Pharmaceutical manufacturers have important decisions to make regarding their patient services strategy. This typically involves an ecosystem of partners and service providers that enable a broad range of support services. The adoption of HL7 FHIR is becoming common while the broader healthcare landscape, inclusive of providers, payers, and pharmaceutical manufacturers, also continues to evolve and adapt to policies for data blocking and system interoperability issues. In many patient service programs, we still see a preponderance of healthcare providers and their office staff default to manual processes and use of the fax.
For successful solution deployments to drive the efficiency and effectiveness of a patient services program, careful consideration must be taken to match the right technology at the right place and right time. Centralized hub services can reduce the burden on healthcare providers and improve patient satisfaction. Technology plays a critical role in enabling the overall service offering and supporting the program design.
Below is a series of advancements in technology that must be carefully considered when and how they are deployed for a patient support program. Picking the wrong solution for a given program can be just as harmful as not deploying a technology solution at all.
Consumer engagement enables a consumer to become aware of services and support by leading those consumers to a common digital front door. With the use of QR Codes in a variety of media, your patients can be driven to a generative AI-based solution for awareness and enrollment.
Integrating support services into the prescriber workflow can improve the efficiency and quality of care provided to patients, while reducing costs and administrative burden.
Electronic prescriptions (eRx) allow healthcare providers to prescribe medications and transmit prescriptions to pharmacies electronically. eRx is a powerful intake tool that can improve efficiency and access to support services. eRx transmissions to a central intake pharmacy can streamline enrollments, eliminate unnecessary paperwork, and ensure patients receive proper medication and dosage. However, there are limitations to what can be prescribed electronically and not all programs can benefit from such a solution.
Online portals are web-based platforms that allow prescribers to electronically enroll patients into program services. Portals provide a central hub for provider support, status updates, and views into the patient journey. As patient-mediated medical record release becomes more widely adopted, the ability to auto-populate enrollment forms for more complex medications will evolve and become more common.
Electronic signatures (eSignatures) provide an efficient way to sign enrollment forms and obtain written consent. eSignature technologies are a powerful tool for optimizing the patient referral process while reducing paperwork and accelerating enrollment into program services.
Optical Character Recognition (OCR) is a technology that extracts text from documents and converts the text into a machine-readable format. OCR is used to automate the ingestion of data from documents, such as enrollment forms, insurance cards, prescriptions, and medical records. Manual data entry is eliminated by automating the intake process and improving overall productivity.
Connected Health Services
Technology can reduce the time and effort required to investigate insurance coverage and obtain benefits information. By automating this process, service providers can submit benefit verification requests electronically, and payers can respond with policy and coverage details more efficiently.
Electronic Benefits Verification (eBV) is a digital process used to obtain information about a patient’s insurance policy and coverage. The eBV process replaces the traditional manual process of obtaining policy and coverage information, which can be time-consuming and prone to errors. Consideration for choosing the right eBV solution, including pharmacy benefit, medical benefit, eligibility lookup, and other information, must be included in your program design.
Electronic Prior Authorization (ePA) allows healthcare providers to request prior authorization for a specific treatment. Payers review and approve these requests electronically. ePA solution providers adopt NCPDP standards to support online data collection, electronic payer submissions, and the exchange of prior authorization status information. This replaces the paper-based process of obtaining prior authorization, which can be burdensome for providers, patients, and payers.
Mobile messaging and chatbots are becoming increasingly popular in facilitating patient engagement. Digital assistants provide personalized updates and guided conversations throughout the patient journey. Chatbots can provide answers to common questions and automate patient support communications. Patient engagement strategies include benefit updates, shipment alerts, and medication reminders. Patient responses captured during digital assistant conversations are used to inform case managers and enhance future engagements. Using generative AI, the ability to deliver approved content with minimal effort will become commonplace.
Artificial Intelligence (AI)
AI has the potential to transform patient support, enhance the quality of care, and improve treatment outcomes. AI is being used to automate time-consuming tasks and increase the accuracy of data.
Predictive analytics leverage AI algorithms to analyze patient data and predict which patients require outreach or follow-up. AI engines can combine data from many data sources including social determinants of health and patient engagement conversations to drive meaningful and helpful next-best actions for the patient. This can help service providers intervene earlier and avoid treatment disruptions.
Payer Intelligence can automate the process of verifying patient insurance coverage and eligibility. Through intelligent, generative AI, the ability to collect patient insurance details and payer policies will help determine whether a patient is covered for a specific treatment or service, reducing the time and effort to provide benefits information to the patient and prescriber.
Analytics and Data Sharing
Data Analytics help extract insights and identify trends in healthcare data. Analytics allow service providers to track prescribing patterns and trends in the patient treatment journey, enabling informed decisions about access to therapy and the effectiveness of patient support programs.
Data aggregation refers to capturing and analyzing data from multiple channels into a single database or data warehouse. Data aggregation can help manufacturers access and manage patient data more effectively, improving efficiency with insights into longitudinal patient data.
Pharmacy integration and electronic triage can help streamline the prescription filling process and access to therapy. Electronic data exchange between patient service providers and a network of dispensing pharmacies enables efficient transmission of prescription orders and shipment tracking.
Hybrid systems bring together a manufacturer and their service providers into an integrated platform. This allows manufacturers to collaborate more closely with their partners, enabling them to streamline their patient access and support offerings. By integrating manufacturer and hub services into a single platform, patient support organizations can collaborate throughout the patient journey, from access and reimbursement to prescription fulfillment and ongoing support services.
UBC operates on the leading edge of patient services as a patient-focused, technology-driven company. We are committed to finding the right support system for your unique patient population and therapy. Get in touch with our team here.
About the Author
Michael Calahan is Director, Software Development and Engineering at UBC. He is a technology professional with over 20 years of experience in the pharmaceutical industry while serving in leadership roles with a focus on client service, product development, and digital transformation. Mike leads the architecture, implementation, and governance of UBC Pathways CRM.