When asked to give a brief assessment for patient support and services, pharma execs and technologists respond, almost to a person, by noting “the state of the union is strong.” They point to the increasing volume and depth of support offerings. They laud the industry for both its enthusiasm and good intentions.
But here’s the thing: “Patient support” means something different to almost every person who’s asked. Some view it as hand-holding over the course of a rigorous treatment regimen. Some consider it an outgrowth of customer service. Others lump it in with other value-adds of dubious value, such as one-size-fits-all nutritional plans.
Thus, it’s a challenge to assess pharma’s progress on the support front. By one definition of patient support, the industry might be earning high marks. By another, it might not have entered the 21st century. The state of the patient support union is kind of complicated.
First and foremost is the question of whether the healthcare business should attempt to provide even economy-class support. “Pharma is excessively focused on patient-centricity. They’re laddering up to this ethereal point of nonsense,” says John Nosta, president of innovation think tank NostaLab and a member of the Google Health Advisory Board. “Pharma looks at Apple in a lustful way, but it should focus on nanoparticle early cancer detection, CRISPR, and all the things — and there are a lot of them — that pharma does well.”
Then there are the traditional worries about healthcare’s historical aversion to risk, and how that could translate into underwhelming support experiences.
“In general, we as a healthcare industry are still relying on traditional ways to support patients, [especially] when it comes to leveraging new communications channels or embracing two-way communications,” explains April Scott, senior director of patient support services at Akili Interactive, a maker of digital medicines, including a video game designed to treat ADHD. “We are living in a digital age, so families expect to be able to communicate via multiple digital channels in a personal and meaningful way. Quite frankly, what patients expect today from digital engagement are simply the table stakes.”
Still, examples of needle-moving support programs have proliferated. For instance, Novo Nordisk has long provided a comprehensive slate of support services to diabetes patients. Similarly, there appear to be new pockets of daring — or at least what passes for daring in pharma and healthcare — emerging in the digital realm. In Italy, Sanofi and Accenture Interactive are currently piloting the UWell platform, designed to serve as a customer data hub and provide support in the form of appointment assistance, reminders, and home delivery of medications.
What patients expect today from digital engagement are simply the table stakesApril Scott, Akili Interactive
At the same time, the industry continues to wrestle with a host of issues around patient support and services. Despite its best efforts, awareness of its offerings remains low. Resources to devote to them, financial and otherwise, are limited. Support teams are often isolated physically from the brand teams with which they’re expected to work, as are the data accumulated by both groups. And it’s an open question as to how much support patients want, not to mention the permission industry may or may not need from patients before extending a helping hand.
So while enthusiasm on pharma’s end for providing advanced patient support and services may be high, this is far from a “build it and they will come” situation. Indeed, it’s more along the lines of “Go ahead, build it. They might come. They might not. Good luck with that.”
Awareness and expectations
Nobody disputes there are numerous gaps in the patient care and treatment experience that need to be filled. Indeed, patient groups, in-house execs, third-party technologists, and behavioral data scientists freely share their frustrations with the current state of affairs. They wonder why a comparatively small number of support programs are rooted in an understanding of behavioral economics as well as why these programs aren’t as customized as the brand- or condition-specific ones designed to reach them in the first place.
Part of this dates back to pharma’s traditional lethargy when it comes to innovating and embracing nascent technologies, but there might also be a bit of a philosophical blind spot. “Historically, pharma has operated off a patient journey that is more a treatment journey than a whole human journey,” says Sara Holoubek, CEO and founder of strategy and innovation consultancy Luminary Labs. “The full journey starts before diagnosis and extends beyond treatment into home and personal life. We’ve only seen so much of that [in patient support] so far.”
This probably explains why patients don’t have all that much to say, whether positive or negative, about industry-backed support and services programs. “Mostly when [patients] think about support, they think about access,” explains Ari Schaefer, SVP of customer experience and co-managing director at Klick Health. “It’s basically, ‘If I get my drug, problem solved.’ But they’re not expecting more.”
The full journey starts before diagnosis and extends beyond treatment into home and personal life. We’ve only seen so much of that [in patient support] so far.Sara Holoubek, Luminary Labs
Perhaps that’s where any patient support state of the union assessment should begin: by addressing those low expectations. Boosters and skeptics alike believe pharma and healthcare have an ankle-low bar to clear and that patients can be wowed by even the smallest support or service gestures.
That doesn’t mean organizations aren’t thinking big. “At Akili, we aim to make wonderful medicine that is not just engaging, but also captivating to the point that, in the moment, patients forget they are taking medicine,” Scott says. “We envision a future where medicine not only doesn’t leave a bad taste in your mouth, but can also actually be fun.” The company is taking concrete steps toward that second aim. “Our philosophy is to form partnerships where we give [patients] as much as they give us. Imagine sitting down with the maker of your medicine to talk about your data together.”
Schaefer and Klick colleague Tim Fisher, VP of brand strategy and innovation, believe expectations for these programs — and for the companies and brands that backstop them — go hand-in-hand with awareness of them. Without assigning blame, they say this awareness is so lacking as to smother expectations entirely.
Generating awareness of support offerings demands more than pressing a case for it via social media, with condition-specific Facebook communities being the one exception to that general belief. It requires a degree of investment that some organizations aren’t able — or willing — to justify.
“You need to think about promoting [support programs] as if they are brands within the pharma company,” Schaefer notes. “You need to communicate about them through the same channels you’re already using to touch the patient.”
Companies might also want to consider a second potential audience for its support offerings. In recent years, HCPs have become a primary target for awareness programs around patient support.
To hear Fisher tell it, this has everything to do with affirming physicians’ confidence in a given medicine. “It’s never going to trump efficacy for them, but you need the physician to feel good about prescribing drug X. ‘I’m on board because I know the support is going to be there,’” he explains. “We’ve built patient support programs that are promoted directly to the physician. The bar has to be higher than just [circulating] coupons.”
The support slate
The patient support success story most often referenced by healthcare execs and technologists is Circulation, which coordinates non-emergency transportation for patients in tandem with health systems and Uber, Lyft, and the like. Since its launch in September 2016, the company has forged relationships with more than 1,500 medical facilities in 45 states. Not surprisingly, one of its cofounders, Harvard Medical School professor and Boston Children’s Hospital research faculty member John Brownstein, Ph.D., sees further opportunities.
“There are so many opportunities across the spectrum of logistics,” he says. “Getting people to appointments is [crucial] because there are very critical interventions as part of that appointment. That broader set of help could include prescription delivery or medical equipment.”
There’s a groundswell to make telemedicine a greater part of the support experience — that is, if the industry can sell would-be users on the depth of care its boosters say such experiences offer. On the other hand, mobile apps may not be the answer the industry hopes them to be. Support via app tends to fail because the app isn’t supported.
“For every app that’s worked successfully, there’s been a whole product team around it,” notes Shwen Gwee, GM, digital accelerator, global drug development, at Novartis. “When [pharma or healthcare] does an app, they hire somebody else to do it. Unless you build it with a team and have somebody manage it through its life cycle, that kind of tool doesn’t succeed in the real world.”
Chatbots can in some ways become better than a clinician. There’s genderless engagement, they can draw on a medical record, they can track your language and communicate with you in a way that’s consistent with your demographic.John Nosta, NostaLab
Gwee is more bullish on the potential of “healthbots” — his blanket term for chatbots and voicebots with health applications — to revolutionize pharma’s service and support offerings. “We live in a world where there are two things we focus on for materials we push out: preapproved content and decision trees,” he explains. “A bot is basically a library of preapproved content, and bots go down decision trees to find answers that have been approved.”
Nosta agrees. “We’ve established humanity as the ideal for all engagements, not just health ones — and I blame [godfather of computer science and AI] Alan Turing for this,” he says with a laugh. “But chatbots can in some ways become better than a clinician. There’s genderless engagement, they can draw on a medical record, they can track your language and communicate with you in a way that’s consistent with your demographic. The question is whether patients are ready, because [chatbots] sometimes kind of stumble after a little while.”
Others say support salvation could come in the realm of the management of chronic disease. “You need to find those moments of wellness in their experience and amplify it, so they become masters of their condition,” Fisher says. He also believes proactive and pre-emptive patient support programs show promise. “The idea would be to design services in advance, so when [patients] encounter a problem along the way, they know what to do and feel a little more in control.”
However, Holoubek warns organizations take a risk in assuming patients will warm to every support offering. “There’s that issue of ‘what do patients need?’ versus ‘what do we think patients need?’” she notes. “There is still not enough understanding of what a patient, customer, or caregiver wants and whether the brand or company offering [support] has permission to do this.”
To this point, Holoubek offers an analogy to another vertical. “We’ve seen brands try to enter other spaces that seem like they could be a fit, but you eventually find they might not have the know-how and relationships to provide [a support or service offering], much less permission. Do you want to buy your music from Coca-Cola or Pepsi?”
The next support wave
In the months and years ahead, look for pharma and healthcare organizations to proceed with care. In pharma, companies with rich oncology pipelines — which is to say, most companies — might consider offering an advanced degree of support for patients undergoing treatment. Ideas that have been bandied about include assistance with child care, possibly in conjunction with local community groups; parking (think valets); housework, both cleaning and handyman-type services; and meals.
There also appears to be enthusiasm for supporting patients around mood and emotion. “I keep wondering why there isn’t a partnership yet with Headspace [a popular meditation and mindfulness app]. When you hear something like 30% of people with diabetes also have depression, you have to think that would be a really smart way to provide support,” Holoubek says.
There is going to be a point of reckoning [with support and service]. Healthcare consumers and patients are going to get so fed up and realize the American healthcare system is broken.April Koh, cofounder and CEO of Spring Health
The only sure bet appears to be that systemic change is inevitable. Incorporating patient experience into value decisions — which sits at the core of all things support- and service-related — will soon be an outcomes-era mainstay, if it isn’t already. So, pharma and healthcare could come to a crossroads sooner rather than later.
“There is going to be a point of reckoning [with support and service],” explains April Koh, cofounder and CEO of Spring Health, which makes a digital mental health platform for businesses and their employees. “Healthcare consumers and patients are going to get so fed up and realize the American healthcare system is broken and so fundamentally different in terms of convenience and efficiency.”