From incorporating an open-platform model to creating ecosystems to implementing next-generation technologies, a trio of industry leaders counsels on numerous HUB strategies that will help providers vastly improve the patient experience.
OPEN OR CLOSED?
Traditional HUB service providers have historically taken a very “build it all in-house” approach to delivering services. However, there is the alternative of leveraging an open flexibility technology infrastructure that easily integrates with other best-in-class service providers. What are the pros and cons of both?
Baffone: The traditional “closed system” HUB service model appears to allow for more control of the user experience. Limiting how services are accessed enables providers to dictate add-on service provisions. A “closed system” also allows providers to concentrate efforts on services versus applying resources to updating platforms and enabling interfaces. An open-platform approach improves access to services and reduces long-term FTEs necessary for all stakeholders. It also enables progress consistent with the meaningful use of technology, allowing a collaboration of systems to improve patient care and better navigate the patient’s journey.
Dulitz: From a vendor perspective, the positive aspect of building out all capabilities internally is you essentially “own” all aspects of the client relationship. At the same time, however, there is the risk that trying to be all things to your client might jeopardize your ability to deliver a quality product. If I were to look at this from the client perspective, it’s always nice to have options and vendors that embrace the opportunity to partner with other service providers to create “1+1=3” solutions. Those are definitely easier to work with.
Morris: Today’s access ecosystem is complex and requires HUBs to partner with best-in-class service and technology providers. This creates challenges, as most HUB systems are designed around a call center and tied to an internal CRM that uses middleware to share data with third-party vendors. This is in stark contrast to today’s SaaS (software as a service) or cloud-based technology companies whose solutions are agnostic, deliver best of breed transactions, facilitate the sharing of data, and automate manual workflows.
THE PATH TO INTEGRATION
Based on the rising trend of manufacturers incorporating multiple preferred or best-in-class partners as part of their overall HUB offering, what experience are third-party technology service providers having with some of the traditional HUB providers when trying to execute on this strategy?
Baffone: The life-science companies that have brought the management of their HUB services in house are working hard to improve efficiencies for the provision of services. The current priority of programming interfaces (APIs) for these HUBs seems to revolve around the transfer of information within their standalone portal. A progressive strategy that incorporates working with organizations that allow for integration with various provider-based systems will have the greatest success in moving the needle on improving the user and patient experience.
Dulitz: Partners that have developed well-documented and standardized integration pathways have an advantage. Alignment on the overall objectives of the “ecosystem” is also vital. If one vendor is trying to salvage business tied to manual processes, while others are trying to automate and streamline workflows, it can create challenging dynamics. HUB vendors are better off adopting an agile IT application development model than utilizing more of a waterfall approach to software development. HUB vendors that can seamlessly and quickly integrate their technology with other market-leading solutions are generally preferred partners for building out these newer HUB “ecosystems.”
Morris: Stakeholder access to timely and accurate data is crucial. To make this a reality, three items are important: First, a single utility to efficiently move data between parties, as well as agreement on what data elements should be shared among stakeholders. Second, a mutually agreed-upon data hierarchy adopted by all partners (e.g., master IDs for patients, providers, and payers, etc.) to create a common data language. Third, your data exchange strategy and infrastructure should contemplate compliance and security issues.
E-SERVICES AND BEYOND
As industry entities increasingly develop self-service intake channels and incorporate eService capabilities, what should manufacturers look for when selecting partners for these “new age” HUBs?
Baffone: Along with eService capabilities (i.e. electronic benefits investigation [EBI], electronic benefits verification [EBV], and electronic prior authorization [EPA], a fully integrated HUB offering should support an electronic bi-directional flow of information that allows for true connectivity and automation of patient-services enrollments between HUB and provider.
One must grasp how technology offerings address the challenges of more difficult specialties. EPAs or EBVs aren’t the same for every therapeutic area. Several specialties require a heavy manual lift to conduct these services. A deep understanding of the technology/algorithms employed through a case study approach to the demonstration of service fulfillment is suggested.
Dulitz: E-services have become a cost of doing business for HUB service providers. It is extremely important to be transparent with your clients when describing the current capabilities of your eService product offerings. If there are limitations to the percentage of benefit-verification transactions you can automate, for example, build that into the contract and routinely revisit it during quarterly business reviews with the client. Another key when assessing capabilities is to ensure your partner is utilizing industry-standard transactions versus developing proprietary technology that may be more difficult to maintain as your program grows.
Morris: Seek out technology partners that offer best-of-breed transactions. To that end, look for companies with proven solutions capable of quickly extending the HUB’s service footprint. In addition, manufacturers should insist that partners have an in-depth understanding of the provider workflows required to get a patient onto their therapy. An efficient patient journey typically is facilitated by a combination of transactions, automated workflows, and, when necessary, the ability to engage manual services. And all of those must work in concert within an intuitive, convenient, provider-facing user Interface.
A HUMAN TOUCH
As technology automates and streamlines workflows associated with traditional HUB programs, how is human capital helping enhance the value proposition of these technology-infused offerings?
Baffone: Technology will never replace the human-touch experience. The most important human capital enhancement will be the improved patient interaction that care-provider organizations are able to provide through improved efficiencies. Increased access to tools and services on streamlined collaborative platforms will allow human capital to propel our healthcare system forward.
Applying technology to human capital to enhance system integration and interfaces will ultimately bolster the value proposition of technology offerings more than any single groundbreaking technology infusion.
Dulitz: As technology continues to commoditize some of the traditional intake and access components of HUBs, there will still be an opportunity to leverage highly skilled and well-trained associates to help patients remain adherent to their treatment regimen. Some of the newer HUB technology is utilizing data and algorithms to stratify patients into risk profiles that will help manufacturers determine when a human-to-human interaction is most appropriate and will add the most value.
Morris: The “high-touch” aspect of HUB services is, in part, here to stay. That said, today’s patient-access-technology companies have a lot to offer in terms of automating front-end workflows and powering key patient onboarding transactions. The real time, self-service aspect of today’s provider portal can address a majority of routine cases while identifying and communicating the service requirements of more complex requests to the HUB. This ensures timely manual intervention and problem solving.
THE LATEST TECHNOLOGIES
Most HUB programs generally include an enrollment process, access and affordability support, and some type of ongoing patient-engagement activities. What current technologies are being integrated into traditional HUB programs?
Baffone: TrialCard is a shining example of improving the processes of traditional services such as adjudication of copay programs. By applying scientific knowledge for practical purposes, it has proven adept at collaboration and has become a valuable option in HUB service program administration.
Our assistPoint Microsoft Azure-based cloud services solution provides a comprehensive single destination for patient and provider services. It offers an inclusive resource for manufacturer and foundation financial assistance programs available in the oncology market with ongoing expansion into other specialties. It also offers the workflow tools (tracking, measuring, and reporting) necessary to manage complex areas.
Dulitz: From an enrollment perspective, the ability for providers to self-service through branded portals or integrations with EMR or practice-management systems has reduced much of the redundancy of data entry. EBVs and EPAs have started to reduce the need for HUB staff to call payers and pharmacy benefit managers to understand a patient’s out-of-pocket responsibility for the manufacturer’s product. Mobile technology has allowed patients to opt in to a variety of services that can help them remain adherent and engaged with their therapy.
Morris: Enrollment in financial-assistance programs is integrated and oftentimes happens alongside other patient on-boarding activities. E-intelligence tools, such as a “government health plan indicator,” can flag patients eligible for financial assistance. Once identified, workflow tools can seamlessly move from an electronic medical benefit investigation (MedeBV) to enrollment in a financial-assistance program. Data used in the MedeBV can be redeployed to pre-populate areas of the enrollment process. This makes it easy for providers to complete many tasks in a single, brief work session.
LOOKING AHEAD
What next-generation technologies do you see being potentially integrated with HUB service offerings to enrich the patient and healthcare provider experience?
Baffone: Cloud-based patient and medical provider services that improve access and affordability for patients through a revolutionary, fully integrated workflow solution that connects medical providers and patients to available services and support. The ultimate goal, a vision our company aspires to, is for all appropriate services to live on the assistPoint platform, which seamlessly lives in the institutional or provider group operational roadmap. This maximizes the effectiveness of FTEs dedicated to accessing or providing valuable services.
Dulitz: As clinical interoperability continues to advance in the marketplace, many of the “future” HUBs will look to embed themselves further into the provider’s workflow through EMR and practice-management integrations. In addition, artificial intelligence (AI) has made great strides recently. I could easily envision a reality where AI systems could be leveraged by patients and healthcare providers to self-service via interactive voice response systems or website knowledge bases.
Morris: A technology-enabled patient-access ecosystem will continue to simplify and accelerate the patient’s path to therapy. The on-demand, self-help model is expanding because it offers lower long-term costs, improves services, and is highly scalable. In terms of future trends, on-demand supply chain intelligence is rapidly developing. New tools with automated workflows are helping the provider understand how to acquire the product for the patient in real time, regardless of preference – referral to provider; white bag delivery, and so on.
This discussion was curated by the Haymarket Content Lab, on behalf of TrialCard.
From the June 01, 2017 Issue of MM+M - Medical Marketing and Media
