Harnessing data to present a holistic view of a patient’s individual journey can transform how pharmaceutical companies interact with patients and providers—unlocking new types of data stories that can target gaps in the patient experience that must be overcome to positively impact the likelihood of medication adherence.
For one pharma brand, an enterprise data platform (EDP) is doing just that. The manufacturer partnered with ConnectiveRx to enable quick access to identifiable patient information that previously was only available in bits and pieces from multiple locations.
An EDP-based tool can be especially valuable for field reimbursement managers (FRMs), patient advocates who educate healthcare providers and their staffs about product coverage, access programs, and health policy, and who are trained to resolve the often-complex reimbursement issues that create barriers to treatment access for patients. It also benefits patient access specialists, typically the first point of contact for patients when they visit their provider, who handle billing and submitting insurance claims.
A Complete Overview for Field Reimbursement Managers
When FRMs have critical information and supporting documents specific to a case through a single portal, they can quickly access secure individual patient data and speak more accurately about a patient’s individual situation. When a provider calls about a patient but doesn’t have the case ID number, FRMs could easily locate that patient’s case details through a series of focused filters.
Once a verification of benefits is sent to the provider detailing coverage and benefit, FRMs can better support that provider because they have access to the exact same document. This enables the FRM to proactively call the provider to determine if there are questions and walk through the reimbursement information and coverage details as if they were sitting side by side with the office staff. The provider in turn is able to call the patient and fully inform them about the insurance coverage (s)he will receive.
A significant challenge facing pharma brands is a lack of visibility into whether patients have enrolled in an affordability program and if so, whether they are using it. An FRM portal can link patient information across various services to provide that visibility.
For example, a portal can show that a patient started by enrolling in a hub program, then was enrolled on a specific date in a copay program because it was determined (s)he was eligible, the date that the first claim was received, and that the patient is continuing to fill the prescription. This information can be customized according to the brand’s specific data needs.
Keeping Reps Alert Regarding Key Situations
For sales reps, custom dashboards can deliver real-time email alerts when providers have prescribed a specific medication. This gives reps the ability to contact those providers to determine if any assistance is needed with the new prescriptions. Information can be filtered in a number of ways, including by state and rep territory, which helps reps stay on top of what is happening in their territories.
Sales representatives can also identify trend information using patient data. For example, they can set conditions to alert them if the average number of cases begins to drop below a predetermined point when a competitor has entered the market.
Tools such as these help reps to work by exception, better addressing issues that surface and ensuring deadlines are met so patients aren’t at risk of delaying or missing therapy. By integrating hub and claims data, patient benefit verification information can be validated, and appeal information can be flagged so a rep can contact the provider to help address the claim.
In addition, data can be analyzed to determine the difference in prior authorization (PA) turnaround time for those providers prescribing a medication who have requested hub services PA support versus those who have not.
In a perfect world, once a patient receives a diagnosis, the provider would prescribe a medication to treat the condition, the insurance company would cover all or part of the cost, and the patient would begin therapy. Unfortunately, the process isn’t nearly that simple. Leveraging and integrating patient data in new ways is changing how pharma brands interact with patients and providers and helping to get and keep patients on their medication. This data integration is allowing field resources and patient access professionals to have more of an impact than ever before on a patient’s treatment journey.