Looking to technology to support your Patient Services Program? Here are six things you need to know.

Drug Channels predicts that “in 2020, 9 of the 10 best-selling drugs by revenue are projected to be specialty drugs.” With the rise of specialty medicine, many of our biopharmaceutical customers are looking to create and take ownership of their patient services programs. We’ve seen many pre-commercial organizations standing up both operational teams and technology to support these programs, as well as a spike in commercial organizations looking to migrate technology from an outsourced Hub (contract services organization). Their drivers are to take ownership of the technology, the data, and the direct relationship with their patient population.

Whether you’re a pre-commercial organization or contemplating migration from a Hub, there are a few things to bear in mind from a technology perspective.

#1: “Everyone has a plan until they get punched in the mouth.”

Mike Tyson was definitely onto something. We all try to plan, define business processes, and prepare for launch, but reality can be very different when you step into the ring. Stabilize your business processes before considering those complex integrations and additional applications. It’s best to focus on the technology basics first. Do you really need specific integrations or channels such as live chat and SMS from day one? 

#2: Automation (usually) isn’t the answer.

System automation and integrations can remove the need for manual process. If you automate enough, maybe you won’t need that additional case manager. Possibly, and those are no doubt huge drivers for an organization. But sometimes that extra case manager may be a better decision—your technology will automate one business process, while your case manager can execute several.

When considering whether to automate, ask yourself these questions to ensure you’re making sound decisions:

  • How much is the technology investment? You should add a percentage for refactoring your code as your processes stabilize.
  • What’s the effort to do this manually, and how much will that cost from a staffing perspective?
  • Would this improve the patient’s experience or affect the patient’s outcome?
  • Is your business process likely to change?

#3: It’s a perfect time to consider your process vs. the Hub’s.

If you’re migrating from a Hub, you have a blank slate to work with. Consider your approach carefully and use this to your advantage. Hubs have considerable experience and mature I.T. teams, and their fee structure is typically driven by transactions. Let’s say a Hub charges you based upon the number of patient enrollments processed. That can lead to a system that connects all tasks and interactions to that enrollment. The enrollment is then at the heart of the process. If the patient discontinues therapy or submits a new enrollment, the process then starts all over again with a fresh enrollment as the next transaction.

But what about all that history, all of those previous interactions surrounding the first enrollment? It’s no longer easy to visualize the full extent of the patient journey, see the notes from your previous interactions, or reuse information.

This leads me nicely to my next point: putting the patient at the center of the process.

#4: Put the patient at the center.

Don’t think about a patient as an enrollment in your program. For most therapies the journey patients follow is far from linear. There are discontinuations, restarts, and potentially multiple enrollments for the same patient and indication/program. Ensure your system keeps the patient at the center of the process where you can view every interaction, on a single page, regardless of how many enrollments there have been. This will lead to a more connected patient journey and a better experience for the patient.


Don’t think about a patient as an enrollment in your program.


#5: Ensure you can spot those operational capacity issues. 

A patient's journey has dependencies. For example, you must capture insurance information before running a full benefits investigation. When a patient is enrolled, many systems will generate every task that’s needed to support the full patient journey upfront. The challenge here is that most of these tasks are not actionable or relevant until the predecessors are complete. Another issue is that you cannot predict when tasks are due. If a patient doesn’t have their medication, how can you define an adherence schedule?

Ensure your system only generates tasks when they’re actionable and have a due date. This ensures you have good visibility on your case managers’ workload. If you fail to do this, it can become very difficult to truly understand whether you have capacity issues, since many of those tasks are just noise until they’re actionable.


Ensure your system only generates tasks when they’re actionable and have a due date.


#6: Don’t be a policeman unnecessarily. 

We’re often asked by customers to build in process enforcers and validation. This can make sense, to ensure you’re compliant or manage risks to patients or your organization. But it’s critical to strike a balance between what the system enforces vs. the standard business processes your agents are trained to follow. Too rigid a tool leads to system complexity which comes with cost to build and maintain—and, frankly, a really bad user experience.

This is especially relevant when you don’t have stable business processes—you risk high levels of rework to accommodate change. One great example we always get is, “If we don’t have consent from the patient, the system should block all future processes.” That sounds logical, but if all processes are blocked, how do you intend to get consent from the patient? To quote Yogi Berra, “In theory there is no difference between theory and practice. In practice there is.” In this case, a red flag indicator is often a better solution.

In summary, stabilize your business processes and ensure you build yourself a strong foundation in which to grow and innovate. You can’t do it all at once, but with a new patient services program, you have the opportunity to make sound decisions that will set you up for success.

Oliver Dunford

Author Bio

Oliver Dunford leads Mavens’ Patient Services Practice. Oliver has over 8 years of industry experience and has been a technology consultant for 11 years. With Mavens for the past 5 years, he has led several patient services projects and worked with customers from emerging pre-commercial through top-10 global organizations.