accessing their prescription medication was more difficult than before, either because of stay-at-home orders or cost.1

For patients prescribed specialty medication, these access challenges only intensify, as specialty therapies are more complex and much more expensive — accounting for almost half of total pharmacy revenue despite representing just 2 percent of prescription volume.2

While the specialty prescribing process will likely always be complex, a tech-enabled solution built around the patient can simplify the process — and help patients access their medications sooner.3

It’s clear that an integrated end-to-end solution is more important now than it’s ever been.

Connectivity and Continuity for a Rapidly Changing World

In a post-COVID environment, we can’t overstate the importance of connectivity — and the ability to continue care even as an unknown environment continues to evolve.

A connected, patient-centric approach allows us to deliver comprehensive support for patients at every stage of the treatment journey — helping patients gain access in a timely and efficient manner.

Hub services exist to ease the specialty burden for the patients and their care team throughout the access journey — and prevent therapy abandonment. But the traditional hub model can be bogged down by complex requirements and time-consuming processes that, on average, can delay treatment by up to eight weeks.4

This process, reliant on manual phone, fax and paper processes, can be slow and inefficient to getting the patient on therapy quickly.

A tech-enabled hub service model with a consistent workflow is a valuable tool for providers, offering real-time visibility into their patient’s care, as well as access to critical information about patient assistance programs, clinical care management and reimbursement — all from their current workflow. Providers can also capture patient consent electronically, important as virtual visits remain higher than before the pandemic.

In this model, skilled case managers support positive patient outcomes through regular check-ins with patients to help them remain on therapy. During the pandemic, case managers for CoverMyMeds’ patient support solution have tailored and, in some cases, increased patient communication, based on the patient’s unique preferences and concerns.

Through electronic connections with network stakeholders and real-time exchange of information directly within a patient’s case, providers can more easily manage complex prescriptions and help their patients begin therapy. In fact, empowering providers with tech-enabled tools throughout the specialty prescribing process has already helped reduce time to therapy by an average of 27 percent for patients.3

Key Features of a Tech-Enabled Model

A tech-enabled patient support solution can help improve patient outcomes by supporting the right parts of a patient’s journey: affordability, connectivity and adherence support.

Through a centralized dashboard, this model offers:

  • Point-of-prescribing enrollment in support services
  • Initiation of PA, as well as electronic prior authorization (ePA)
  • Benefit verification
  • Copay enrollment
  • Insight into therapy dispense
  • Dedicated patient support from case and field managers

This model is also designed for patient cases requiring intervention and additional support, such as proactive clinical support, behavioral coaching and financial assistance. Technology can take us far, but the human element is important, too. We’ve found these patient-centric programs improve adherence by an average of 10 percent.5

Technology & The Future of Specialty Support

Expertise, continuity, speed and scale are essential factors that drive the specialty patient experience. A support model built with these factors in mind has the ability to deliver timely, expert assistance — even in a healthcare crisis.

Evolving a complex, often manual and time-consuming model with a comprehensive, automated one is an important step in supporting providers and their patients now and in the future.

Sources

  1. COVID-19 & Medication Access, CoverMyMeds, 2020
  2. The Global Use of Medicine in 2019 and Outlook to 2023, IQIVIA Institute, 2019
  3. End-to-End Electronic Support Improves Patient Access for Specialty Medications, CoverMyMeds, 2019
  4. The Impact of Disease-Modifying Therapy Access Barriers on Multiple Sclerosis: Mixed-Method Study, Journal of Medical Internet Research, 2018
  5. RxCrossroads by McKesson data, 2018
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