COVID-19 is quickly and dramatically changing our world. The healthcare industry is the tip of the spear in fighting the pandemic, but the industry is also experiencing some of the most rapid and far-reaching changes. For specialty pharma, our response to the new normal and the needs of our patients will determine success or failure in this very challenging season.
Drug Channel’s Adam Fein released a three part series named Coronavirus Industry Impact on the specialty pharmaceutical segment, based on a survey of specialty pharma leaders, covering many facets, including supply chain, warehousing, retail vs mail-order, providers, and payers.
But not much is being said about how this is impacting the patient experience, specifically the specialty patient experience that traditionally involves a multitude of touchpoints. At HelpAround, our mission is to make patients’ lives easier, so we wanted to share some observations from the patient’s perspective.
Patient Experience Challenges
Continuity is a popular buzzword right now: business continuity, leadership continuity, financial continuity, economic continuity…. For specialty pharma, Patient Continuity refers to how patients are able to stay in touch with healthcare workers when traditional communication channels are eliminated or severely constrained.
This raises a few questions for patients:
- Is my prescribing physician still available?
- Should I look into backup pharmacies?
- Can I order a refill for home delivery?
- Is my insurance going to change? How is the cost of the drug going to change?
- Should I hoard medical supplies?
- My caseworker is suddenly unavailable – where do I find answers and information?
Even the providers (clinics, pharmacy, hubs, payers) are encountering challenges, including:
- Adapting to remote working
- Navigating disruptions to healthcare facilities due to reconfiguration for virus protocols
- Maintaining staffing levels at call centers due to child care needs
What will these challenges look like in the short and long term? How can patients interact with the specialty pharma ecosystem in a way that is convenient, easy, and secure in this new era? How will we provide continuity to patients?
Patient Experience Opportunities
Many of the pandemic challenges are being addressed through technology. Industries around the world are adopting digital channels for both internal and external communication because, frankly, what choice do they have? Within specialty pharma, Adam Fein says, “This has the potential to spark a wave of technology and HUB/SP call centers will shift to more digital friendly engagement.”
Over the past few years we have seen many technology solutions for specialty pharma. Almost all of the successful ones connect back office systems to make transactions faster or cheaper. These include solutions that digitize traditionally analog transactions such as prescriptions, prior authorizations, and copay programs. These improvements impact the patient experience, but indirectly.
The patient-facing hub industry often markets a web interface as a technological solution. However, this falls into a trap that Neal Khosla described: “The industry’s dirty little secret is that ‘tech enabled service’ means ‘service where we built some software that hardly makes a difference.’ They still have a person doing most of the talking directly to the patient.”
To be fair, this is not unique to specialty pharma. Khosla also says, “Investors have poured over $30B into digital health since 2011 but what material change can we point to in health care costs or the experience of the average patient?”
How can we take advantage of this opportunity to improve the specialty patient experience in the current global pandemic and beyond?
We See Three Opportunities
1 – Reformed Regulation on Technology
The difficulties that the healthcare regulatory environment creates for innovation are many. Change has been slow, and often for good reason — protecting the patient is paramount. However, there is agreement on many fronts that regulations should be better suited for our current digital world, but changes have been slow. Nikhil Krishnan explains (in his comic style) how regulations are changing with less resistance in the current environment. “Right now, multiple issues in the healthcare system have been exposed extremely quickly and everyone is interested in fixing them simultaneously. It’s also a time where if you’re an interest group pushing back against a law, you look like a huge asshole. So passing a lot of temporary regulations that are common sense is getting very little pushback.”
HHS unleashed a surge of telehealth innovation by announcing their relaxation of enforcement for non-HIPAA-compliant communication platforms. “Covered healthcare providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”
The adoption of consumer tele-conferencing has been broad and swift, with two main advantages. First, workers and patients are learning technology tools in an immersive environment. When there are no alternatives, even the most reluctant are using the tools and increasing their technological aptitude.
Second, procedures and processes are being edited and adapted for technology. For example, exchanges of papers and pens, even in clinical environments or through the mail, carry risks of virus transmission. So when a form can be signed on a patient’s personal device, the anti-viral benefits make the digital solution the first choice.
Will this last after social distancing is behind us? We don’t know, though Krishnan notes that “We’ve already seen huge spikes in usage of Chinese telemedicine platforms + willingness to try more digital tools in the future.” So yes, probably.
2 – Friendlier Payers and PBMs
The fee-for-service world of US healthcare often makes industry cooperation difficult. Value-based care is starting to chip away at these barriers, and the current environment now makes any resistance to multilateral cooperation a public relations nightmare. Fein notes that “Many respondents expect that the coronavirus pandemic will tarnish the reputations of pharmacy benefit managers (PBMs) and insurance companies. Unsurprisingly, the only group that disagreed with this assessment were the respondents from PBMs, health plans, insurers, and plan sponsors.”
Much of this disagreement comes from examples like copay accumulators that appear to only bring benefits to part of the ecosystem while adding complexity. We can hope that future changes will have more benefits to the patient and the ecosystem overall.
Krishnan brings up a change that requires cooperation and is starting to gain traction — skipping prior authorizations. It is a complicated issue, and he summarizes the pain points well. “Doctors hate them because they feel like they have to jump through hoops just to appease the insurance companies, but insurance companies use them to make sure doctors try cheaper but cost-effective alternatives first. Unfortunately it’s a huge hassle for everyone and there are entire administrative layers built just to handle prior authorizations on both sides.”
He proceeds by connecting that idea to doctor scoring and offers a wonderful rumor: “It would be cool if reputable doctors (via the legitimacy scoring?) could skip prior authorizations. I’ve heard some insurance companies potentially building products like this.” These types of innovations would indeed make the specialty pharma experience less complicated for all involved, including the patient.
3 – Healthcare Embracing Agile
The last area where the crisis can help is healthcare embracing agility. We are seeing incredibly rapid responses to problems driven by companies that have agile mindsets, with examples like Tesla, Dyson, and several others providing solutions to the ventilator shortage problem in days. Many of the genetic pharma companies — often built like agile technology companies –are finding ways to shorten the time it takes to find treatments and/or a vaccine.
In the age of COVID-19, agility is about survival. If you don’t adapt quickly, people and businesses will die. The experience of the Seattle Flu Study in the New York Times is a great example of how agility helped save lives despite the regulations in place. The article notes “But the Seattle Flu Study illustrates how existing regulations and red tape — sometimes designed to protect privacy and health — have impeded the rapid rollout of testing nationally, while other countries ramped up much earlier and faster. Faced with a public health emergency on a scale potentially not seen in a century, the United States has not responded nimbly.”
Healthcare has been slow to adopt this mindset, and is reluctant to accept it in vendors. The regulatory environment and the need to “do no harm” are limiting factors. However, there are many ways to be more agile while not sacrificing the foundations of healthcare.
We have seen some recent agile examples such as GSK and Sanofi partnering for vaccine research and J&J cooperating with BARDA to quickly and significantly increase their vaccine production capacity; however most of these are around sharing Intellectual Property rather than using agile technology to significantly change existing processes.
Khosla notes in his conclusion that healthcare needs to “allow companies to test and iterate fast in a responsible way.” He goes on to develop this idea further, mentioning ideas such as developing sandboxes for fast and responsible iterations and focusing on helping innovative companies develop products, not testing perfect ones.
Adoption of these ideas will make improvements faster to implement and improve, with the patients reaping most of the benefits.
COVID-19 has given the industry opportunities to change the specialty patient experience, especially through technology. This can be helped by the revision of regulations, higher cooperation within the industry, and embracing more of an agile mindset to improve the speed of innovation.
We believe specialty patients will see dramatic improvements in their experience through technology. How much and how fast are the only questions.