The Evolution of the PSP - Amazon S3...On average, physicians spend only 49 seconds discussing all aspects of newly prescribed medications •In a research study, 42% of physicians

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www.ashfieldhealthcare.com

The Evolution of the PSPPatient Support Program

May 2016

Nareda Mills, RN, BScN, AE-C

Senior Vice President, Ashfield Healthcare USA

www.ashfieldhealthcare.com: Part of UDG Healthcare plc2

Agenda

The Spirit of the PSP – why is Pharma clamoring to develop these programs?

Innovation – How is technology playing into these programs?

Differentiation – How do you build a program that is not a ‘me too’ program?

The Gaps – What do patients and HCPs still need from these programs?


The Spirit of the PSP



The PSP

PHYSICIAN

PATIENT

PAYER

$

NURSE EDUCATORMSL/SALES REP

SPECIALTY PHARMACY

REIMBURSEMENT SUPPORT


The Patient Support Program ApproachPlacing the Patient at the Center

KPIs and metrics to measure the impact of the program in order to

support continuous optimisation

What success will look like; how to get there; ensuring internal alignment

Understand patients’ attitudes, needs and behaviors in order to design a more effective program

A consultative approach to define and agree solutions and services

Documentation, plan, recruit, train, accredit and deliver

STRATEGYIMPLEMENTATION

OUTCOMES

Everything we do should focus on patient outcomes

: Ashfield Commercial & Medical Services www.ashfieldhealthcare.com

Sample Journey

Plus understanding the patient journey

7

: Part of UDG Healthcare plc www.ashfieldhealthcare.com8

Getting a PSP right makes good commercial sense

50% of patients don’t take their

medicines as prescribed1

Total potential savings from

adherence and related disease

management could be $290 billion

annually

The top 3 areas driving non-

adherence costs are diabetes, high

cholesterol and high blood pressure/ heart disease…3

The most expensive drug is the one that goes to the wrong patient or never gets taken properly

Lode Dewulf,Chief Patient Affairs Officer, UCB

Estimated annual pharmaceutical revenue loss due to medication non-adherence (CAPGEMINI REPORT, 2015)

premature deathsa year in the US4

Non-adherencecontributes to nearly

[1] Osterberg L, Blaschke T. “Adherence to Medication.” New Engl.J. Med., Aug 4, 2005; 353(5): 487-97.[2] NEHI Research Brief, “Thinking Outside the Pillbox: A System-wide approach to Improving Patient Medication Adherence for Chronic Disease.” NEHI, 2009.[3] Viewpoint: How Nonadherence Is Killing Us—and What Can Be Done (Robert Nease, Express Scripts )[4] McCarthy R, “The price you pay for the drug not taken.” Bus Health. 1998;16:27-28,30,32-33


Bridging the Adherence Gap

of patients would never tell their doctor they did not plan to fill the prescription just written for them

of doctors believe their patients are taking their medicine

83%

74%


The Window of Opportunity

A critical window of opportunity exists between the point of prescribing a medication and 3 to 6 months after patients start therapy

After 6 months, 50% of patients suffering from chronic diseases do not take their medications as prescribed

Activities designed to improve patient adherence to treatment should be initiated early and become a part of routine conversations with patients

“Drugs don’t work if people don’t take them” C. Everett Koop, MD US Surgeon General 1982-1889


The numbers can be staggering


The Empowered Patient

THEY’RE NOT ONLINE TO SEE MORE MESSAGES. THEY’RE ONLINE TO FIND ANSWERS.


The RealityPatients want to know about their prescription medications and feel frustrated when they don’t receive enough information

Most patients want information on:

• Why their medication has been prescribed

• Duration of therapy

• Possible side effects

• What could happen if they don’t take their medication

On average, physicians spend only 49 seconds discussing all aspects of newly prescribed medications

• In a research study, 42% of physicians said they discussed the potential risks of the prescribed medication, but only 3% actually did so

Tarn DM, et al. How much time does it take to prescribe a new medication? Patient Educ Couns. 2008;72:311–319. 35.

Makoul G, et al.Health promotion in primary care: physician-patient communication and decision making about prescription medications. Soc Sci Med. 1995;41:1241–1254.


Commonly Adopted Adherence Interventions


Adherence Lifecycle

62%

The increased cost of acquiring new patients is 62% more than retaining existing ones

Patients’ non-adherence results in a “real-world” perception of a lack of efficacy and a lack of safety

$104BILLION

Specialty drug market

Source: IMS Institute for Healthcare Informatics, October 2014


Why do you need a PSP?


Innovation – How is technology playing into these programs?


Mobile will be one of the top three trends reshaping the healthcare industry in 2016 1

32% of U.S. consumers have at least one health app on

their mobile devices (up 16 percent since 2013)

2/3 of patients or 66%1 would use mobile healthcare apps to prevent and manage disease by:

Tracking diet/nutrition (47 percent)

Receiving medication reminders (46 percent)

Tracking symptoms (45 percent)

Tracking physical activity (44 percent)

79 percent would use a wearable device to:

Track physical activity (52 percent)

Track symptoms (45 percent)

Manage a personal health issue or condition (43 percent)1. PWC’s Health Research Institutes' Annual Report

2. Makovsky/Kelton “Pulse of Online Health”


Virtual Interaction Platform

INTEGRATEDSOLUTION PROVIDING:• Alternative to in-home or in-office training

ideal for remote location or based on preference

• Live video interaction with nurse

• Ease of access - no download of software

• Offered by nurse at clinical contact center orfield nurse from home office

Value added service provided by either in-field nurses or clinical call center


Differentiation – How do you build a program that is not a ‘me too’ program?


Att

rib

ute

s

Understanding Non-Adherence

Behavioral, attitudinal and needs-based attributes

Perception

Attitudes, beliefs, needs

and values

Motivation

Behavioral:e.g. Non-adherence

Attitudinal:e.g. I don’t tend to take my medication when I feel ok

Needs:e.g. education on importance of taking medication, practical reminders to take medication

External factors / environment

Behavior (i.e. level of adherence)

“I started to feel better, so once I started feeling better, as a young adult in my twenties, I thought ‘I don’t need to go to a hospital anymore’ – I’m running now,

I’m getting back to normalcy, I don’t think I need these (treatments) anymore, so I would miss an infusion and there was no follow-up call saying ‘you missed your

infusion’; it was up to me to follow up and then I just fell off the grid. Nobody was following me to say get back on this drug because you may not be able to get back on it, you may build up an antibody, so I went years without it…. then of course, the

disease came back.”

Pati

ent


Beliefs, Motivation and Behavior


Ashfield NARA Development Process

Exploratory qualitative research (n=20) with target patients and desk

research / SPLASH to identify attributes,

language, and support needs

Quantitative research (n=300)

gathering data from a large

sample of target patients

Statistical segmentation

analysis to identify

discriminate factors

Develop ‘typing tool’ using output

from segmentation

Validate and refine typing tool(validation of tool

with patients)

Nurses to utilize the tool in-field

(on-going longitudinal assessment of patient

segments)

Persona creation –identifying optimum

communication/intervention cadence to maximise

adherence for each persona

ImplementationTyping tool development

and validationPersona identification

Primary and desk research with target patients

Which attributes determine

level of adherence?

How many segments

are optimum?

Optimum frequency, order and channel?

How is it validated?

Key

qu

est

ion

s to

ad

dre

ss:


Patient Beliefs

I don’t believe the benefits outweigh the risks

No one in my family has hypertension, so I don’t believe I have it

I don’t think the medicine is worth it for what it will do to help me

Concern

Cost

Commitment


MONTH 1 MONTH 2 MONTH 3

Adhoc

Digital

Nurse Scheduled

Adhoc

Digital

Nurse Scheduled

Customized Journey

LOW RISK

HIGH RISK

1st Home visit

2nd Home visit

3rd Home visit

1st Home visit

Reactive call Reactive call


Right Program = Right Outcomes


The Gaps – What do patients and HCPs still need from these programs?


PSPs Must Address 3 Key Factors

Concern about medication – concerns about how to correctly use

their medication, when they may experience side effects, and about

short- and long-term safety

Commitment toward medication – intellectual, psychological, and

emotional commitment to the perceived need for treatment and the

importance of adherence

Cost of medication – affordability (perceived financial burden) and

the value of treatment


Harmonizing the Data and Closing the Feedback Loop

As the data gap grows, so will the communication gap between doctors and patients, and that prognosis doesn’t benefit anyone

We must optimize the entire experience –efficiencies in the HCP office AND the patient experience

We must give ‘all’ of the players a way to connect


It’s a Journey – Not a Sprint


QUESTIONS


THANKS FOR YOUR ATTENDANCE!

Documents

The Evolution of the PSP - Amazon S3...On average, physicians spend only 49 seconds discussing all aspects of newly prescribed medications •In a research study, 42% of physicians