Brandon Salke, Pharmacist in Charge, General Manager of Operations, Optime Care
“Thank you for calling our pharmacy. Please listen carefully, as our menu of services has changed. To refill your medication, press one. For questions about taking your medication, press two. For questions about your insurance coverage, press three. For all other questions, press four. To repeat this menu, press five. To speak to a live human, good luck.”
Who hasn’t had the pleasure of navigating an IVR (interactive voice response) system? It is the gateway to virtually every organization, and specialty pharmacies (SPs) are no exception. Many SPs employ automation across the entire patient experience, from starting a new medication to ordering refills. Both dispensing and patient communications are automated. Any time a patient needs to interact with the SP, a complex (and often frustrating) IVR phone tree stands in the way.
The reason many SPs rely on automation is simple: efficiency. The approach is best suited for large patient populations that have common conditions such as hypertension or Type 2 diabetes. Serving these patients involves a high volume of simple, repetitive actions. If there’s any variation in those actions—such as a patient changing insurance plans—the automated service model can begin to unravel.
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Why automation doesn’t work in the rare and orphan world
Rare and orphan diseases have small patient populations and are not suited for a high volume-based service model. There’s too much variation in the service patients require; everyone is unique and requires tailored care as circumstances change.
For example, a patient may switch jobs and insurance plans, or the medication dose may be modified. The SP needs to effectively respond to the changes in each patient’s life. In an automated environment, this level of customization is difficult if not impossible to achieve, and patient and physician satisfaction diminishes as a result.
As I just mentioned, the patient needs to navigate a complex phone tree process, hoping the right message gets to the right person at the right time. Often, that message isn’t delivered the first time to the right person, so the patient must repeat the process—sometimes more than once. The patient may be put on hold multiple times and deal with several escalation points.
Eventually the message may be delivered, but only after a great deal of time and frustration. Meanwhile, the right medication may not be delivered in time and the patient could fall into non-compliance.
Automation can be challenging for physicians as well. For example, a physician may need to use an SP’s online portal to start a patient on a medication or revise the treatment plan. What if the physician accidently enters the wrong information or forgets to hit “send”? Or the physician may have to navigate a complex IVR system to attempt to start or change a patient’s medication. The physician doesn’t have a specific, go-to person at the SP to resolve any issues. So the physician’s instructions may not be met and the frustration level begins to rise.
In short, automating communication simply doesn’t work in a rare and orphan environment.
The impact of automation on manufacturers
Manufacturers that rely on automation to serve patients with rare and orphan conditions can expect to face many challenges as well, including:
- Delays in starting patients on the medication
- Incorrect dosing
- Mistakes with billing
- Non-compliance when there are changes in a patient’s life, such as switching insurance plans
Despite the issues created by automation, manufacturers can be reluctant to switch SPs, believing the experience wouldn’t improve and that the risk of change could be too high. Manufacturers may even rationalize that an IVR is a valuable tool that can improve patient care—for example, calling patients automatically to remind them it’s time for a refill. But if a patient has a question, an IVR stands in the way and patient satisfaction suffers.
I should note that patients with common conditions can share this frustration with IVR systems. Who hasn’t had a difficult experience pushing what seems like endless buttons to reach the right person?
Volume first vs. patient first
For patients with rare and orphan conditions, the more effective service model is patient-first. With this approach, a live person at the SP answers the phone 24/7. Even after hours, a friendly voice is on the phone, triaging the patient’s concerns and recommending the best course of action—whether the patient simply has a question or is having an adverse event. It’s a knowledgeable, reassuring voice caring for the patient—not a robotic IVR system that requires patients to press button after button to find the right person.
Outbound patient calls are an equally positive experience for patients. To begin a patient’s regimen, an SP representative reaches out to explain the medication, answer any questions, evaluate insurance coverage and determine if the patient qualifies for any financial assistance programs.
It’s a one-on-one relationship to ensure the patient starts and continues taking the medication. At Optime Care, we even have a pharmacist standing by to directly answer any patient questions about the medication.
In an IVR environment, a patient simply can’t have this level of personal interaction. Compliance and patient wellbeing can suffer as a result. In contrast, a patient-first model that favors human contact over automation can yield significant improvements in compliance. While a traditional, automated SP model may approach 65% to 80% compliance, a patient-first approach can achieve 90%. In addition, manufacturers can start patients on medications faster, yielding an “extra” fill.
Data capture and quality are critically important benefits as well. With a patient-first model, manufacturers receive 100% of patient data for 100% of patients. Manufacturers have full visibility into every patient interaction. In an automated environment, data can “fall through the cracks” and decrease visibility to the patient population’s experience with the medication.
Just as important, the quality of data that a patient-first model yields is superior—empowering the SP to not simply react to but anticipate patient needs. By being immersed in how a rare or orphan disease impacts individual patients and their families, the SP can improve the experience of both far beyond what an automated platform could ever achieve.
In our view, replacing automation with a patient-first model is a proven strategy for optimizing the manufacturer’s program and achieving its full potential.
The human touch
Rather than relying on automation, look for an SP that actually talks with patients, understands their needs and builds the program around them. Technology can have an important role in the patient-first model, but not for its ability to handle a large volume of patients. Rather, the right application of technology can further customize and improve the patient experience.
For example, we were designing a program for younger patients and learned that they preferred text messages over phone calls. How did we discover that? We simply asked them. That’s the power of the human touch—and the patient-first approach.
To learn more, download our white paper, “How to create a patient-first strategy.” Or contact me directly at email@example.com or call 888-287-2017.