Informa Connect Hub West 2022 Post-Conference Brief: Hub Strategy & Tactics Highlights

The 2022 Informa Connect Hub West conference included several presentations focused on hub strategic and tactical issues. We are pleased to provide the following highlights from those presentations. 

Fireside Chat: Profiling Partner Expectations and Excellence 

Tom Tsilipetros, Senior Director of Market Access, Fresenius Kabi USA

Tricia Sterling, Vice President Patient Affairs, Aeglea 

Tom and Tricia led an interactive discussion focused on identifying the attributes of a good hub services vendor partner. They opened the conversation by exploring the decision as to whether or not to outsource hub services in the first place. Some of the questions to consider include:

• What is the size of the patient population?
• What are your competitors doing with their hubs? (What are patients and HCPs used to?)
• What is your budget?
• What is your brand philosophy? (Need a partner that matches.)

The speakers described how the patient services program vendor landscape has evolved recently. For example, there has been an expansion in the number of large vertically integrated companies such as Cover My Meds/RxCrossroads, Lash Group, and Cardinal Health. These large companies provide multiple access services and have deep pockets. Tom and Ticia also called out a second group of provides that are smaller, newer, or independent: AllCare, Asembia, AssistRx, CareMetx, ConnectiveRx, Eversana, PharmaCord, TrialCard, and UBC. Many of these are owned by private equity companies and are perceived to be more flexible and less rigid than the large integrated providers. Interestingly, Tom noted that in large part, all these companies provide a similar range of services and it is hard to differentiate one from another.

So how is a hub services buyer to choose between providers? In many ways, it boils down to relationships: current relationships, previous relationships, etc. Still, it is important to take a measured approach to the vendor selection process, including gathering multi-stakeholder input from across your company and using a scorecard of vendor requirements/expectations. The speakers suggested a 4-quadrant vendor analysis: Experience, logistics, philosophy, and cost.

1. Experience
   1. Therapeutic area
   2. Branded vs. biosimilar vs. generic
   3. Large pharma vs. small pharma client
   4. Medical vs. pharmacy benefit
   5. HCP & patient experience with platform
   6. Number of partners

2. Logistics
   1. Communication
   2. Platform
   3. Capacity/dedicated team
   4. Location of operations (talent pool)
   5. Internal processes, procedures, and flexibility
   6. Firewalls between different client programs
   7. Reporting & KPIs

3. Philosophy
   1. Culture
   2. Commitment to quality
   3. Consistency of performance
   4. Ownership short-term and long-term plans

4. Cost
   1. What is truly included/excluded
   2. What components are outsourced oversees
   3. Portfolio discounts
   4. Fixed vs. variable costs
   5. What are the assumptions

Vendor scoring is a crucial component in the vendor selection process, and the speakers presented a sample scorecard that called for each vendor to be rated from 1-5 on each of 8 differentially weighted categories (each manufacturer should use categories and weighting based on its own needs and priorities):

• Implementation/operational structure (10% weight)
• Platform/technology/reporting (15%)
• Experience (15%)
• Nursing (15%)
• Pharmacy services (5%)
• Quality (10%)
• Contracting (10%)
• Financials/cost (20%)

One of the keys to designing and implementing a successful hub program is a strong focus on each of the core stakeholders: patient, caregiver, HCP and staff, manufacturer, and specialty pharmacies. A strong hub vendor will be able to demonstrate how they support each of these groups.

In closing, the Tom and Tricia identified several elements that suggest what a good partnership looks like: trust, performance, teamwork, collaboration, win-win mindset, etc. In the end, while a vendor only offers a product or service, a partner becomes an extension of your business.

Copay Accumulator and Maximizer Solutioning 

Simon Kasmir, Director of Product Management, ConnectiveRx

Simon introduced his talk by defining copay accumulator and maximizer programs. Accumulator programs are implemented by PBMs and payers to prevent any copay assistance dollars provided by a pharmaceutical manufacturer from counting toward a patient’s deductible or maximum out-of-pocket (OOP) expense. Payers change the way they apply and account for payments from a drug manufacturer’s copay card. Maximizer programs have emerged as a more patient-friendly alternative to accumulators by shielding patients from significant OOP costs. In maximizer programs, patient copays are set to equal the maximum annual value of a copay program, and these manufacturer payments are still not applied to patient deductible or maximums. This enables payers, not patients, to benefit from manufacturer copay assistance dollars. Patient enrollment in the maximizer program and the manufacturer’s copay assistance program is required, so patients are actually signing up for maximizer programs.

Accumulator programs were piloted in 2015-2018, and in 2019 CMS announced that they would allow commercial payers to implement accumulators for branded products with generic equivalents. But in 2020 CMS expanded their approval, saying that accumulators were now acceptable for all products, not just those with generic alternatives. And in December 2020, CMS went even further, proposing a “CMS Final Rule” that stated that beginning in 2023 drug makers must ensure that 100% of the value of a benefit paid to a patient goes to the patient. After a PhRMA lawsuit challenging the Final Rule, it was struck down in July 2022.

Nevertheless, it is still important to solve for accumulators and maximizers. For brands, these programs take a big bite out of gross-to-net, and accumulators often lead to prescription abandonment. Patients are often blindsided by increased OOP costs after their copay benefit is exhausted by an accumulator program, and they could suddenly be responsible for thousands of dollars of copay expense after several low-cost fills. They often blame the brand, ask the prescriber to switch products, or just stop therapy altogether.

Unfortunately, these plans continue to grow. In 2021, 43% of covered lives were in plans that had implemented an accumulator program, and 45% of covered lives were in plans that had implemented a maximizer program.

So how do manufacturers counter accumulators and maximizers? Simon identified 3 key areas of focus.

1. The Importance of Data and Payment Flexibility

When program design is integrated with advanced analytics, the impact of accumulators and maximizers is reduced:

1. Analytics can be leveraged to identify accumulator and maximizer patients before they ever set foot in the pharmacy
2. The sooner you can intervene the less benefit a patient will require
3. Leverage the real-time pharmacy data so the solution fits into the pharmacy transaction workflow
4. Quickly learn which plans are leveraging accumulator and/or maximizer programs.

Simon emphasized that no 2 patients are alike, and therefore no single payment solution meets the needs of all patients. But we can meet patients where they are by giving them options in how they choose to interact with a brand. If we expect to achieve a true “no patient left behind” approach, an effective accumulator mitigation solution must include multiple payment options. By utilizing patient-first design, marketers can account for outliers in their solutions and ensure that they are addressing patients’ needs. 

2. Six Pillars of Effective Mitigation

Keeping in mind that the goal is to minimize patient disruption wherever possible, Simon reviewed 6 pillars of an effective accumulator or maximizer mitigation solution: 

• Offer-design and analytics modeling allows a solution provider to be proactive and bring data-driven insights to manufacturers 
• By utilizing a real-time claims service, top-quality solutions function in real-time within workflow 
• Enhanced enrollment services should accommodate simple and intuitive onboarding to minimize disruption
• Patient preference for reimbursement is all about meeting patients where they are with options that work for them 
• Enhanced payment services means partnering with pioneering and enterprising fintech companies to bring advanced solutions to the market
• Integrated claims and payment reporting is necessary to meet the needs of the brand, satisfy financial and auditing requirements, and ultimately prove the effectiveness of the solution 

3. Digital Leads the Way

Since most accumulator solutioning requires the patient to take extra steps to receive savings, robust digital engagement programs can drive desired behavior. Just as it is important to meet patients where they are by being able to select funding and reimbursement options, we also let patients have a say in how they communicate with the brand. It's important to engage with the patient every step of the way. Whether that’s to provide streamlined enrollment, detailed instructions, or expected next steps, you can’t overcommunicate when it comes to patient access. Patients should be able opt for email, SMS, phone calls, or a combination of the 3. Finally, Simon noted that while robust patient communications can dramatically improve both the adoption and success of accumulator and maximizer solutions, patient engagement should not end there. The intent is to make the brand a trusted partner in the patient’s treatment journey and provide ongoing support and resources.

In the end, noted Simon, the goal in mitigating accumulator and maximizer programs is to protect patients from financial toxicity, minimize disruption, and ensure that the brand’s investment goes into patients’ pockets (not PBMs’).

Patient Services as Your Secret Weapon

Eric Schupp, Patient Services and Commercialization Leader 

Eric introduced his session by suggesting that marketers need to find a way to give patient services their appropriate weight within the overall commercialization mix. Many organizations rally around next-generation omni-channel CRM digital technologies, yet many patients first feel truly heard in an old-fashioned phone conversation with a case manager, a hub, or a reimbursement specialist at a specialty pharmacy. These person-to-person interactions are very powerful influencers in the patient journey experience. Yet we often undervalue them.

Patient services are often viewed as must-haves for patients. However, they rarely deliver the truly exceptional customer experience that can create strong patient loyalty and positive HCP perceptions by removing barriers to access in a connected, personalized, omni-channel way. In an era of Amazon and Netflix, what steps can we take to make ordinary services extraordinary?

As an appetizer, Eric presented a brief case study: A tale of two service models. The case presentation highlighted a new process of designing patient services, a process similar to that used by Disney in its theme park design and execution. Just as Disney can’t control the Orlando summer heat, humidity, or daily rain, drug marketers also face uncontrollables: NDC blocks, patient copay amounts, prior authorization challenges, etc. If we can clearly identify these and help patients navigate them successfully, they can and will have a positive brand experience.

Eric focused the bulk of his talk on 4 ideas that will help transform patient services:

• Integrated technology
• Voice of the customer
• Listening to all customers commensurately
• Service culture

Integrated Technology

First, Eric made the point that technology is not a single thing, it is everything. He encouraged the audience to avoid thinking of technology as an “all or nothing” proposition. Instead, we should prioritize the most impactful incremental solutions, focusing on getting continuously better. What’s more, we should control our own brand’s destiny by creating alternatives to the conventional model. And finally in this section, Eric reminded us that digital transformation is not about technology as a strategy. Rather, we should focus on strategy first, then decide how we can overcome inertia to integrate technology into our strategy.

Voice of the Customer

Eric encouraged audience members to consider their customer listening instruments:

1. Best practices that can help us hear the true voice of the customer
   1. Consistent core questions across brands, services, and segments
   2. Customized questions for specific brands, services, and segments
   3. Good frequency, short/simple/easy modality, thoughtful business rules
   4. Diverse KPIs with targets like first-call resolution, customer effort, rep/overall satisfaction, Net Promoter Score, etc.
2. Verbatim feedback pattern can be the most actionable insights
3. Harmonize questions and structure with brand ATUs/other instruments for continuity
4. Prioritize actions and evangelize results — speak loudly and often about results

Listening to All Customers Commensurately

While we all agree that patients are our most important customers, they are far from being our only customers. The truth is, we have many customers, and Eric suggested that one group we need to pay more attention to is office staff. Since these are the people on the front lines of patient services battles and may actually be more aware of patient needs than prescribers are, we should take the time to listen carefully to their experiences, understand their needs, design for and invest in them, and translate and celebrate patient successes as their successes.

Service Culture

Eric touched on 3 key items that will help us arrive at the service culture we need to provide. First, we must make a point to deliberately establish a service culture that delivers for patients, or an unintentional and less effective culture will emerge on its own. Second, we must be careful to align all customer- and partner-facing teams (sales, brand marketing, field reimbursement, service providers, etc.) to the central mission and culture. Finally, we should channel the power and importance of service recovery when failures occur. Mistakes and errors will happen; how they are managed affects brand perceptions powerfully. In fact, how an organization recovers after a failure actually has a larger impact on a brand’s total customer experience than if the service was error free.

Ultimately, by being attentive to these core elements of designing and delivering extraordinary patient services, we can help patients achieve long-term adherence to therapy and positive clinical outcomes.

Voice of the Customer: Why Quality Monitoring Matters Pre- and Post-Launch

Paul Battaglia, Vice President, Patient Services, Two Labs 

Paul began his talk by playing audio recordings of 2 simulated patient calls to a patient support center. While the first call did result in the patient’s need — copay assistance — being met, the second call not only resulted in the need being met, but demonstrated much more caring concern for the patient, included HIPAA compliance, and captured a potential product quality issue. The 2 calls highlighted the importance of call quality monitoring, which led to the 4 topics included in the presentation.

Topic 1: Common Patient Service Launch Challenges

Paul identified 4 pillars of high-quality patient service launches, and key questions in each:

1. Determine program strategy and model design
   1. Do we have the correct patient services strategy?
   2. Does our service model adequately address and resolve access barriers?

2. Identify partnerships required to deliver intended services
   1. Do we know what services need to be insourced vs. outsourced?
   2. Did we follow a structured and disciplined selection process with objective criteria?

3. Build and implement program
   1. Do we have a robust implementation plan?
   2. Do we have a dedicated implementation team?
   3. Are internal and external stakeholders aligned on timelines and delivery expectations?
   4. Do we have contingency plans?
   5. Did we hire the right people, train them effectively, and are they ready to execute on the service model?

4. Post-launch monitoring and assessment
   1. What should we be monitoring, and why?
   2. How do we prioritize and correct issues identified through post-launch monitoring?

Topic 2: How Are Manufacturers Using Pre-Launch Quality Simulations to Ensure Launch Readiness

Paul pointed out that a comprehensive pre-launch optimization program can be developed and deployed in as few as 3 months. The quality simulations require a minimum of 2-3 weeks, but when executed correctly will effectively test service delivery and allow for targeted process and associate improvement in advance of launch. He provided an important list of 6 key steps needed to implement pre-launch quality simulations:

1. Program materials review
   1. Process flows
   2. SOPs
   3. Correspondence
   4. Training materials

2. Launch readiness test plan creation
   1. Checklist
   2. Timelines

3. Scenario development
   1. Inbound test scenarios
   2. Outbound test scenarios

4. Call simulations
   1. Test calls (listening for both agent-specific and program-specific issues)
   2. Survey completion

5. Readout
   1. Performance analysis
   2. Summary results

6. Comprehensive improvement plan
   1. Process improvement
   2. Associate performance improvement

Pre-launch performance analysis provides insights at the agent, scenario, and program level. For agent-related gaps, address them via additional training and identify the need for workflow automation or job aids. For program-related gaps, assess how best to remediate depending on the scale or scope of the gap. Ideally, this process leverages pre-launch quality monitoring to ensure that Day 1 of launch is successful. 

Topic 3: Benefits of Ongoing Monitoring to Improve Service Quality and Build Trust Through Consistent Performance

Post-launch quality monitoring is like pre-launch, but now the stakes are higher. Now we’re monitoring live and recorded interactions with real HCPs, patients, and caregivers. Paul laid out 3 key areas of focus:

1. Program branding: Are the communications consistent with the look and feel of the overall brand?
2. Customer experience: Are caller needs understood and addressed in both a timely and courteous manner?
3. Compliance: Are services deployed in a compliant manner that adheres to laws, regulations, and program guidelines?

In post-launch monitoring, we want to listen for all the items in pre-launch monitoring, plus items such as process-driven challenges, hidden needs of callers, unanticipated access barriers, etc. Ultimately, we want to know whether the program is performing well and delivering quality service. To do that, we need to ensure that, 1) we engage in timely listening to identify gaps quickly, 2) we provide timely feedback to agents, 3) we are aligning expectations between operations and client, 4) we recognize outstanding calls and reward agents, and 5) we address service gaps in a timely manner.

Topic 4: Creating an Ecosystem Linking the Quality Feedback Loop with Training and Operations

Paul highlighted the idea that the creation of a feedback loop aligning training, QA, and operations delivers an optimized and consistent experience. The loop consists of 4 continuous key actions: conduct call monitoring, identify opportunities for improvement, implement enhancements, and evaluate.

Paul wrapped up the presentation by challenging audience members to assess their current approach to pre- and post-launch quality monitoring, develop an optimized program, align with internal stakeholders and service partners, and implement the new plan to benefit patients.

Enhancing Communications Between Hubs and Physicians' Offices -- Centralizing, Improving Accuracy and Return Time of Benefits Investigations

Pearl Pearson, Senior Director of Patient Support Services Dermatology, Respiratory and GI, Sanofi

John Klimek, RPh, Senior Vice President, Standards and Industry Information Technology, NCPDP

Jamie Anderson, CMA, AAMA, Prior Authorization Specialist, Biologics Coordinator, Cary Dermatology Center

This trio of speakers highlighted the importance of integrated communication between support services and stakeholders. Jamie gave an on-the-ground description of her role in helping patients access biologic drugs in a busy multi-prescriber dermatology practice. She explained the many challenges she must navigate on a daily basis, including frequent prior authorizations, aggressive step therapy requirements, and ongoing coverage and cost concerns. Her frustration with payers’ access hurdles was evident, and she noted how those challenges have increased over the past 5 years. She referred to manufacturer hubs and their field reimbursement managers (FRMs) as her “best friends,” and reaches out to them regularly for help in supporting her patients.

Pearl extended the discussion from her vantage point as a provider/purchaser of hub services. She corroborated Jamie’s access concerns and noted that the Sanofi team works closely with various stakeholders starting at the very beginning of the process — with the supposedly simple process of completing the hub enrollment form. They often need to engage in a back-and-forth conversation with providers to capture the critical information needed to get a patient enrolled and get them the help they need. The benefits verification phase typically goes smoothly, Pearl said, but leads quickly to the access challenges Jamie noted: prior authorizations, step therapy requirements, and ongoing coverage and cost concerns. Once those hurdles are overcome, prescriptions are sent on to specialty pharmacies, which arrange shipment of the medication to the patient and provide ongoing follow-up. Pearl noted that she relies on her hub provider to interact closely with the specialty pharmacies to overcome any issues that might delay therapy. She and the hub team work to take some of the pressure off providers at each stage of the patient journey.

Jamie reiterated the challenges of properly completing and submitting enrollment forms and other accompanying documentation, and explained the lengths she goes to to keep track of old and new forms, manage new application requirements, provide patient consent, and jump through many other hurdles in the path to drug access. She also noted the emphasis that she puts on maintaining open communication with other parts of the patient support team, such as the hub, FRMs, and specialty pharmacies.

The speakers agreed that convincing patients to submit personal financial data is often particularly difficult, especially with older patients. Jamie described several strategies she uses to persuade patients to submit all requested/required information: she helps the patient identify which information is absolutely required and which is not, she offers to support the patient’s privacy by faxing the form to the hub and then shredding it, and she sometimes has to resort to explaining to the patient that if they refuse to provide the required information they will not be able to receive the support being offered.

Getting the initial prescription filled is a crucial first step, but it is really just the beginning of the patient journey to wellness. Ongoing adherence to the medication regimen is also vital. The speakers shared their experiences in promoting adherence by helping patients navigate effectiveness questions, adverse events, re-emergent cost challenges, and their own apathy. Pearl noted the importance of ongoing refill tracking and reporting by the hub provider, and quickly acting on reports of adherence fall-off.

Taken together, the speakers presented a powerful patient-level view of the necessary work of building and maintaining strong communication between patient services partners.

We hope you have found value in these brief reviews of key strategy and tactics sessions at the 2022 Hub and Specialty Pharmacy Models West conference. Be sure to also check out our reviews of key legal, regulatory, and standards sessions at the conference.