Second Opinion: Patient Support: Did we give up too quickly?

2023-05-02 |  Shrinivas Anikhindi & Carol Cao

Welcome back to Second Opinion, where this month I want to talk about the cyclical nature of change.

In our industry, it feels as though developments often come in waves; technological followed by human, followed by tech again, followed by, followed by. It makes sense, as we so often find a new cutting-edge technology and then have to work out how to make it work for real patients and healthcare professionals.

The only issue is that new tech is often louder and shinier, and sometimes the needs of patients as individuals get left behind. So, this month, following our issue on the big shiny wave of chatbots, we want to turn our heads slightly and look to human-centred innovation that still deserves some attention for the value it can bring to our industry: Patient Support Programmes (PSPs).

On the theme of human-centric design, Carol Cao has also taken an in-depth look at the factors which significantly influence population health and require increasing consideration, while we have also looked at how technology is pushing us further and further towards healthcare that works in individuals, not masses.

All that and more in this month’s Second Opinion. As always, these topics only serve as introductions, not the final word.

We’re Far From Finished With Patient Support 

We have spoken about patient services before, about the rise of tools such as Patient Support Programmes (see here and here) to help patients manage chronic conditions with greater capability, improving outcomes and lowering the burden on healthcare systems.

Though PSPs are now some years in as a concept and may feel old hat, it’s important to recognise the major change in thinking they precipitated – to start pharma on the road of thinking about the virtues and importance of managing outpatient care, of stepping beyond just treatments to maximise outcomes.

While there remains limited data about the large swathe of PSPs out there that are being implemented, the outcomes we are seeing remain encouraging – but more on that later. That said, the landscape of this data does suggest a lack of consistency or clarity in the way outcomes are being captured which must also be addressed to start showing and proving success.

Ultimately, one of the biggest myths about PSPs is that they are ‘charity’ investments, or perhaps non-core side ventures to appear more friendly to patients or meet CSR commitments. This is flat out wrong. By creating better outcomes for patients, PSPs generate a significant amount of value for the companies that deploy them, by reducing treatment discontinuation and helping patients stay on their approved treatment regimens for longer.

The knock-on impacts of this on the healthcare system are manifold, from reducing pressure on healthcare resources to decreasing the need for physicians to be doctor, therapist, and coach. I won’t dwell on this point, as we have covered it extensively (see here and here).

PSPs are in place to deliver better outcomes for patients. But for the pharma company, the potential commercial knock-on is clearly positive too – it’s not an attractive statement to make, but successful PSPs that drive better adherence also generate more revenue. Furthermore, they revolutionise the way patients are treated and make their lives and the lives of their physicians easier. They are a crucial step required to move from volume to value strategies, an imperative transition to thrive in the coming era of healthcare.

So why are we treating them like secondary opportunities to use leftover budget on? Why aren’t we putting these programmes front and centre as cornerstones of our Oncology, Rare Disease, and Immunology strategies?

Well, for one, it’s not easy. So, let’s talk about that first, and then let’s look at how we fix it.

Why we’re still talking about PSPs

This is an easy one: the need is still there. More interestingly, however, the value offered by them has not yet been tapped into. A study that fascinates me is Noorduyn et al, 2021, which speaks to the average persistence of patients on an asthma medication. The study doesn’t look into the effect of the PSP specifically, but the data was only available because of patients’ use of a basic patient programme.

The level of anonymised insight these programmes offer into patient behaviour, to help us understand how we can maximise outcomes from treatments in real-world settings, is crucial to have access to in order to improve the quality of the care we deliver.

Layered on top of that is the value of superior support programmes, which can reduce the risk of therapy discontinuation by upwards of 70%, as seen in the case of Abbvie’s Humira (Marshall et al, 2018), and AstraZeneca’s Fasenra (Rabe et al., 2023).

Why aren’t more PSPs able to reach full potential?

Given the evidence of their value, and clear role to fill for patients and healthcare customers, why is PSP development and implementation losing momentum?

For one, they’re hard work. Not only are the operations and capabilities required for patient support unfamiliar to deliver, but organisations implementing this type of service are often left wondering how to evaluate success. This leaves PSPs as a clunky part of the product toolkit which is difficult to reconcile with the prevailing strategy.

Furthermore, a rise in the advertisement of “lightweight PSPs” built around digital and flashy apps has led to a number of PSPs being put in place which fulfil 20% of the need but present themselves as the full package, which means the service is associated by many to be delivering minimal value and primarily style over substance.

This phenomenon is often paired with the need for easy solutions to manage the complexity of different markets and the need for a one size fits all solution, as well as low regulatory confidence and a desire to avoid unnecessary changes to a working, approved formula.

Neither of these challenges remove or take away from the real patient value and real business return that quality support programmes can deliver when executed with the right objectives in mind, the right stakeholders in the room, and the right measures of success.

To do this, we must look to the market-leading PSPs that have boasted outcomes that the industry should be striving to replicate across all therapy areas, such as those shown by AbbVie Cares and AZ Connect360 which we’ve referenced above.

Delivering excellence in programmes that truly support patients

Having stepped from observations to challenges to unmet needs, where does that leave us? With millions of patients, thousands of rare diseases, and hundreds of products left without sufficient levels of support.

How then, do we mobilise support programmes to begin delivering the significantly improved outcomes and business performance that evidence has shown is possible?

1. 💁🏾‍♀️ Start with people, then get creative: It’s easy to innovate for innovation’s sake, especially in worlds of digital platforms and machine learning. That said, however, patient need must always come first, which is why we espouse the values of human-centred design. Start with the needs of your patients and physicians as the base of your PSP’s core features, and then innovate to deliver them as effectively and seamlessly as you can manage.

2. 🌍 Go big, or stay local: PSPs can be delivered locally and often more easily, avoiding the complexity of multi-vendor or market-flexible blueprints, but the barriers of cost and tech sophistication become significantly more difficult. If you’re going to develop for more than one market, invest in enterprise-wide platforms. They will help keep costs down, lay the groundwork for onward implementation, and focus on the ‘support’ part instead of the ‘programme’ part of PSPs.

3. 💾 Get ahead of your data: Finally, make sure you get your data strategy right, in two dimensions. Firstly, ensure that it meets perceived compliance barriers so that you have clearly documented what you are collecting and why. Secondly, consider what is required to be able to more insightfully use captured data – the worst situation is to end up with valuable datasets which are incomplete.

Ultimately, we’re not ready to give up the ghost on Patient Support Programmes, and neither should you. They deliver superior outcomes for patients, they lower healthcare costs, and they deliver significant return on investment for the business units that deliver them. Make sure you consider whether they can fill the gap in your product strategy and improve the value you bring to market.

The Greater Good: Equity In Healthcare 

As we consider patients as individuals, and highlight the importance of human-centred design, we must be sure we are looking at the whole of those patients. Moreover, we have to make sure that in doing so everyone has the same chances and opportunities to attain their highest level of health.

We can’t talk about tackling health inequity, however, without talking about Social Determinants of Health (SDOH). These are the social, economic and geographic conditions in which people are born, live and work, that influence their health outcomes.

Things like access to healthcare services, economic stability, education levels and quality, the safety of their neighbourhood, being in a vulnerable group, and social networks, can all positively or negatively influence our ability to be healthy – often without us being aware of it. These conditions can also be difficult to change, especially at the individual level.

For example in England, there is a 19-year gap in healthy life expectancy (average number of years that a person can expect to live in ‘good health’) between the most and least ‘deprived’ areas of the country (based on The English Indices of Deprivation 2019). What this means in real terms is that, depending on the type of life a person has access to, people can be more likely to spend more of their lives in poor health and die sooner.

Furthermore, previous analyses have shown that between 60-80% of health outcomes can be out of the control of a direct health provider (e.g., a hospital), and instead down to these wider determinants. These are not just additional factors to consider, but rather the majority of the iceberg that we are ignoring while hurtling forward at full speed.

In recent times, progress has been made towards identifying and improving key determinants of health for many groups of people. While health equity is mostly seen as the concern of governments, providers and payers, pharma companies are well-positioned to play a role in closing gaps in access and outcomes. Here, we’ve honed in on two opportunities for pharma companies when it comes to health inequities.

🏡 1. Opportunities to meet underserved patient populations where they are

In underserved patient populations, there is often a much lower uptake of healthcare. Lower access to healthcare makes it harder for patients to receive the right treatments at the right time, gives a higher potential for late diagnosis, and increases the chances of no follow-up.

In many cases, we need to examine our patient population and ask ourselves: what kind of solutions do we need to create to truly address their needs? What interventions genuinely address the roots of these problems and result in better-targeted approaches?

By identifying social determinants across different markets and mapping how they affect different populations, pharma companies can identify, for example, which conditions are undertreated or underfunded, and pinpoint which type of intervention is most effective and when.

🏘️ 2. A vicious cycle: Distrust in communities contributes to negative health outcomes

It has been observed that more disadvantaged communities have a higher level of distrust in healthcare and that the distrust is often strong and complex. There can be sociodemographic differences in healthcare distrust, where certain populations perceive disparities in the quality of care they receive, are more sceptical of medical research, and are less likely to seek out healthcare services when they need them.

There is a need to understand the lived experiences of different communities, and how and why distrust is created and maintained. Companies can then foster trust by tackling inequity upfront, considering access holistically, and having more consideration and representation of these populations in product development and clinical trials.

An ongoing societal change

There are many potential ways that pharma companies can work to impact social factors, such as working with HCPs to improve health literacy, developing datasets that take SDOHs into account, and sponsoring or participating in national and local collaborations.

When it comes to addressing health equity, we require ongoing societal change driven by all, including pharma companies, that places equity as a priority in both an ethical and business context.

The Personal Touch: Evolving Landscapes In Medicines 

Lastly, some words on a key subject when discussing patient services: the rising complexity of medicines. What does this mean though, and how widespread actually is the impact of this development on our industry and the way we go to market?

Precision medicine, at its heart, is about specifically tailoring drugs and other treatments to a group of patients – based on factors such as age, genetics or risk rather than administered on a one-size-fits-all approach. Recent developments have allowed pharma companies to harness the power of new technologies (such as CRISPR, mRNA and non-coding RNA) in the precision medicine area, incorporating these complex and powerful techniques into their drug pipelines.

Ultimately, moving to this model brings with it disruption and poses a challenge to the long-standing ‘traditional healthcare delivery model’ that is designed around volume over value. Instead of operating like textile mills focused on maximising market share and patient numbers, precision medicine challenges pharma to start to think like bespoke tailors, prioritising the optimisation of individual patient outcomes.

Some would argue there’s a chicken and egg situation here – do we invest in these approaches after precision medicine has changed the needs of our customers or make the change first to improve the effectiveness of precision medicines in our pipelines? This conundrum, however, we think is simple. The principles behind value strategies, which involve maximising outcomes and taking a needs-first approach, will be important to secure the effectiveness of your pipeline, and the next generation of medicines.

Move fast, move early, and get ahead of the trend. As the industry of precision medicines rapidly grows to the tune of a 6.1% CAGR alongside parallel waves of innovation such as digital therapeutics, be prepared to rethink the way you approach meeting market needs, moving from Manchester mass-produced fabrics to Milan high fashion.

Authors: Shrinivas Anikhindi & Monique Biryiana

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