Specialty Patient Continuity Webinar Rewatch

by Yishai Knobel,

Welcome to the first installment in the Specialty Patient Thought Leadership Series.

In this exclusive webinar, five specialty pharma industry experts share their unique perspectives on the opportunities and risks for specialty patient continuity in a post-pandemic landscape. They discuss pain-points,  failures and successes, tools and tech that are working, and insider secrets you won’t want to miss.

All it took was a Global Pandemic to upend the healthcare industry and jumpstart some much needed progress.

Specialty Patient Continuity is often blocked by bureaucracy and risk aversion, but progress is now moving at light-speed, creating unimaginable opportunities. 

This is the specialty patient webinar you’ve been waiting for.

Specialty Patient Webinar Transcription

Transcribed by otter.ai

SPEAKERS

Paul Stanley – HelpAround
Kristine Lemke – (Moderator) Blue Fin Group
Sheila Arquette – National Association of Specialty Pharmacy
Brian Haenni – ConnectiveRx
Ameya Phadke – Chiesi
Yishai Knoble – HelpAround

Paul Stanley – HelpAround

Hello! I am Paul Stanley from HelpAround, and it is my pleasure to welcome everyone to the inaugural event in the Specialty Patient Thought Leadership Series! I am happy to introduce our moderator, Kristine Lemke, Senior Principal consultant with Blue Fin Group, and she has extensive experience across the pharmaceutical ecosystem. Coupled with her Six Sigma black belt, she has all it takes to keep our panel of experts in line today. With that said, I’ll hand it over to Kristine. 

Kristine Lemke – Moderator – Blue Fin Group 

Thank you, Paul – it’s a pleasure to be here, and I’m looking forward to this afternoon’s conversation. It’s also my pleasure to introduce some of the best and brightest minds in specialty pharmacy industry. I’d like to introduce you to Ameya Phadke. He’s here from The Chiesi Group, which is a leading manufacturer of specialty pharmaceuticals. He’s a scientist, turned strategist, turned dealmaker with experience creating and scaling new business models with innovative partners in the marketplace. 

Kristine Lemke – Moderator – Blue Fin Group 

And also second panelist today is Yishai Knoble. He is the founder and CEO of HelpAround, a mobile patient concierge platform for specialty pharmacy. Prior to HelpAround, he led the mHealth platform at Agamatrix, served at Microsoft’s Startup Labs in Boston, and shipped numerous award winning warfare systems in the Israeli Army Cyber Unit.

Kristine Lemke – Moderator – Blue Fin Group 

Also joining us today is Sheila Arquette, she’s the Executive Director of the National Association of Specialty Pharmacy. She’s a specialist in nonprofit organization management skills and healthcare management, health policy and so much more. Sheila’s a strong business development professional, and we’re honored to have you with us today.

Kristine Lemke – Moderator – Blue Fin Group 

Last on the panel, Brian Haenni brings a unique combination of building and managing successful patient services and reimbursement experiences. He has been both on the service provider side at Lash and other service providers, as well as the manufacturer side at BTG, and currently leads the client solutions at ConnectiveRx. He not only has pulled off nine product launches in nine years, he is an expert when it comes to making patient services and reimbursement hub services work for the patient, as well as for the company.

So today, thank you and welcome our panelists, we look forward to a very tight schedule, gaining insights and answers from each of these industry leaders, and so we’ll be moving quickly today. Each panelist will have an opportunity to answer the question for two minutes, and then we’ll have a lightning round of questions at the end. I feel like a game show host today! So bear with me, and we’re going to have fun.

Kristine Lemke – Moderator – Blue Fin Group 

If you have any questions, as those participating in the audience today, we ask that you submit them through the Q&A link found down below on the screen. And if we have time at the end, we’ll give panelists an opportunity to answer them. However, if we run out of time in our fun-filled questions and answers today, please know that all of your questions will be answered offline. And we’ll put those questions together as blog posts, etc. So feel free to introduce yourself in the chat so we know who you are. And we’ll be launching poll questions throughout the webinar today. They’ll come to your screen, just weigh in on those, and then we’ll have a chance to showcase those at the end of the webinar as well. So thank you all for joining.

We’re going to get started with our first question. And this one is for Ameya first, and then Sheila and Brian. 

What has the pandemic forced you to improve or adapt regarding patients? 

Ameya? Would you go first?

Ameya Phadke – Chiesi

Yeah. So thanks for having me here. I think so first off, I guess all I need to say is anything I’m saying is my own opinion not that of Chiesi’s. This also means that I can be a lot more blunt and transparent. So, I think I can speak about patient trends in general. And what we’re seeing in the space, especially in places outside the US, like Europe, it’s forcing markets that were actually quite resistant towards digital health to actually sit up and take notice, right. So especially places like Italy and Spain, which are not known for being sort of the most forward thinking in terms of adopting digital health. I mean, I remember hearing someone quote basically saying that the digital health industry in Europe is now making 10 years of progress in the last couple of months. So it’s really been interesting, right? It’s really forcing these markets to take it seriously. Candidly, I’m not entirely sure how much sticking power it’ll have. I hope it does. But I think that is something that we should also just think about, which is, we found this, it’s forced us into this really interesting way of working. We don’t necessarily want to go into the status quo if and when the situation resolves. But we are, at least for now, we are seeing definitely significant changes, especially when it comes to access to care.

Kristine Lemke – Moderator – Blue Fin Group 

Thank you. Sheila, would you like to add to that, please?

Sheila Arquette – National Association of Specialty Pharmacy

Sure, Kristine. So from our specialty pharmacy member perspective, specialty pharmacies were already very well positioned to deal with the challenges of this pandemic with respect to dispensing and shipping medications and also patient education and disease management. So our focus initially shifted, right away to performing an evaluation of who needs to physically be in this pharmacy, right, to ensure that the medications get to their patients, and who do we have to move to work from home? And what does that look like? And how do we get folks set up? Because traditionally, our staff all comes into the pharmacy. So how do we get folks set up so that they can perform their job duties at home while keeping those key pharmacy personnel safe and ensuring their safety and looking at staggering shifts? And how do we sanitize and make sure that things are clean? Also due to all of the information around COVID. And as I’m sure you’ll all agree, it was often times changing by the hour, especially pharmacists had to try to keep abreast with all of what’s happening around COVID. And then also being a resource – a continued resource around the drug and the disease management. So I think it was setting up different email addresses and trying to triage the information. And also just trying to process all that information so that they could be the best resource as patients continue to struggle with these specialty conditions right in the midst of a pandemic.

Kristine Lemke – Moderator – Blue Fin Group 

Thank you, Sheila. Brian from the patient services support services arena. What are your thoughts?

Brian Haenni – ConnectiveRx

Yeah, so in many ways, we see the impacts very directly, right? So as a service provider helping patients access and afford medications. Medicaid affordability has always been a priority for patients. But now when we speak to patients, we’re hearing more and more stories about a patient losing a job, right, not having insurance, worrying about how they’re going to stay on the medication. And certainly, we have to make sure that we’re continuing to demonstrate tremendous amounts of empathy and act as an advocate for the patient. But we’re also realizing that in this telehealth world, in this remote world, in this … world, we have to rethink and really innovate how our … so that our engagements with patients have to be digital. We’ve got to meet the patient where they are, with the phone that’s in their hand. We’ve had some mobile capabilities for a while things like text reminders, and patient websites. But really what this has done is forced us to look at the entire patient experience and say, ‘Where can we open this up digitally? Where we make more self service options allow patients, really just take more control of the process and really figure out two way interactions that are much more engaging, much more robust, and …? So combining that digital experience with human expertise is really where our focus has really sharpened in the last few months, and we’re starting to make investments in those areas. But I think the first thing that I would say is, is that it’s just the devastation that the epidemics caused from an economic perspective and a job loss perspective that is really coming to the forefront for us.

Kristine Lemke – Moderator – Blue Fin Group 

While we’re talking about the telehealth adoption, I’d like to switch a question to Sheila first which is how is the surge in the telehealth adoption impacted your patients and the patient’s support through the organization.

Sheila Arquette – National Association of Specialty Pharmacy

First I think for our patients, as I mentioned, they were very accustomed to dealing with our specialty pharmacies and pharmacists, right, through either digital means or technology. But, as we know, most of these medications require prior authorization, so I think as our physicians and our provider practices moved to working from home, it was, there were issues and challenges around being able to get in touch with the prescriber to get the information necessary to satisfy either a new authorization or to continue any existing authorizations. So we are especially pharmacists, quickly shifted and trying to work, with the payers and looking at what authorizations could be continued right, based on the patient’s clinical course and how long they’ve been on the therapy and what information absolutely was necessary to obtain … and then working with, the limited capacity of somebody’s office staff to get those patients onto therapy as quick as possible.

Kristine Lemke – Moderator – Blue Fin Group 

And then, Brian, as you were talking earlier about the impact for patients here as well, what are some details that you see the surge of… Is there any segmentation among the patients in terms of telehealth adoption? How has it impacted the patients at ConnectiveRx, sir?

Brian Haenni – ConnectiveRx

Yeah, so it’s impacted, really, all the patients, and what I say is those medications that are, chronic in nature, that model has continued. What we’ve seen though, is patients who may be on a non-chronic or optional sort of medication, we’ve seen quite a bit drop off in terms of their engagement through, really, any channels. And then one of the biggest challenges that we see is one of the primary ways that physicians and patients learn about the kinds of services that we provide has historically been with sales rep interactions, so the pharma comes into the clinic, into the office, provides information… services that they’re offering, and with that model evaporating or going away, how do clients really figure out what programs are available to them? So what we’ve seen is a real request surge from the pharma companies to figure out a way to push the right information to the patient at the right time. So that has led to a growth in the use of the EHR. And EHR patients along with pharmacy systems, right, to provide that right information so that when a doctor makes a prescribing decision, they’re not having to remember what information they may have been told by a rep, about a support program, that information appears to them in real time to be presented to the patient. So again, because of the affordability issues, which are becoming more and more of an issue through the pandemic, this becomes a more critical aspect to make sure that patients who want to access therapies can.

Kristine Lemke – Moderator – Blue Fin Group 

That certainly makes sense. And looking now to the manufacturer side of it – Ameya from Chiesi. What do you see from that?

Ameya Phadke – Chiesi

I think there’s a couple of really foundational issues that this pandemic is actually helping the industry overcome. You know, one of the biggest challenges with telehealth adoption, more so than the patient acceptance was really the provider acceptance, providers actually accepting this. And likewise, even providers being able to bill for things like tele-visits, until only a few years ago, it was actually considered … I believe it was actually considered Medicare fraud if you billed for visit where you didn’t physically see the patient, right. So, that’s the kind of stone age we were in from a systems perspective. And so it was less of an issue of, providers and systems, providers actually taking this seriously was actually one of the biggest issues. And so now, I think, with patients actually, with, because patients also seeing that, right, like they’re able to get access to a lot more services through telehealth than they were otherwise able to, with providers and systems without having to like choose a new provider and things. So I think it’s really if I had to put it in one sentence, it’s really being able to get care that is as close to what they were getting before as the current environment allows or minimizing disruption to sort of their typical way of getting this care. And that’s, especially if you consider that a vast majority of these patients have conditions that require them to see a large team of physicians that require them to have these care teams that they really have to develop these, this is not something you can spin up in a day. I think being able to work in as much of that workflow as possible is really one of the things that’s driven a lot of that change.

Kristine Lemke – Moderator – Blue Fin Group 

Yishai?

Yishai Knoble – HelpAround

I think a big challenge and opportunity that is taking place right now is that a lot of patients actually, they don’t, not just the salespeople, don’t make it to the doctor. Also, the patients don’t make it to the doc. A lot of patients are putting off their visit. They don’t want to get exposed, they stay at home. Telemedicine is not for everybody, people … sometimes it works and it’s awesome and you can see the graph in some of the telemedicine companies. But for some specialty patients, it doesn’t quite work. So this really brings us to ask ourselves, ‘Okay, as an industry that is looking to support patients in this period, what do we do to support patients now that they are farther removed from the doctor?’ So now is the time when patients need to rely on more connectivity with all their stakeholders that are already there. I mean they’re already here. Especially pharmacy and the hub, but now is the time to really step in and bring value to patients because they need that guidance in the absence of the doctor visits.

Kristine Lemke – Moderator – Blue Fin Group 

Any of you, through your patients, have found that there is a preference for telehealth – is it providing where in the past, they actually are getting more out of this connectivity, that there’s a preference that even post pandemic, if things change back to a new normal, if you will, that we’ll see still an uptick and in fact, an enhancement of the telehealth options?

Brian Haenni – ConnectiveRx

Yeah, I can sort of speak to that. I’ve heard anecdotally through our patients, but I also think about my own personal experience. So, I’ve had three telehealth visits since the pandemic, one for myself, and one for each of my children. And in talking with the doctors, they had a preconceived notion about what they could do via telehealth when they started, and they’ve seen that they can really expand it to look at a whole lot of different things than they could before. And so they’re getting to thinking about their practices and their workflow and interaction with patients in a whole different way that certainly there’s always going to be a need, I think, for some level of, in-office visits for a variety of reasons, but I think it’s only going to expand what’s possible. I thought about when I had a sprained ankle for a son and taking the laptop and zooming in towards where the ankle is, and come in and have that diagnosis was fine. We weren’t certainly sure that was the right way, we went in and the diagnosis when we went in was exactly the same as we got via telehealth. So I think we, as patients, will get more comfortable, more confident with the feedback, the diagnosis through that channel. And I think that will lend itself to your conveniences and lend itself to more interacting with a specialist that’s thousands of miles away without me having to make that trip, those expenses. Like there’s all kinds of things to think about, from this early model that really I think it’s very possible.

Kristine Lemke – Moderator – Blue Fin Group 

You talked about the patients, any thoughts of anyone from interactions with the healthcare professional on the other side is delivering quality patient care? In that model of telehealth?

Ameya Phadke – Chiesi

Yes, I think just to, I would say just to follow up on one of the things that Brian mentioned, I do think somewhat of an unmet need, but I think one that we’ll start to see being filled is a lot of these ancillary things that you can tag on to telehealth to really replicate as much of that. So I’ll give you a very specific example. Right. So respiratory care people have traditionally been pretty resistant to telehealth, because doctors are saying, well, I can’t listen, I can’t ask the patient to breathe into the microphone. How am I going to listen to that? Right? But it turns out, you have a number of companies that have actually developed, basically software based diagnosis where you could literally cough into a smartphone. It’s essentially a classifier that’s trained to tell you what you have, which is actually relatively accurate, right. So think through a future state where you’re seeing a physician, let’s say for respiratory, let’s say for a respiratory issue. And the patient says, ‘Look, I don’t feel so good.’ Physician says ‘All right, well, why don’t you cough into this?’ Why don’t you cough into this app? The physician sees the diagnosis on on his or her end and says, ‘Oh, yeah, it looks like your looks like your condition is getting worse, we may want to up the amount of controller medication or what have you, right.’ And so, or having some of these devices that you may be able to pick up like at CVS that can talk directly to the telehealth system. And so having a lot of those, not all those diagnostics can live on a smartphone. But the point is, I think, as we integrate a lot of these into the telehealth experience, for example, with the with the example that Brian gave, you might actually, with training, image recognition is something that we’re actually getting quite good at. And so being able to leverage some of these technologies, so that the physician can really remotely diagnose it, and I think it’s something that the technologies are there. I think we’re going to start to see adoption of those because, spurred on by, say, COVID, but I think it will have a little bit more sticking power. Especially when it comes to getting to, specialty patients that are in these sort of far flung rural communities that may not have a ton of health infrastructure there. And I’m thinking like, someone in the middle of Alaska right, like how can that person be seen by… So for example, if cystic fibrosis patient in some remote community in Alaska. How did they get access to cystic fibrosis expert at, like, Penn, or like a large academic medical center? Well, something that required that person to jump on a plane is, the telehealth of these, I guess, ancillary diagnostics that may actually become something in the very near future.

Kristine Lemke – Moderator – Blue Fin Group 

Great, thank you. I appreciate that. Great!

Yishai Knoble – HelpAround

Can I add on another point? I think the other thing that is already happening, and I think it’s an amazing opportunity for drug manufacturers, is the fact that, it is the same patient … think of all these interactions as interaction with the HCP interaction with the SP interacting with the hub, all these interactions that the patient has, some of them are clinical interactions. Right? So telehealth etc. Some of them are administrative interaction interacting with the hub, about … and some of them are with the SP, right, but at the same patient. So gradually, we’re going to start seeing consolidation into one place, one platform, just like rolling into consuming everything on mobile, everything is coming to mobile. So the HCP interaction is on mobile, the SP interactions are mobile, the Patient Support Program, everything is mobile. And that’s a good thing. Even – you’re going to start seeing digital therapeutics – that also goes on mobile. You will be able to interact with everyone in the same place… That’s really the future I think of patient support, especially for specialty patients who are interacting in so many places.

Kristine Lemke – Moderator – Blue Fin Group 

Sheila?

Sheila Arquette – National Association of Specialty Pharmacy

I just wanted to say that I think this is going to be another awesome tool, right, and an armamentarium for physicians and for providers. Most of the specialty patients are immunocompromised. So for example, we have a chemo patient which is coming in for a follow up and their their ANC is pretty low right? And we’re afraid about exposing them to other people. Well jeez, now we have this telehealth visit that we can do instead, and keep the patient safe, right. And so I think it’ll be a much more tailored approach, taking into account that a lot of these patients really shouldn’t be out during a pandemic or not. Right, we still have cold and flu to worry about. So I think this is going to be great. I think it’s really going to expand our capabilities.

Kristine Lemke – Moderator – Blue Fin Group 

That leads to a question I want to go back to: Yishai, what don’t we know about the patient, currently, that would help enhance the patient experience the most. What have we learned and what don’t we know?

Yishai Knoble – HelpAround

So there’s ‘What don’t we know?’ I think on the individual basic level. And I think the big question is, first of all, who’s We. Right, because we could be the doctor, we could be, the manufacturer, we could be, we could be the caregiver. So let’s assume for a second that, there are a lot of stakeholders that have slivers of information about where the patient is in the journey. And in specialty as we know, this specialty patient journey is really complex. And there’s a lot of handoffs. So this is onboarding, the vendor, the prior auth verification and another handoff to the hub and another from the hub and up to the SP and then from the SP maybe maybe they don’t hold that drug, so they hand it off to another SP. And then you got to send information back to… Our industry is inundated with data feeds. Data feeds, data feeds, data feeds. And which, by the way, from the world of, outside of healthcare, it’s unconceivable that we’re still sending files. So the data feeds are our attempt to exchange data. But guess what, not everybody has one picture of the patient. And that’s the problem. This is an example. The whole ecosystem wants to know whether the patient is taking their meds, and took the first medication, have they used all their benefits. Everybody wants to know that. And by the way, the patient… this is the patient’s information but it’s private information that the patient needs to have the power to share with other stakeholders. So where the patient isn’t a big journey is a huge part that we don’t know today. And the most important thing that we need to keep in mind is we don’t know what they don’t know. What do I mean by that. We the industry, we the people who are supposed to serve these patients, the patient doesn’t know where they are, they don’t know if a prior auth is approved. They don’t know what they’re waiting for. They don’t know if an SP is gonna reach out to them, they don’t know who’s calling them on the phone. So closing that knowing gap is a huge opportunity to provide value to patients, a patient will happily share information back … ‘Oh, I’ve seen what the prior auth says, I see where I am in the drug delivery in a shipment has been sent!’ Hello, Amazon is doing that for 10 years now.

Kristine Lemke – Moderator – Blue Fin Group 

Right, then that knowledge becomes powerful there. So one of the stakeholders then would be a manufacturer. So, Ameya, what is the perspective of what we don’t know from that stakeholder about the patient?

Ameya Phadke – Chiesi

Yeah, I think—and I’m going to throw pretty much all pharma companies under the bus right now—pharma companies fail to acknowledge the fact that patients have issues related to their condition that have nothing to do with taking medication. So pretty much everything that pharma companies have historically done, I call it the McDonald’s toy in a Happy Meal model, right? It’s really to sell more burgers. And I think we could do a lot better if we acknowledge the fact that patients have issues very related to their condition, but which have nothing to do with the underlying medication. Right. And so at this point, you’re really providing, people love to throw the buzzword Patient Centric solution around, I would challenge every pharma company to like what they’re doing, are they really patient centric? Or are they pill centric? Right? Like a patient isn’t something that just takes a pill and then writes us, like, there’s all these other things that go with it. And we’re starting to see a move towards some of that, but I would say that’s one area where pharma—and this isn’t just specialty, this is in general—pharma has just really dropped the ball in terms of going past this, beating the medication adherence drum. And I think we could do a lot better today. be completely candid.

Kristine Lemke – Moderator – Blue Fin Group 

Sheila, some comments from you on this last question.

Sheila Arquette – National Association of Specialty Pharmacy

Sure, Kristine. And to follow up on what Ameya just said, I think that we need to focus more on what are the patient individual goals of therapy? As he said, a specialty pharmacy, focuses on this high touch patient centric, specialized plan of care in services that we provide. And I think we really need to include what does the patient expect, right. An oncology patient’s journey is going to be entirely different, right, from somebody who has cystic fibrosis or RA or Crohn’s disease… So I think we have to periodically reevaluate, right, especially as things change, and tailor what we’re doing for these patients based on what what is, what are the patients expecting, and what is realistic. Right? And then making sure that we share this information back to the caregivers, to the treating physicians, to the health plan. Just to make sure that we are all on the same page, right? And we we maximize that patient journey and we keep it clinically relevant and as cost effective as possible.

Kristine Lemke – Moderator – Blue Fin Group 

It’s interesting that with that of having, as you talked about that, what are the patient individual goals and the patient centric model. There’s the tension out in the marketplace of how do you balance what we know about the patient, the patient information safety, with still being agile in order to help meet that patient where they want to be met, if you will … to have that patient centric model? So Brian, some thoughts from you as to what do we do to balance? How can we be more agile as stakeholders in the industry without compromising patient information safety?

Brian Haenni – ConnectiveRx

Yeah, and I think that’s how I would answer this is gonna, it’s gonna bounce off of what everyone else has just said on a previous level. We don’t know about patients. So I can’t speak from an R&D perspective and making sure medication is safe and effective is paramount. But that’s only as I think everyone just mentioned earlier, that’s the only part of the patient journey without medication. And where I see agility coming from is a better and a more comprehensive understanding and what a patient must overcome to start and stay on those therapies to begin with. So for example, I think as part of the clinical trial process, I would recommend that pharma, and some do as well, but I don’t think it’s universal by any means, is that they invest more on patient engagement upfront, learning about those non clinical financial emotional support aspects. Patients, caregivers, their communities, where are their barriers? Where are the are solutions that patients want and have been able to use, right? So don’t wait until you decide to commercialize a medication before you start to … with that non-clinical profile and these … patient of ours. So it’s not just a day in the life of the patient, but years in the life of a patient. What factors led to this clinically, what was the decision process? Who was involved? When they were making that specialty medication choice? What else is the patient going through socially, economically, emotionally? I think we have to just dig deeper on what keeps the patient up at night. And then what motivates the patient to make changes with regards to the medication, not just the medication itself?

Ameya Phadke – Chiesi

I was just gonna follow up with that. I think Brian really hit the nail on the head, I think we really have to start as an industry, understanding all these other factors that are that actually do end up becoming very critical components of the patient’s outcome, right, even even related to a given medication. You know, I think one of the things that pharma needs to be better at is, it’s interesting, you bring that up, because a number of trials actually will collect a lot of this data. Where things fall through is pharma just doesn’t know what questions to ask of this data or even what to do with it from a tactical standpoint. So you’ll start to see them collecting behavioral data, activity data, and things like that. And then when you ask them, ‘All right, what are you actually doing? Like, what actionable thing is coming out of this?’ That’s really when the eyes start to glaze over. Right? And so, I actually do think what pharma needs to do, the specialty industry in general, is really think from the standpoint of a consumer business, right? At the end of the day, what is your consumer experience like? What can you do? What can you learn about it? And I think the other part of it is, pharma loves to take a very academic approach to risk, right? So lay out every single risk that could show up, and we can mitigate every single one. We’re not doing this. Right. And I think there’s an academic and a more pragmatic approach. I think it’s really about assessing what the magnitude and probability of each risk is. And then, taking that for what it’s worth. It also does help at the regulatory authorities are also sort of reflecting this sort of more pragmatic view, like, to their credit, agencies like the SCR are really trying their level best to understand how these kinds of things can be incorporated into sort of a more right environments we don’t end up in a wild, wild west, so to speak. But I really think it’s as A) being more pragmatic towards risk and then B) actually asking, really diving into ways to measure the patient experience, right? Like how do you quantify the patient experience? And what are those metrics you can use to make sure that you’re either meeting that or not and then being held accountable to it? Honestly.

Kristine Lemke – Moderator – Blue Fin Group 

Yishai what would be your thoughts in terms of how the industry needs to be more agile, and not compromise patient information safety.

Yishai Knobel  

Definitely I agree with Brian and I mean I think on the pragmatic side, the term agile comes from software. …Other things, but the first one that really embraced agile methodology was software. And the move, the predecessor of Agile Software was called waterfall and the waterfall model, the waterfall model felt very often like a waterfall, especially when you hit the bottom. You kind of plan and plan and plan and plan and plan and plan and plan ahead just all at once. Okay, and this reminds me a little bit of a drug launch, where you prepare for the drug launch for two years. You prepare you prepare you prepare, and that’s an inherent challenge in the industry. Now, what do we do? Very often, I think the playbook of launching a drug has become a need, the help in place. I need my contracting in place. I need my patient assistant rolling in place. I need this, I need this, I need this. I haven’t tested anything yet. I’m going to test everything at once when I launch. That is very risky. A very risky approach to do that. So I would challenge anyone either launching a drug trial and program to be very creative here on experimentation. What do I mean by that? I don’t mean experimental, like, the software code will launch and then crash and compromise patient safety and then we all get fired. Probably not a great idea. But an approach that says, you know what, we’re going to launch an unbranded program first. That’s very often the case. You launch an unbranded program before the drug is ready, and you achieve a few things, you start achieving something then you see how people respond to that specific disease. You’re not talking yet about the drug, you start talking to patients, not just to research groups, you will really get some water in the system. And you can really start getting your patients and some companies who we see out there are doing a really really good job in skin conditions. We see a nice experimentation with unbranded programs. But then okay, so you have your learning from that but the second thing is when you prepare the launch of the drug … assume there will be changes. Assume as that how you prepare for rapid changes after you launch, for example, you pick the hub. And after six months, assume you’re gonna want to replace it. What do you need in place in order to easily switch? What infrastructure what connectivity do you need in place so that you don’t have to go over the whole thing and reset it. Go through the exercises of adapting before the launch. After launch work in tiny tiny increments. Because every improvement you run into the MLR. So someone is like ‘No we have a program and it’s gonna be for next year.’ No, give me a program that I can launch every three months. So I can get, so I can see the improvement this is when the drug is already live. And again going back to it for that you need, you can’t have a spaghetti of data feeds. You can have a mishmash of that vendor, that vendor and just launch and hope for the best. You need to prepare the infrastructure and ask the vendor the question. ‘Okay, tell me about the switching off process. Okay, here’s my backbone of connectivity and communication. How do you plug in and out?’

Ameya Phadke – Chiesi

Kristine, I think you may be muted.

Kristine Lemke – Moderator – Blue Fin Group 

My apologies. We could dovetail on that of compatibility. How will the EHR interoperability impact the specialty patient experience. So as you look at that connectivity, and what needs to come together… and we’ll start with Sheila and what are your thoughts about what are the needs there? And how will that impact the patient experience, then?

Sheila Arquette – National Association of Specialty Pharmacy

I think as we’ve been talking about this hour, the specialty pharmacy patient journey is incredibly complex, right? And so we have complexities built in all along the way. It’s the drug, it’s the disease state, it’s the coverage policies of the payer, it’s affordability issues, there’s so much complexity. So I think if the EHR can function as a single source of truth for this patient, and not only with respect to their specialty pharmacy condition and drug management, and also their comorbidities, and what other providers are they seeing, and how do we get a comprehensive 360 degree view of this patient so that we can best manage that. Right, you can’t do it in a silo. I think we’re figuring that out. Right. I think that as we’ve all had to retreat into our homes during the pandemic, we’re adapting, but we’re figuring out it’s very, very hard when you’re siloed, from the people that you’re used to working with. No different here with respect to managing a patient with something incredibly complex or life threatening or life altering. So I think it’d be awesome if this could really serve as the single source of truth to this patient and help us better manage them.

Kristine Lemke – Moderator – Blue Fin Group 

Part of that patient centric and thinking of all the psych social, not just the pill centric that Ameya was talking about earlier. So moving to Brian, what are your thoughts there about this interoperability impact for patient care.

Brian Haenni – ConnectiveRx

And I don’t have a crystal ball other than I think it’ll have, it’ll be a huge domino, right to improve the overall experience. So think about having a common sort of medication or confirmations standard that’s gonna open so many doors to allow you to do a couple things. So we interact with EHR today, but the interaction is almost the practice level, sort of a bottoms up approach because of the only interoperability but just the extreme levels of customization that occur and so you could come up with a data and information standard that was universal. I think you could then from a top up perspective, bring new services, new innovation, to everybody in a much quicker, faster, less expensive model. Because right now, the experience is really as you just mentioned, it’s really centered around the processes of the special drug and not necessarily the patient. So if we can give the physician more information, more tools at the point of prescribing, not only is that going to create office efficiencies, which physicians will love and will enable them or give them more capacity for patient care, which is going to be a part a big part of the patient experience … So again, the goal is to give patients access to the health information when they need it in a way they can use it. This will only move us closer to that patient centered ecosystem. Certainly, it’s gonna unleash and I don’t know what it’s gonna look like, but it’s going to be a wave of creativity and a wave of investment, in my opinion, to create digital healthcare experiences that are going to be more like the experiences we take for granted and other areas of our lives.

Kristine Lemke – Moderator – Blue Fin Group 

Yishai you like to talk more specifically about the EHR interoperability to dovetail onto this conversation.

Yishai Knobel  

Yeah, I think the view that a big, EHR operability opportunity in my view, which is going to happen, is automated handoffs. I think that’s an even bigger opportunity than your access to data because, patients and caregivers, sure, they will have access to their data, but how often is it actionable for them? Actionability is where the point of the script was written. And automatic handoff to the Patient Support Program. Now, now you can really make sure the patient makes it all the way. And I think that’s really the opportunity, and we’re starting to see quite a lot coming up in that area in terms of automatic handoffs from the HCP automatically to the patient support program.

Kristine Lemke – Moderator – Blue Fin Group 

But the details of those handoffs, right, that everything’s created equally will be where the rub is. Ameya were you going to comment a little bit?

Ameya Phadke – Chiesi

I mean, I was going to take a little bit of a… I think, along with the handouts, I was just going to add, I think another massive opportunity is that I think personal health records will actually become something useful beyond just just, sort of Apple Health kit or whatever that’s sitting on your phone. You know, I think the problem is this, personal health record systems that exist right now that really allowed patients to bring their data from, to bring their data with themselves. They tried to build it for everybody, and as a result, they built it for nobody. Um, and so, I think the problem here is this and I especially think about, patients with rare diseases, where patients are typically seeing a specialist who is really like the specialist in their disease. They see a number of specialists who are there to help treat the symptoms that are underlying that condition, so there’s neurological symptoms, GI symptoms, etc etc. You know, though there will often be care providers, nursing teams, etc etc. And we’ve seen patients and families that are literally traveling with like binders of paper and reams like wallets, CDs, because the reality is transporting that data from one point to the other is just, you have to jump through 17 hoops. And so I think we’re gonna start to see the… and there’s already several PHR platforms that have really been built with the specialty or the rare disease patient in mind, I think we’re going to start to see those be used in a more meaningful way just because the friction that the lack of that is causing, it’s bad for anybody but for especially someone like a patient with cystic fibrosis patient or some other rare disease. They’re like, their burden is hard enough without having to throw these bureaucratic things at them. Right. And so, I think we’ll start to see the emergence of PHRs that patients actually want to use. And that’s almost like a feedback loop, right? Like the more patients want to use it, the more useful it becomes, and so on, so forth. So I do think that that’s a massive opportunity that hasn’t really been adopted at scale in this as a patient support service that really will, it’s really a way to ride that wave of EHR interoperability… Without having to make the Epics and Cerners and whatevers of the world be friends with each other.

Kristine Lemke – Moderator – Blue Fin Group 

And we need to work through the regulations of data going from one place to another which is an easy statement to say, but not necessarily when you look at HIPAA regs and all the other aspects of covered entities to ensure Patient Safety/Data safety, which is a fuse there. As we look, I want to go back to Yishai for this last question before we get to the lightning round … and I truly appreciate the the depth of the conversation so far, and the questions that have come in. But as we look at digital adoption, why has digital adoption and specialty pharmacy lagged behind the society as a whole? We’re talking about different technologies here. But why has digital adoption in specialty lagged behind? And your thoughts? We’ll start with Yishai and then go to Ameya and then Sheila.

Yishai Knobel  

So, there are a few, a few levels here. One, I’m not going to go into the whole, healthcare, macro analysis of why healthcare is lagging behind. So let’s focus on why specialty health is lagging behind, either behind general healthcare and in the industry. So, most of the systems that we have in place digital systems were actually designed for retail drugs. And, retail drugs, when prior auth started coming out, this is we are now almost at 50% of all drug spending is specialty. So in a way where the industry is kind of struggling faster trying to adapt their patient support systems, the visual tools to this kind of individual tools to a much more complex boundary. Because specialty is so much more complicated than retail. So many companies in traditional specialty pharmacy are not tech savvy. That’s not what they do for a living, or the patient hubs that tech shows in their, in their background. And you see some agencies that really thrive in building apps for patient flows. But now, when it comes to specialty, it’s a it’s a much bigger and more complicated ecosystem. So if five years ago, you saw drug manufacturers coming out with with mobile apps, I’m speaking about mobile because it’s obvious that everything has to be on mobile, that also trend of the past 5-10 years everything in the patient portal that is available on just my phone. Then then five years ago drug manufacturers you would see come, initiatives like AZhelps by AstraZeneca trying to put out there an app that would handle the cooking program. But guess what? You need expertise in order to build such experiences. So then I think the drug manufacturers realized ‘Okay, we can’t pretend that we can build these things.’ The only – we saw some attempts with Humira complete, which is an app Abbvie put out there is actually pretty impressive effort that only Humira can fund probably. I don’t want to ask how much it cost them but only Humira can go and put a really big infrastructure that would have all the pieces here. Novartis put the Cosentyx equivalent out there. But these are really, you know, its good when the biopharma is launching a drug you can’t build a platform that will handle the hub, SP, prior auth, benefit verification. So you end up with all these partnerships and again, the data. So I think we are now, starting as of the last year or two, drug manufacturers realize that mobile is here and technology is here and that’s not in their wheelhouse and they need help. The next step is that the drug manufacturers are realizing that first you got to plan for digital, and then you start overlaying of services, SP contracts, shipping because you need that digital backbone, otherwise they end up with a database problem.

Kristine Lemke – Moderator – Blue Fin Group 

Yeah, you’re right.

Ameya Phadke – Chiesi

I think I’ll add a little bit of a counterpoint to what Yishai mentioned, which is I think the problem is that pharma has been throwing too many apps at patients. Most of them are atrociously bad. Pharma equates app to experience, right? Um, speaking personally, I use four apps to take up like 95% of my time. I need a really good reason for a new app or whatever it is to break into that mindshare. And that’s something that’s just completely escaped pharma’s viewpoint, right, they equate app to experience. They throw apps at patients with the expectation that it will make them look cool, and then ultimately, nobody ends up using it. And it ends up being a wasted piece. So that’s number one. I agree with you guys’ point. They should not be building these on their own. But it’s really a controversial thing. I think I would venture a guess that a vast minority of pharma companies have actually done any real ethnography and really followed a patient in their home, understood what that experience is. The idea is not to throw an app or some kind of technology tool at a patient, right? The idea is, it’s really about looking at experience and why should a patient use your digital product? Right? Why would they care? Why would they care that you hire X number of developers or partner with X company and put this… they really don’t. Specialty patients have enough of a burden without having to deal with some crappy technology tool that’s ultimately useless to them. Right. And I think it’s, it’s that hubris, honestly, that the specialty industry has had as a whole, which I think has really been its own worst enemy in terms of getting these sort of modernized tools. It’s really been throwing tools with the expectation that patients will use them without really diving into what patients actually want to use. So I think it’s really just being a little bit humble and understanding what patients actually want. And also understanding that not everything needs a digital tool, right. And there are some very low tech, low tech approaches to engage patients that works phenomenally well. Picking up the phone right? Setting up a really well trained call center. It’s actually shocking how good those are at engaging patients. And I will say those approaches are arguably just as good as any mobile app… probably even better in terms of patient engagement rates. So I just think it’s, people are thinking digital first experience. Second, I think they need to turn the other way around and think what patients actually want.

Kristine Lemke – Moderator – Blue Fin Group 

And looking potentially at – even as you talked earlier about that patient centric model, and understanding what all the aspects of the patient and treatment journey and even among patients, their segmentation of what their needs are and the company manufacturers-

Ameya Phadke – Chiesi

Or caregivers, right, especially for rare disease patients. I mean, that’s really what you want to the patient experience is really the caregiver experience. And so, these basic, there’s these basic concepts that a lot of a lot of the industry either doesn’t seem to grasp or doesn’t seem to care about.

Kristine Lemke – Moderator – Blue Fin Group 

Agreed. Going to go into the lightning round, and I hope that this will be a lot of fun and we’ll start with, any of you. I’m going to put out a question to start with. If we could give you a magic wand to change one thing to improve patient continuity here in the specialty space, what would it be?

Sheila Arquette – National Association of Specialty Pharmacy

For me, it would be that all of the folks or all of the stakeholders are taking care of the patient or touching the patient could see what everybody else is doing, right, so that they would truly have a 360 degree view of that patient. I’m very focused right now on how do we get specialty pharmacy to just even talk to retail pharmacy, right? Because they have so much that they both know about the patient in silos, how much more impactful could those interactions be if they were able to share that information? So if I had a magic wand, I’d like everybody to be able to see what everybody else is doing.

Kristine Lemke – Moderator – Blue Fin Group 

Okay! Others?

Brian Haenni – ConnectiveRx

So, two things: one is very much on the practical side, the ability for pharmacies to be able to get the authorizations they need from patients. So that they can ship the medications. If you think about all the miscommunications that happen because they just don’t make that that analog connection. And then I think as a more aspirational, being able to assign, let’s call it digital health sort of assistance for every patient that’s all independent from the EHR and insurance plan, but you’ll see as a concierge for the patient to get appointment scheduling, clinical support, and connect the patients with a relevant program. So the landscape is so complicated, and there’s so many bad avenues that a patient could go down, from a research perspective, that having a smart assistant to kind of help them navigate the world would be really, really impactful. 

Ameya Phadke – Chiesi

I’d like that, too. I again, two things, I think number one is every stakeholder in the value chain understands the entire patient journey, like as from the point of view of the patient, not just they’re not just this specific part of the value you may be responsible for, because I think ultimately that just makes for everyone being… that just helps us understand inefficiencies in the system a lot better. I think the second one is really more about focusing on what patients want – to Brian’s point, right? Something that just helps them navigate the system, as opposed to things that throw cool charts or analytics and stuff at them, which is where a vast majority of digital solutions for some reason tend to focus. Right? I mean, they all focus on sort of the quantified self enthusiasm. 99% of patients don’t fit that … And so I think we should think about giving actionable recommendations without blasting people with data.

Kristine Lemke – Moderator – Blue Fin Group 

Now, who owns the specialty patient experience?

Sheila Arquette – National Association of Specialty Pharmacy

I say it’s the patient. I think the patient’s the ultimate driver. All the stakeholders have accountabilities, but I think it’s that patient who needs to drive the experience and ensure that we are meeting their expectations, right. We serve this master so I say it’s the patient.

Kristine Lemke – Moderator – Blue Fin Group 

…Slash caregiver. 

Sheila Arquette – National Association of Specialty Pharmacy

Yeah, yes, true.

Kristine Lemke – Moderator – Blue Fin Group 

In certain situations, it’s not as many because of the journey together with chronic illnesses that they’re placed there. Brian, thoughts? Do you agree? 

Brian Haenni – ConnectiveRx

Yeah, I agree that it should be the patient. I think that, we talked about all of the different players that are involved in supporting the patients, from diagnosis to shipment to adherence, and it’s really the the specialty manufacturers who’ve got the best visibility into all of those pieces and components today. And so if they on the front end better understand and use the data well, what is going on with the patient clinically, non clinically, and then work with the right partners to support the patient at the right spots along the way. They’ve got a huge role play in terms of orchestrating how all of that aligns, make that patient experience that the patient… because I think … the patient. They’re not going to necessarily know all of the ins and outs that are going to be necessary. I agree, the patient should be the center of it all and choose how that experience would interact. I think they should, but they’re also not privy to kind of all the pieces that are really a part of that journey and that experience today.

Kristine Lemke – Moderator – Blue Fin Group 

Yishai, anything you’d add before the next question?

Yishai Knobel  

Yeah, I think the owner – I think I agree with Sheila and Brian that the owner is the patient, the owner in the sense that they make the choices on the experience, like Ameya said. Which experience do I choose, do I choose the analog one, do I choose the phone one, do I choose the digital one? The owner of the of the experience for a drug, for a journey, is on the brand manager and if the brand has convenient patient services, or it can be the brand manager but on the other hand, every brand needs to come and say ‘What experience do I want my patient to have?’ And and you can’t escape that.

Kristine Lemke – Moderator – Blue Fin Group 

But through a knowledgeable base of what the patient’s and caregiver’s needs actually are and not just about the pill and what the brand wants. But as overall total care.

Ameya Phadke – Chiesi

I mean, even something from my own personal perspective, I think every brand manager should be required to shadow a patient that is part of the target population, and just watch their workflow, watch their daily life, see the challenges they come up against, regardless of whether it has to do with their medication or not. Now, I’ll leave it to the compliance folks to figure out how to do that. But you learn things you’re not going to learn in, like, a focus group or a survey or a table interview. I mean, we really don’t use ethnography nearly as much as we should. And I think, to me, as a brand, I’m not a brand manager, so… but I would say every brand manager understanding the experience around a product, I feel like you have to put yourself in the patient’s shoes.

Kristine Lemke – Moderator – Blue Fin Group 

Couldn’t agree with you more on many, many levels. A little, very provocative question, and a little bit coming out from the left side is, do you think that Amazon will enter the specialty pharma space in the next couple of years? What are people’s thoughts on that?

Ameya Phadke – Chiesi

No, it’s not profitable enough. I mean, I think at its core, Amazon is a logistics company. So I think this is a question a lot of people ask me like, how is big tech going to enter Life Sciences and healthcare? And I think the reality is they understand that, the things that they’re really good at which are really providing the technology enabled services. So do I think Amazon will start to sell services into specialty pharma? Potentially, but are they going to become a big specialty pharma player? I think there’s a lot more appealing areas for them to attack that don’t necessarily require the the level of deep domain expertise. But that’s that’s my own personal view.

Kristine Lemke – Moderator – Blue Fin Group 

Yishai, do you agree?

Yishai Knobel  

Not really. But I … I don’t think we agree on much.

Kristine Lemke – Moderator – Blue Fin Group 

Sheila or Brian, before I get to the last question?

Yishai Knoble – HelpAround

Yeah, I think we could see Amazon coming in through acquisitions, so they’re gonna make pill pack work. Pill pack is getting there. They will make it work on the specialty side gradually, and then they will make more acquisitions – a smaller McKesson… I would be flying to Seattle every now and then.

Kristine Lemke – Moderator – Blue Fin Group 

Yeah, I think they’re gonna buy their way in. Okay, I’m going to switch to the last question for us. We’ve all made the best of this global pandemic we’ve been surviving, and if you think of the classic making lemonade out of lemons – we’re going to get to a new normal. 

What would you personally miss about what happens during the season that we’ve been in, sheltering in place and being a little bit more creative of how to solve our day to day life? 

What will you miss?

Ameya Phadke – Chiesi

I will miss not having to deal with Boston Public transport.

Brian Haenni – ConnectiveRx

Yeah, I think I’m not gonna… Well, what I’m gonna miss is just the spontaneous events I have with my children, right? Lunches together with them. Think I’m gonna miss lunches that I get to have every day with my wife, and I know at some point I’m going to miss working in shorts.

Kristine Lemke – Moderator – Blue Fin Group 

I can see the few comments saying they’re gonna miss you’re working in shorts, too. Sheila, your thoughts before we close? What will you miss?

Sheila Arquette – National Association of Specialty Pharmacy

I mean, I think can be pretty … right? I’ve been in my home longer the past three months than I have in five years. So I’m not going to miss looking at all the things that need to be done and still aren’t getting done. But I think I’m gonna miss, just everybody seems to have this spirit of cooperation and innovation, innovative thinking, flexibility. What are we going to do with this in the best interest of the patient? Let’s not say that we’ve done it this way. We always have to do it this way. What can we do? What do we need to do differently? Let’s just get it done. And so I hope that I don’t have to miss that right. I hope we can continue that when we all get back to doing what we used to do and still look for ways really to move away the bureaucracy and the barriers. Just take care of patients the best that we can.

Kristine Lemke – Moderator – Blue Fin Group 

Truly, patient continuity has changed. And let’s bring forward the thoughts and ideas shared today, and what each of us are doing in the home front with our partners and stakeholders.

And I want to thank you all for joining the panel today. 

For those listening in on the webinar we will be following up with questions and blog posts coming out of all that was received today. And thank you also for the polling that has happened through it. 

So, as we said, best of luck to everyone in continued health and safety as we look to patient care and patient continuity at the core of what we do. Thanks everyone. Have a great day.