Specialty Drugs: Promising Future. Complex Reality.

IntroductionSpecialty Drugs Image Final

During the past ten years, pharmaceutical & biotech companies have made significant progress discovering new specialty medications for both rare and prevalent conditions; these advanced medicines are rapidly becoming available to serve niche patient populations. Unfortunately, gaining access to such specialized drugs can be difficult due to HCP awareness, insurance issues, and complex dosing procedures. How would you know if one of these medicines were right for you? Most likely you wouldn’t – an issue which is poised to become an increasing healthcare dilemma within the next decade. Though estimates vary, specialty drugs are expected to account for 45 to 50 percent of total US drug spending by 2020. Yet from every stakeholder angle, our healthcare system is currently ill equipped to manage such explosive growth. Consequently, what can we expect from this shifting landscape, and who will patients depend on to help them access these life-saving treatments?


The age of general medicines for diseases like depression, hypertension, and cholesterol is coming to a close as traditional chronic medications such as Cymbalta, Diovan, and Lipitor, for example, lose patent protection. Generic medications treat these conditions well, to the extent that large pharmaceutical companies are now transitioning into the specialty drug space, a new frontier with the opportunity to drive revenue.

However, specialty drugs are much more complicated than traditional drugs because they require extensive support structures and services. Highly expensive and needing lengthy approvals, specialty drugs create a substantial amount of paperwork well before distribution. Consider that patients often need pretesting for drug suitability, along with all manner of aid from financial assistance to training in self-administration, such as injections. Furthermore, the products themselves may be fragile and frequently involve specific handling and storing conditions before shipment. Additionally, initial administration of the drug generally requires clinician involvement, while ongoing hurdles are found in the form of dosing complexity, patient monitoring and long term adherence plans. A further complicating factor is that drug coverage may fall under a health plan’s medical benefit instead of its pharmacy benefit, contributing to the perplexity of the approval procedure – a daunting process which many patients cite as the most wearisome obstacle among the various steps.

Potential Solution

The uncertainty surrounding patient support within this uncharted territory is evident; no single group (be it health care providers, payers, specialty pharmacy or pharmaceutical manufacturers) has come forward to assume the role of treatment coordinator around these specialty products. Who, then, will assemble the disparate pieces to create a centralized patient care capability? Although physicians and nurses are perhaps best placed to aid in this regard, they are already required by government and other entities to address numerous administrative issues related to specialty drug use, and they certainly cannot be expected to build the solution alone. Specialty pharmacies are in a position to assist in this role since they commonly communicate directly with patients, though they were never equipped to serve this function and lack the capability for extensive patient care coordination. Similarly, manufacturers are uniquely situated to offer support for the drugs they produce, and are now presented with the opportunity to integrate solutions across various pharmacy, payer, and HCP partners. Considering that manufacturers are the most intimately aware of issues concerning their products, such as patient burden and adherence, as well as distribution chain and coverage matters, the potential role fits.

Moving forward, these companies must embrace patient support as a core competency rather than a disjointed set of brand tactics. Subsequently, marketing modification will be a key driver in this shift; manufacturers should replace traditional marketing strategies geared toward mass market drugs with an emphasis on patient focused services. As we further envision this centralized capability, patient experience officers become indispensable, as well as the development of a holistic management platform for patient support. Undeniably, this integrated level of infrastructure will be expensive and complicated to implement – an undertaking further challenged by the varied nature of disease characteristics, product attributes, and supporting partner dynamics within each particular case. Nevertheless, this model embodies Nuvera’s vision of building a world where healthcare organizations put the patient experience first and foremost in their efforts to enhance treatment outcomes.

If Netflix Were In Charge of Your Patient Experience

Several companies in the consumer industry excel at netflixcreating personalized customer experiences.
Netflix leads by example with
a strong commitment to understanding and delivering
exactly what customers want. Moreover, as Steve Jobs put it “A lot of times, people don’t know what they want until you show it to them.” Netflix does exactly that – helps the customer define what it is they desire most.

They achieve this by consistently offering three key features:

  • simplicity & ease of use
  • convenience & speed
  • proactively personal experience

Previously, we have commented on the need to improve patient experiences, and considering healthcare’s history of poor patient satisfaction, the industry could use a creative intervention from an unconventional source. So what might it look like, this Netflix-inspired healthcare experience?

Netflix users enjoy the flexibility of choosing from a wide array of options within a pleasing interface. Similarly, suppose that there existed the simplicity and ease of health data available at your fingertips: access to a single and reliable source of information concerning disease, along with an ability to search for doctors and hospitals based on your preferences, not to mention a wealth of information concerning other patients’ feedback. Additionally, your own reviews would not only generate first rate recommendations, but also serve to help others in their search for patient care. Unified health records would be available, where you and all your doctors could access your health records in one central location.

Netflix offers convenient, real-time access to movies or home delivery within a few days time. Likewise, once you’ve selected your doctor, you may not even have to go to the office every time, and you definitely wouldn’t have to wait there for an hour even though an appointment had been scheduled well in advance. Instead, you could send providers an email or text, and enjoy the convenience of a medical Skype session with your physician, who could give advice and answer questions thoroughly and efficiently. Refills would be predicted accordingly, including delivery right to your door.

Netflix’s business model relies on customer feedback to provide exactly what consumers crave: when Emmy-winning House of Cards was created, the plot, actors, and duration were based on customer preference data which had been collected for several years. Comparatively, how would this customer centric approach translate into healthcare? Imagine that all caregivers (including your doctor, nurse, pharmacy, and lab) knew your needs at different stages of your illness and painstakingly tracked your preferences so that they could meet your expectations at every interaction; the doctor’s office would already know your preferred appointment slot, what time of the day you take your medicine, and when you get your refills. Then they would issue personalized health reminders using your chosen communication channel (text, phone, email). They would know if you struggle financially and would automatically enroll you into a manufacturer’s patient assistance program. In fact, they would even know that several times a month you get discouraged by painful flare-ups and would connect you to several peers for the encouragement and support to get through the day.

Patients are customers; they deserve the very highest level of satisfaction, which has too often been reserved for consumer industries. Conversely, Netflix customers are also healthcare consumers, and as the consumer space becomes richer in providing this level of support, the expectations placed on healthcare may very well evolve into demanding the Netflix experience. Furthermore, though innovation drives progress, it remains equally important to recognize clever ideas already inspiring success around us. When Nuvera designs patient services, we strive to incorporate novelty generated outside of the pharmaceutical industry as cross industry leaders illuminate one of the most important lessons: We must begin and end with customer need.

Not Just Any Help Will Do! Moments That Matter on the Patient Journey

Help at the Moments That Matter Along the Patient JourneyOur previous post called attention to the lonely, disjointed steps along the path of patient journey. Lacking a dedicated guide, patients are left to weigh their difficult care decisions alone.

We believe that the power to create a cohesive, connected patient experience is within reach. So how do we get there?

Specifically, what must organizations do to begin this patient centered evolution?  And how will they know where aid is most essential along the way? Interpreting patient journey and mapping patient experience are the first steps. Primary consideration must focus on patient need: her physical and emotional struggles, the barriers she must overcome to access help, participants in the system with whom she interacts and the channels across which it all occurs. Experience mapping identifies the areas of greatest opportunity to affect health outcomes and change the value of patient experience. We call these crucial points along the patient journey “moments that matter.”

Consider an example at precisely one of these vital instances – hospital discharge:

Jane S. is admitted with acute symptoms of cardiovascular disease. Following intensive care, she is stabilized and discharged with limited instructions on medication dosage from the attending doctor. From this perspective, it would seem her journey has ended. In reality, it only begins – Jane must now learn how to manage this new disease and master self-care while proactively changing a lifestyle that was years in the making. Regrettably, at this stage the system closes its doors. Left without further assistance in regard to behavioral changes or medication adherence, over 50% of patients like Jane end up back in the hospital within six months. This outcome is good neither for Jane nor for hospitals since the implementation of the Affordable Care Act tied hospital reimbursement rates to patient readmission. Alternatively, if Jane were provided with support at this important stage, she would be better equipped for the care challenges that lie ahead of her, motivated to begin those life-affirming changes, and significantly less likely to return to the hospital. In this example, hospital discharge is the “moment that matters” since providing support at this stage has a potential to significantly affect Jane’s health outcomes.

Are there any organizations going above and beyond in helping the patient to find their way? Moving forward, we would like to highlight a number of them in our posts. For today, here are 3 examples relevant to Jane’s story:

  • Inova Health Systems has illustrated their commitment to patient need by introducing a new executive position – Vice President of Patient Experience – and hiring a non-medical professional with a strong customer experience background to provide exceptional patient experiences within their hospitals and outpatient facilities.
  • Wellframe promotes home recovery and adherence; its mobile app allows doctors to remotely track chronic illness patients’ progress at home and provide feedback when necessary. Once a patient is discharged from the hospital, they will continue to engage with their doctor by reporting back on daily, personalized to-do lists sent to their mobile device.
  • CarePort links patients with aftercare, helping them to find quality post-acute care customized to their needs, following hospital release. Because many patients discharged from hospitals still require a number of specific rehabilitation and treatment services, they often have difficulty finding an appropriate provider quickly and efficiently.

Admittedly, there is no single resource available to comprehensively guide patients through such critical phases, though we applaud those pioneering organizations forging ahead in putting patients first. Do you know of other innovators? Please share your examples with us and our readers.

Thank you for staying tuned to Nuvera’s posts dedicated to innovations in patient experience.

What Healthcare Keeps Getting Wrong: The Patient Journey

The diagnosis comes. It is delivered swiftly and the air catches in your chest. You are choked back to mortality, an impermanence that your overloaded day obscures. Anxiety crashes down: What about your family? How will you afford it? Can you get leave from work? The illness itself is a startling revelation, but now you are thrust into navigating the confounding labyrinth that is our healthcare system. So how do you manage it all?

Patient journey is defined as a succession of care events from the point you first experience symptoms through diagnosis, treatment, and eventual outcome of the illness. Consider how confusing it must be to travel along this journey. For instance, you want to educate yourself about the disease, but cannot seem to find reliable sources. In seeking a community of fellow patients to better understand treatment options and shared experiences, you fail to locate a legitimate forum with compassionate conversations. Payment and insurance matters are overwhelming; how do you begin to make sense of coverage and costs? Finally, where do you turn when your specialty drugs require self-injections and you are terrified by the idea of sticking yourself with a needle – let alone doing it weekly, for the rest of your life?

The problem is not simply finding help; eventually you do, but only after exhausting hours of research and speaking on the phone with dozens of people whom you spent weeks locating. You could truly publish a book with all the knowledge you accumulate throughout the process.

Now envision a system less daunting by design. What if there were a dedicated guide connecting you to the right people and serving to lift you through each stage from the informative, yet encouraging words of the doctor through countless events to the administration of life saving medication? Imagine the comfort and relief you would feel as that guide tended to your needs at every step of the patient journey. We believe that healthcare stakeholders (doctors, pharmaceutical companies, pharmacies, payers, etc.) can collaborate in ways that leave behind the stale, stand-alone, disconnected services of the past, while embracing comprehensive solutions in service to the patient. The question is this: who will be the innovator leading the effort to craft this exceptional experience?

Patients are often told that they are not alone in their struggle, yet illness has a considerable isolating effect. A united front among the healthcare community would significantly impact patients’ lives, rendering them not merely a data point within a colossal entity, but a uniquely important human being whose wellness is of absolute importance. Healthcare stakeholders must align and partner together with the goal of placing patients as the pivotal focus of the system – because lives depend on it.

This has been an introduction to Nuvera’s Patient Journey Series dedicated to cultivating innovations in the quest for improved patient experiences.