Scott Dulitz, SVP of product innovation, TC Market Access, a division of TrialCard
In a rapidly changing pharmaceutical marketplace that continues to focus on the importance of patient health outcomes, the need to simplify access to treatment while finding new ways to keep patients engaged in their health and adherent, is an undeniably growing trend.
More than a decade ago, HUB programs were initially developed to reduce administrative burden for prescribers by streamlining the process of gaining access to a prescribed medication.
As the marketplace evolved, particularly in the dramatic shift towards specialty medications, traditional HUB service offerings fell short of delivering the impact that the market required. A new approach was needed.
Scott Dulitz, SVP of product innovation for TC Market Access, a division of TrialCard, spoke at the 9th annual HUB and SPP Model Optimization Conference on September 26 in San Diego. He argued that next-generation HUBs must embrace technology, navigate the continuing adoption of specialty medications, and utilize patient-centric operating modules to guide the future of their program design.
RECOGNIZING AN OPPORTUNITY FOR IMPROVEMENT
Traditional HUBs, while offering some benefits to patients, providers, and pharmaceutical companies, fell short in many ways. While speed to therapy was the primary benefit for patients in the early days of HUBs, “many times these programs overpromised and under-delivered,” Dulitz explained.
Something such as a missing signature could cause a patient to see a delay of therapy. In addition, HUBs and specialty pharmacies often duplicated services, causing further delays.
Providers also found that traditional HUBs added a significant amount of administrative burden for their office staff that frequently outweighed the benefits. Poor integration between multiple channel partners caused further confusion, often leaving them to wonder who they should contact for what services.
Meanwhile, pharmaceutical companies were “discouraged by the inconsistent delivery of services and patient experiences, which created a lot of frustration for their field-based sales and reimbursement resources,” added Dulitz. “Incomplete and error-prone data also left significant gaps in pharma’s ability to gain a more robust understanding of the patient journey.”
ADVANCEMENTS IN TECHNOLOGY START TO ADDRESS SIGNIFICANT BARRIERS
To address these shortcomings for patients, providers, and pharmaceutical companies, HUBs are beginning to adopt new technologies to supplement the services typically seen by traditional HUBs. Virtually every HUB has an online, self-service enrollment option. In addition, the widespread adoption of digital signatures for patient consent is streamlining the process.
“The promise of interoperability with provider electronic medical records, e-prescribing, and patient management systems is finally starting to be realized in the marketplace,” said Dulitz, “with more and more programs tapping into these technologies in order to streamline that open enrollment process.”
“E-services are all the rage in the HUB community,” he continued. The adoption of electronic verifications and pre-authorizations is widespread. This allows real-time monitoring of pharmacy benefits. Many HUB programs are now using the well-established ANSI X12 270/271 Eligibility and Coverage Checks for Medical Benefit drugs. Used in conjunction with a robust rules engine, patient-specific out-of-pocket responsibility can be established.
In addition, the National Council for Prescription Drug Programs released an electronic prior authorization standard that is now being embedded by many HUBs into their self-service portals. This enhances turnaround time for prior authorization requests.
As a result of these new technologies, HUBs are also reallocating resources away from enrollment and access functions toward support and engagement. Traditionally, about 75% or more of their dollars were used in enrollment and access functions, but this is shifting.
“If we use validated assessments and third-party data sources inside of HUBs today to be able to risk stratify patients into risk cohorts, that will then ultimately drive personalized interventions and messaging that’s tailored to a patient’s individual needs,” Dulitz explained. In addition, many HUB programs are beginning to capture reported patient outcomes.
DELIVERING EVEN MORE VALUE
Even with recent advancements, including the adoption of new technologies, an opportunity still exists for HUB programs to have an even stronger impact. Dulitz outlined what he called “the five Ps”: payers, providers, pharma, policy, and patients. He identified the critical issues within each “P” that next-generation HUB providers must address to enhance design and keep pace with the changing pharmaceutical landscape.
“The tremendous consolidation of payers in the marketplace has aggregated a lot of negotiating power with a few companies,” he noted. “Next-generation HUBs will need to figure out how to familiarize themselves with the processes and policies, as well as the new initiatives that are being launched by the major payers and PBMs (pharmacy benefit managers) in the marketplace.”
On the provider side, a huge shift is happening from fee-for-service to value-based reimbursement and outcomes-based contracting. In addition, there is a consolidation of care into integrated delivery networks and accountable care organizations that is driving a lot of specialty care out of the community setting into larger, institutional facilities based in metropolitan areas. At the same time, patients are opting for smaller, convenient care and retail clinics for their well and acute care needs, as opposed to designating a primary care physician.
To address all of these provider issues, Dulitz emphasized how next-generation HUBs will need to thoroughly train their agents on the details of value-based care in the marketplace, assist patients with the complex logistics and transitions of care that occur within the larger healthcare entities, and manage relationships with multiple providers while identifying which provider ultimately owns that patient experience with respect to the HUB-supported product.
For the pharmaceutical manufacturers, changes in the types of drugs coming on the market and the competition from biosimilars will have a major impact for HUB programs over the next few years. Many specialty and targeted therapies require companion diagnostics and additional coordination of care. For biosimilars, it’s anticipated that by 2020 most of the 50 approved biologics currently on the market will have biosimilar competition.
“Next-generation HUBs will need to design solutions to address the unique logistical challenges, as well as the access and adherence challenges, associated with some of these newer targeted therapies and biosimilars,” Dulitz explained.
Pharmaceutical companies are starting to appoint chief patient officers responsible for driving patient-centric strategies throughout the entire organization.
“Next-generation HUBs will need to embed patient-centric services and engagement services into their broader offerings,” said Dulitz.
A major issue overshadowing the entire healthcare landscape is policy, which is ever-evolving. Potential major changes to healthcare legislation and drug benefits to Medicare beneficiaries create an uncertain landscape.
“Next-generation HUBs must consider cross-organizational compliance issues that include representatives from both manufacturers and the HUB service provider in order to ensure adequate oversight of these services,” advised Dulitz. “They will also need to be agile in terms of their processes and be prepared to modify their services to address whatever new healthcare landscape ultimately emerges.”
THE PATIENT COMES FIRST
At this point, Dulitz turned his attention to the most important consideration of all – the patient.
“The 21st century patient expects healthcare benefits to be personalized and tailored to their individual needs,” explained Dulitz. “Legacy adherence programs will need to evolve to address this new expectation.”
So what will next-generation HUBs need to focus on so they can drive the most successful outcomes?
“Compliance, compliance, compliance,” answered Dulitz. “And security of patient data will need to be the foundation of every HUB program. This will be non-negotiable moving forward.”
To close his session, Dulitz called upon his manufacturing colleagues to adopt a three-pronged approach to HUBs of the future:
1. Be open to adopting patient-centric agile operating modules. Put the patients at the center of your HUB program design and use the patient journey as a guide for developing new solutions.
2. Consider implementing a HUB center of excellence within your organization with representation from cross-functional teams. Diverse stakeholders will only help ensure consistency across HUB services.
3. Utilize your own market research and data to design HUB solutions that have as their foundation evidence-based strategies and tools.
This article was curated by the MM&M Content Lab, on behalf of TrialCard. The MM&M editorial team was not involved in the creation of this article.