Effective Patient Support Globally

Effective Patient Support Globally

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Matt Hall: Speaker

Matthew P. Hall, CEOHuman Care Systems, Inc.

Direct: 617.649.2118Mobile: 617.501.1818

[email protected]

Matt is the CEO of Human Care Systems (HCS), which he founded in 2008. HCS provides better tools to clinicians and patients to manage complex diseases, particularly focused on behaviors and decisions.

HCS was spun-out from the Kerdan Group, a biopharma and medtech consulting firm. Matt co-founded Kerdan in 2001.

Prior to Kerdan, Matt ran several healthcare-related businesses, worked in venture capital and was a consultant at Bain & Company.

Matt has lived and worked in the US, Europe, Japan, South Africa, and South Korea. Matt has a BA with honors from Williams College.

mailto:[email protected]

http://www.humancaresystems.com/

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Industrial vs. information age healthcare

Individual self-care

Friends and familySelf-help networkProfessionals as facilitators

Professionals as partners

Professionals as authorities

INFORMATION AGE HEALTHCARE

Professional care

Self-care(off the map)

Tertiary

Secondary

Primary

INDUSTRIAL AGE HEALTHCARE

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How does poor patient self-management impact you?

• Missed initiation opportunity• Delayed initiation opportunity• Unhealthy lifestyle habits• Interrupted course of therapy• Confounding biochemical events• Decreased overall adherence• Premature therapy termination• Increased hospital admissions• Lack of return to therapy

...due

to...

Poor self-management:

• Reduces the positive outcomes associated with your diagnostic/therapy/solution

• Results in more safety problems in real world use

• Increases clinician and patient burdens associated with treatment

• Decreases the health economics from your solution

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Many differences and many similarities

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What is the goal of patient engagement and support?

• Biopharmaceuticals and medical technologies are facing pricing pressure in nearly every global market. Rising co-pays in Private Pay markets.

Price discounting in National Pay markets.

Self-pay barriers in Emerging markets.

• Manufacturers must ‘increase the value’ of their solutions in response. Re-shape value propositions from active comparators and TPPs to real-world solutions to complex, difficult, expensive health

problems.

• Globally, the capabilities of the patient to take medicines as prescribed and manage the disease more broadly are clearly linked to Quality of Life, outcomes and health economics.

•Valuable relationship with patients and clinicians do not come from a carefully scripted series of marketing emails. Automation of noise is not the goal. The goal is authentic service relationships to accompany clinicians, patients, and families in their experiences.

Give patients and family the right self-management support at the right times through the right channels.

Provide clinicians with timely, helpful answers to questions and simple tools to improve decisions and patient self-management.

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Key Trends: Competitive Markets

Competitive. Biopharma must show added value to payers/employers, as well as increasingly self-paying patients (through high deductibles). At the same time, prescribers have enormous choice in most classes and must see meaningful differentiation to prescribe. Finally, FDA is increasingly requiring risk management programs where enhanced support must be provided to patients, prescribers and pharmacists.

Competitive Markets Price-Reference Markets Health Economic Markets Emerging/ Cash Markets

Markets (private) (Medicare Part D)

( (PMPRB) (DoD/Medicaid)

(NICE) (Provincial)

and Scandinavia

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Key Trends: Health Economic and Price-Reference

Health Economic and Price Reference. In both health economic and price reference markets, it’s all about what can be proven as valuable and, in the case of price reference, what is new. In addition, EMEA, MHLW and other regulatory bodies are increasingly requiring risk management programs where enhanced support must be provided to patients, prescribers and pharmacists.




(NICE) (Provincial)

and Scandinavia

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Key Trends: Competitive Markets

Emerging/Cash Markets. Across most emerging markets, there is need to engage and show truly greater value to the holy trinity of largely self-pay patients, powerful neighborhood pharmacists and physicians. This is critical for both brands and branded generics. At the same time, regulatory bodies and physician groups are clamping down on ‘added value’ practices of the past (eg, CFM 1939 in Brasil). High mobile phone penetration presents opportunities to use integrated voice, text and web to engage patients in their care, and to better loop in the pharmacist.




(NICE) (Provincial)

and Scandinavia

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Global Patient Needs

Local Tailoring

Evaluating what you have & Building what you need


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The World

If the world were a village of 100 people...

61 are from Asia15 live in the Western hemisphere20 are white

2 have college educations17 are illiterate

47 in cities and 53 in rural areas17 are undernourished

33 have internet access67 have a cell phone

33 are Christian21 are Muslim16 are non-religious

2 will give birth within the year1 will die within the year

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Managing complex disease has more similarities than differences, whether you live in Anchorage, Bahrain or Cape Town.

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Many Patient Needs are Universal

• Disease symptoms and burdens.• Therapy burdens and side effects.• Taking therapies as prescribed.• Financial issues.• Self-care and behavioural elements of

managing disease and therapy (eg, motivation, self-confidence, resilience).

• Managing feelings of fear, anxiety, guilt, shame and anger.

• Productively involving family.• Working effectively with Health Care

Providers.

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Patient/Clinician Communication

Clinician communicates information about disease,

therapy and self-care

Patient goes home

Patient acts on clinician

recommendations

• 72% of patients unable to list medications they take• 58% of patients unable to recite their own diagnosis• Patients rarely ask questions, across cultures• Physicians interrupt patients who do ask questions

within 30 seconds, on average

• Many clinicians use a strategy of ‘scare and scold’ to encourage patient self-management

• 47% of what clinician says is never understood by patient

• ~50% of what the patient understood, is forgotten by the time patient gets home

• 40% of what is understood and remembered, is acted upon by patient

Source: Health Literacy & The Prescription Drug Experience: The Front Line Perspective From Patients, Physicians and Pharmacists, Roper ASW, May 2002Mayo Clinic proceedingsBritish Medical Journal

Clinician and patient often start visits on a weak basis

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How well does your doctor communicate?

Source: Worldwide Independent Network of Market Research, Patient-Doctor Global Communication Assessment, Fall, 2010. N = 22,581

Q: Thinking of your most recent visit, please rate the doctor’s communication with you.

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Would you recommend your doctor?


Promoters: Rating 9-10Fence Sitters: Rating 7-8Detractors: Rating 0-6No Answer

Q: Please rate the doctor you most recently met with on a scale of 0-10, where 0 means you would never recommend and 10 means you would definitely recommend this doctor

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How is your health?


Q: How would you rate your health?

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Do you want your doctor to give you choices?


Q: I prefer that my doctor give me choices

Q: I prefer that my doctor just tell me what to do rather than give me choices

Want choicesWant to be told what to doNo answer

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How do people define value?

Patient Value

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“Value is the difference between what I give up for a product and the benefits that I receive” Real World

OutcomesCosts

(financial, hassle, safety)

People are Rational about Value

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It’s About Patient Value

€ ¥

Prescribers Regulators Payers

Patient Associations &

Disease Advocacy Groups

Pharmacies & Other

Channel Partners

Patients & Family

As voters in National Pay markets, payers of increasing co-pays in competitive markets and self-payers in developing markets, it’s about the patient.

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Self-Management Drives Value

Levers to impact Value Equation:

Change patient self-management

Change diagnostic or therapy

Change clinical practice

Change reimbursement

Real World Outcomes

Costs (financial, hassle, safety)

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4 Areas of Global Unmet Need

Take Acti

on

Engage

Gain Insight Learn

Set goals, take actions, monitor progress

Internalize critical knowledge and understanding

Overcome emotional, cognitive, and behavioral

barriers to change

Clinician and pharmacist tools, effective direct support

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What works for most people

•Engage them where they are. Language and culture. Channel (clinician, pharmacist, mobile, paper, web). Specific needs at that time.

• Help solving real problems.

• Help with understanding the disease and therapy in an actionable way. Socratic questioning. This is a logical, positive approach that teaches people to reason with the reality

around and inside them and discover solutions. Targeted, relevant information. Interactive learning Where possible, providing tools and resources to clinicians and pharmacists to better use their positions to

educate effectively

• Support to learn productive health behaviors Build resilience, strength, motivation, calm. ‘the answer is inside you. Adhere to medicines Better manage diet, exercise, smoking cessation and other behaviors Learn to work more effectively with HCPs Involve family productively

•Build change that is part of daily life Learn to set useful goals and track them through to success. Use simple tools for keeping track of appointments, medicines and other parts of therapy. “You are not a victim; you are a survivor.”

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Self-Management is Universal

Relationship with healthcare providers

Effective Self-management

Thoughts & Feelings

Knowledge & Understanding

Social and family environment

Behaviors

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What doesn’t work for most people

•‘Scare and scold’ clinician counseling.

•Reminders and other one-off tools.

•Generic education.

•Support that doesn’t incorporate context (e.g., social, emotional, family, cultural)

•To keep plugging away in the same behaviors.

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Local Tailoring



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The Opportunity to Think Local and Build Global

Situation:

•Substantial investment in marketing and patient support across geographies, yielding varying rates of patient engagement and ROI. •Some geographies have low promotion of patient programs. •Some geographies have low penetration of patient programs

Think ‘Local and Build Global’ Objectives:

• People have far more in common than they have differences. They have the same problems, and need the same things to manage complex diseases.

• Help each geography provide effective patient engagement and support, building on existing assets.

1)Diagnose the total treatment environment, patient journey and inflection points for that geography.

2)Define the shared fact-set.

3)Determine fit with market access strategies.

4)Develop regional and global best practices.

5)Deploy to each geography.

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5 Critical Areas Must Be Localized

Language & Cultural

References

Language & Cultural

ReferencesReimbursementReimbursement

ChannelsChannels Legal & Regulatory

Legal & Regulatory

PartnersPartners

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What is local culture?

• The learned, shared, transmitted values and beliefs and practices of a particular group that guide the thinking, actions, behaviors, interactions, emotions and view of the world.

• Art Beliefs about:• Relationships Family obligations• Customs Gender Roles• Clothing Preventative Health • Environment Illness and death• Economics Sexuality• Religion• Diet

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How do culture and language impact health behaviors?

• Health, healing and wellness belief systems;

• Illness, disease and how causes are perceived;

• How health care treatment is sought and attitudes toward providers, impacting treatment;

• Delivery of health care services by providers.

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Language Pitfalls

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Areas to watch for: Language Localization

Language that patients use to refer to…

•Access/reimbursement•Pharmacies•Providers•Symptoms•Side-effects•Drug efficacy•Behaviors and self-management

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Areas to watch for: Cultural Localization

Cultural differences…

•Role of individuals vs. group•Role of family•Role of elders vs. young•Views toward illness and medication•Views toward Western medicine vs. traditional medicine•Color and image meanings•Tools and training systems for clinicians:

how much choice did the patient have in their therapy options? how much access does the patient have to care providers, medications? how much patient knowledge is there about basic care practices, hygiene, human anatomy, etc?

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Reimbursement Localization

Public InsurancePublic InsurancePrivate InsurancePrivate Insurance Self PaySelf Pay

Increasingly high co-pays on new treatments. Not all patients have coverage.

Need to work directly with the doctor to introduce the support program because insurers are so fragmented that they have no relationship with the patient.

Resolving patients ability to pay issues should be a top concern. Focus on value cards, and patient assistance programs.

Usually good coverage with lower co-pays, but high limitation on treatment options.

Look for opportunities to work with public payers - potentially tying results to different pricing schemes.

Access to all new treatments. But Patients must pay themselves.

Patients require more education on the benefits of their medication - particularly in asymptomatic chronic conditions.

Resolving patients ability to pay issues should be a top concern. Focus on value cards, and patient assistance programs.

Impact onPatient

Impact on Support Program

Map out healthcare journey for each country including how and when the drug gets paid for to help make the right decisions.

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Legal & Regulatory Localization

1. Direct to Patient. Nearly every country globally allows manufacturers to provide necessary education and support with therapies. However, there are many differences between countries as to where education/support end and marketing begins.

2. Branding: Branded or unbranded? Implications for naming, colors, links, mentions of specific medications & devices, etc.

3. Adverse event reporting: Ensuring the appropriate data capture, screening, and reporting steps are taken in each market.

4. Privacy Requirements: Tailoring data capture & disclaimers to local requirements.

5. Claims Language: Identifying any unusual watch-outs on claims in specific markets that must be managed.

6. Review Process: What will be the formal review process in each market that the patient support program will need to go through.

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Channel Localization

Patients

Family & Caregivers

Clinician tools and support

Different media – mobile, internet, paper, etc.

Different HCPs – nurses, other allied professionals, specialists, primary care.

Different roles for family.

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Local Tailoring



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Evaluate & Build

• Diagnose the total treatment environment, patient journey and inflection points.

• Define the shared fact-set.

• Determine fit with market access strategies.

• Develop regional and global best practices.

• Deploy to each geography.

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Diagnose

Diagnose the total treatment environment, patient journey and inflection points and understand differences by geography and culture.

What are the key distinctions•Who/where does the patient interact for healthcare? •What is the experience of the disease & therapy? •What is the underlying human experience (physical, social, behavioral, cognitive, emotional)? •What are the inflection points along the way where intervention is needed and impactful?

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Diagnose journeys…

Guiding Questions Why it Matters

Healthcare journey Which people & organizations does the patient interact with on his or her journey?

Determine what communication channels can be used to reach patients at their inflection points.

Disease & Therapy journey

How and why do the the specific diagnostic & monitoring tests, and classes & brands of treatment change through the journey?

Identify opportunities to drive optimal use of your therapy.

Human journey What are the physical, cognitive, emotional, behavioral, and social experiences the patient goes through?

Understand the medical and self-management needs that impact the course of the patient journey.

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…and understand inflection points

• An intervention is needed, impactful, or critical e.g., initiation of injectable insulin

• Not intervening could be dangerous e.g., vaccination • When benefits of intervention outweigh risks e.g., immunosuppressant after transplant • When which interventions are best e.g., aspirin or ACE inhibitor or beta blocker for CHD

✔

✔

✔ Small or large windows of opportunity where science helps us decide...

Moments when patient risk factors and protective factors coalesce to be exponentially powerful predictors of outcome e.g., 2nd trimester for fetal brain development, adolescence in general

Life events that are physical, cognitive, emotional, behavioral, or social e.g., initial diagnosis of a condition, relapse, change in disease status

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Identify highest impact needs and points to intervene

A patient journey has critical inflection points... key moments in patient experience where variables intersect to predict outcomes.

Patient decisions and actions at this time have a significant impact on long term outcomes.

Long-time diabetic has been warned, “If you can’t control

this, we’ll have to put you on the needle.” Now is the

time.

10 year-old hemophilia patient wants more

independence with his condition. His mom is

nervous, but now is the time.

Dialysis patient finds out that a compatible kidney

has been found. A new self-care routine is starting.

Today my doctor told me I have Crohn’s. I feel like

my whole life stopped. I’m in a daze. What do I do?

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Define

Define the shared fact-set.

•What is the investment vs. penetration vs. ROI on existing patient support programs for each geography? •What are the relevant assets and investments in each geography?

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Define: ROI

Cost

Increased Initiation

Improved Share of Class

Better Adherence+ +

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Define: Fact-Set

Country D Country A

Country B

Country C

ROI

Pen

etra

tio

n

Stop Invest

Country G

Country H

Country I

Country E

Country F

Change Costs Learn From & Enhance

= €1M Investment per year (fully loaded)

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Determine

Determine fit with market access strategies.

•What ‘total solution’ evidence is most impactful for each geography?

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Develop

Develop regional and global best practices.

•What combination of effective programming, tools and systems will allow each geography to maximize patient support investments? •What training, support and tools will allow clinicians in each geography to most effectively support patient adherence and disease management?

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Deploy

Deploy to each geography.

•Support each geography with translation, legal and regulatory, as well as multi-channel promotion and engagement to leverage existing investments within context of global parameters. •Create a plan for each affiliate to leverage existing assets and investments within context of global parameters. Work with each affiliate to implement patient engagement and adherence programming, tailored to each indication. •Provide structure and support for ongoing measurement, learning and improvement.

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Global Capabilities, Highly Effective Local Support

Take Acti

on

Engage

Gain Insight Learn

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HCS: Valuable Stakeholder Relationships

EngagementCloser to the real patient experience by

understanding the dimensions and inflection points of the patient journey

Action from InformationNot just words and data, but

understanding that drives actions that change outcomes

ConnectionIntegrated multi-channel: web, mobile, phone, printed, social

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Q&A

Questions?

Documents

Effective Patient Support Globally