Overcoming Payer Barriers through the Three Pillars of Hub Onboarding: Rate, Time, Duration

April 7, 2020 Anthony Bianchini

 

Pharmaceutical manufacturers and payers are often at odds over pricing and barriers to new medication access. Payers will typically initiate a variety of cost containment initiatives, including multi-tiered step protocols; prior authorization requirements; tiered copays; deductibles and restrictive formulary evaluations. 

All of these controls cause delays and can pose serious challenges for patients — resulting in either rejection of coverage, treatment delays, or conversion to medications not originally prescribed by the physician.     

To overcome these challenges, manufacturers deploy a variety of access support services that help providers navigate payer approval, while mitigating patient cost.  Hub programs also provide a valuable resource for helping patients comply with recommended medication regimens and in the process achieve better health outcomes.1

Hub programs are designed to impact three core pillars of medication therapy onboarding:

1)  Rate

As many know, this refers to the conversion rate — the number of filled prescriptions divided by the total number of support request forms received. In short, it’s the percentage of enrolled patients who ultimately go on therapy.  Higher conversion rates correlate with better program performance and improved patient outcomes.

2)  Time

This is the length of time it takes for a patient to commence medication therapy after receiving a prescription. Also known as turn-around time, it is the period of time from when a patient or practitioner submits the first request for medication access support to when the patient fills the corresponding prescription.

Some of the typical impediments to this are missing information, signatures, delays in obtaining patient and drug-specific benefit information, prior authorization processes, and required medical tests and diagnostics prior to therapy initiation.

3)  Duration

This is how long a patient adheres to their medication therapy over time. The extent to which patients take medication as prescribed by their healthcare practitioner is another core factor in their ability to achieve wellness. It’s impacted by factors such as getting prescriptions filled, remembering to take medication on time, and compliance with the directions from the practitioner.

How much hub programs can favorably impact these three pillars is key to evaluating their ability to improve medication access and in turn, foster better health outcomes.

Manufacturers are making significant headway in this regard by partnering with hub services partners who can provide specialized expertise in areas such as step edits and prior authorizations, as well as integrated hub platforms. These platforms empower healthcare providers and hub agents with automation capabilities, payer connections and expanded self-service options to accelerate rate and speed and enable a shift in resources to further advance patient adherence. 

At Conduent, we’ve seen our patient reimbursement support programs reduce average time to therapy by as much as five days compared with a direct-to-pharmacy model. Through integrated technology and support, many of the handoffs required in a direct specialty pharmacy model are avoided.

The most effective hub service providers will also offer an omnichannel approach to patient engagement that can produce significant increases in patient adherence. In our programs, nurse care teams lead these efforts, typically achieving 11% or greater improvement in patient adherence over traditional approaches. 

On the whole, pharmaceutical manufacturers who partner with a hub services partner can see:

  • Higher conversion rates with patients gaining quicker access to therapy
  • Better adherence to therapy
  • Increases in average length of therapy
  • Increases in provider and patient self-service
  • Improvements in overall program efficiency

The benefits of a well-executed hub program not only can improve patient wellness, they can enable a greater percentage of patients to access treatment and become more adherent to their therapy — versus patients who go directly to a specialty pharmacy.  While there are costs associated with providing these services, the benefits often financially outweigh hub costs four to one, depending on program design and treatment cost. 

Conduent is leading the way in integrated patient access solutions and customized pharmaceutical hub services and technology. Conduent’s new IntelliHealth platform addresses medication access challenges through a layered approach of diverse third-party data integrations, automation of routine tasks and AI-guided agent actions.

Conduent’s IntelliHealth Access solutions combine people, processes and technology focused on significantly impacting the three core pillars of patient onboarding: Rate, Time and Duration. IntelliHealth drives a patient friendly experience by enabling all stakeholders (patients, caregivers, payers and healthcare professionals) to interact seamlessly to get patients from diagnosis to wellness.

Learn more about Conduent Pharmaceuticals and Life Sciences solutions, and call 844.ONE.CNDT to connect with an expert.

Source:  1 -  “Understanding Prescription Assistance Programs” - National Council on Patient Information and Education (NCPIE)

About the Author

Anthony Bianchini is Vice President and General Manager of Conduent's Pharmaceuticals & Life Sciences Business

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