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Patient support programs are fast becoming ‘cost of entry’ for new drugs and the pressure to deliver differentiated services with measurable results is building across the industry

By Nagore Fernande... on Jan 18, 2018

Last year, we published the first part of an article looking at the five big pitfalls to delivering effective patient support programs – and outlined the first two of five steps to avoid them. In this, the second and final part, we examine the remaining three steps.

Step three: Changing behavior and improving adherence

In the previous article, we discussed the importance of working with both internal and external stakeholders to understand everyone’s needs and concerns. Yet, even with this insight, patient support programs can still fail to deliver the desired results of patients taking their medications properly and adhering to them.

The reason? The objective is to change people’s behavior, and that means dealing with complex and context-driven human psychology.

Over 17 years of experience of developing patient support programs, we have recognized five ingredients needed to change behavior. They are:

• Deep insight into how patients think, feel and behave
• Health psychology expertise to diagnose the problems and design solutions
• A map of possible therapy failure points to ensure appropriate interventions are in place
• A consistent approach from the insights, to design and delivery of the program
• The agility to respond to individual needs and change.

The deep insight that drives much of this work comes from talking and listening to patients and their caregivers, as well as their prescribers.

Working with health psychologists, we use a behavioral change model that provides a map of the factors that influence behavior – capability, opportunity and motivation. This model helps us to ensure we ask patients the right questions and then make sense of what they tell us, as well as identifying segments based on risk factors and barriers to adherence, then create tailored care plans to counter these barriers.

Behavioral change is embedded in the way we deliver our care plans, and we ensure that the look, feel and messaging of materials are right for individual patients and their specific non-adherence challenges.

It is important to also acknowledge that individuals change over time; they may respond well to nurse support or experience a change in their lives, such as the loss of a partner or carer. Many different factors affect individuals’ risk of non-adherence. Understanding this from the outset – and building in feedback loops to effect change along the way – will lead to better and more consistent results.

Step four: Integrating channels and data

Consider for a moment the many stakeholders and channels involved in communicating with the patient – prescribers, nurses, pharmacists, carers, websites, social media, smart phone apps and patient literature. Each generates data, which is often collected, stored and managed in independent siloes.

Now consider the added layers of communication with a global patient support plan, and it’s not difficult to understand the inherent problem in managing data from different sources within a patient support program.

Disadvantages include:

• No single view of the patient and their needs/preferences, making it is extremely difficult to adapt a program to support individuals
• A limited role for the nurse or care coordinator as they cannot see (or respond to) the full picture of the patient’s care
• Patient experience can feel disjointed (for example, if a nurse is unaware that the patient has been tracking their exercise and adherence in a self-support app)
• Suboptimal operational efficiency (ie, duplication of efforts through different channels, wasted time and unnecessary repetition)
• Difficulty measuring success due to the time needed to pull together and analyze data from different sources.

A global CRM that is purpose-designed for personalized, multichannel PSPs can resolve many of these challenges. Some pharma companies implement this internally, while others use a provider platform (at Ashfield, we use Salesforce Health Cloud).

Such an integrated platform can provide live data and real-world evidence to demonstrate success of a program and help support the value proposition for the brand, offering global reporting, the ability to filter and drill into data, as well as analyze data trends.

Having all the data generated by a patient program at your fingertips allows for agility that would be impossible without it. What’s more, by centralizing patient information, caregivers and healthcare providers can get a complete view of individual patients and their unique needs.

The result is the ability to provide truly personalized care and a seamless patient experience.

Step five: Breaking down the barriers to patient enrollment

In a survey of more than 360 HCPs in France, Germany, the UK, and the United States, only 40% reported being ‘very aware’ of pharmaceutical companies' patient services. The research also revealed that nearly half of HCPs hear about patient services less than 25% of the time they meet with sales reps. When they do hear about patient services, respondents say that only 30% of reps present services in terms of their ability to improve patient outcomes.

Sometimes even the best patient support programs run into resistance and lead to little or no enrollment. This doesn’t mean that the entire program needs to be scrapped, but it does call for a different, more intensive approach to get HCPs and patients to take notice and understand the benefits. 

Field force and nurse teams
The commercial field force has a critical role to play in helping HCPs to understand how to select appropriate patients for therapy, educate them on the benefits of PSPs, and explain how to easily enroll their patients. 

Our top tips to activate the sales force are:

• Ensure the program is embedded into the brand strategy to get the field force on board
• Use your nurse teams as well as sales teams to both sell the benefits of enrollment and help identify appropriate patients
• Equip and train field force and nurses with the right messages and materials
• Consider a patient service team as a highly effective and cost-efficient additional resource to promote the program.

Prescribers and HCPs
The biggest enrollment hurdles are often that HCPs are unaware of the program, that they don’t understand the benefits or that they consider enrollment a burden.

Our advice to address these common issues includes:

• Talk to HCPs to understand their needs and what would motivate them to enroll patients
• Develop clear benefits statements and evidence of outcomes and savings (tailored to the HCP and hospital/practise type)
• Explain that the program is complementary to existing health services and care plan for the patient, not competing
• Gain buy-in from KOLs and patient groups to demonstrate a program’s value and credibility
• Include a system for HCPs to receive feedback on their patients enrolled into the program
• Provide patient feedback and success stories
• Minimize enrollment actions for the HCP and provide different channel options (such as via the web, a Freephone number and traditional fax enrollment).

Patients
When designing a patient support program, it is vital to fully understand patient needs and adherence challenges. Don’t rush into enrollment without considering how these insights can also help you communicate the benefits of enrollment to patients.

We recommend that you:

• Consider how to tailor the enrollment messages and imagery the same way care plans are tailored for individual patients
• Provide multichannel opt-in options and an easy consent process
• Use pharmacists to enroll patients for products dispensed through community/retail pharmacies
• Make sure relevant patient associations understand the support available to patients.

Nagore Fernandez is Head of Patient Services for EUCAN at Ashfield and Nareda Mills is President, Patient Services for Ashfield USA. Ashfield is part of UDG Healthcare plc.