Streamlining Access: Delivering Value Throughout the Hub Experience
By Lash Group |
Hub Models: Definition and Drivers
Using the hub approach effectively requires an understanding of what a hub is — by definition and by its benefits — as well as where the approach originates. The literal, Merriam- Webster dictionary definition of the word “hub” is:
- The central and most active part or place
- The airport or the city through which an airline sends most of its flights
- The center of a wheel, propeller, fan, etc.
What each of these definitive phrases has in common is the notion of centralization; however, asking various stakeholders across healthcare what a hub is often elicits varying responses. This is because the hub model’s healthcare application differs based on those stakeholders’ needs. To effectively define the hub approach, let’s look at the value centralization delivers in healthcare. In terms of support program centralization, hubs:
- Offer a single point of contact that streamlines patient and provider access to specialty drugs
- Prevent potentially redundant resources
- Increase short- and long-term access to products
- Deliver comprehensive healthcare management services
- Are a centralized, strategic approach that interjects value
Simply put, the hub model streamlines the delivery of valuable services to patients, providers and payers. And the hub can be delivered in three key ways:
- As a mandatory single point of contact to register/ certify and receive medication
- As a highly preferred and centralized access point to manage the entire patient and prescriber experience
- As needed for a central point of access to a particular component such as affordability support
The hub model was born out of an increasingly chaotic and challenging healthcare environment wherein providers are seeing shrinking reimbursements and increased payer management, compliance and management considerations, a low threshold for billing and coding errors. These provider pressures then become manufacturer challenges as they create an elevated need to differentiate a product among providers, and thereby patients. Hubs provide the opportunity for pharma to address multiple challenges through a single point of contact and overcome access barriers.
The evolution of hubs
The hub model has come a long way since its inception in the early 2000s. Early iterations of the hub approach measured effectiveness with data-driven KPIs — “vital signs” that proffered a view of tactical outcomes such as the number of hotline calls, aggregate payer information, the average answer speed and Patient Assistance Program/Benefit Verification turnaround times. While these measurements are important, hub data has evolved over the last 10 years to include not only the vital signs, but also the “value signs” — speed to therapy/time to fill, duration of therapy, prescription abandonment rates and patient literacy/ risk assessment scores. This evolution is a response to stakeholder needs, regulatory requirements and technological advancements. Manufacturers have learned that it’s these value signs that differentiate a product and shifted to proactive service offerings that leverage the value of centralization. Figure 1 represents the evolution in service offerings as manufacturers change how they position the hub.
Value delivery demands alignment not only in terms of matching strategy with resources, but also when it comes to finding crossover between the priorities of many customers. The hub model accomplishes two things: aligning services through a single point of delivery and aligning patient and provider access to required therapies. As such, effective program design means tactical and strategic alignment. As healthcare stakeholder needs often compete or differ, manufacturers need to approach this alignment with the customer in mind, addressing key triggers to access barriers as well as stakeholder goals and initiatives. In addition, services and programs must be scalable to the evolving needs of these stakeholders and, to an extent, their customers.
But what about manufacturer objectives?
With providers focused on clinical outcomes and manufacturer goals encompassing product performance indicators (speed or duration of therapy), a critical part of hub model design must be identifying and prioritizing objectives. Engaging as early as possible will ensure the hub targets all relevant initiatives and players, explicitly aligning on which outcomes take priority. With service priorities changing over time, one trend in program design is the anchoring of manufacturer services to affordability or clinical education support to blanket the mix of priorities. Then, as the product matures, coverage and formulary issues tend to course correct as provider and patient knowledge grows.
What manufacturers will see as they find alignment within the hub design is that the key success indicators are — and must be — tenets of patient access. Figure 2 demonstrates the value drivers to keep in mind in terms of access barriers.
Creating customer value throughout the hub experience
Optimal outcomes can be achieved if the hub is positioned properly. Figure 3 represents a case-based, Lash Group example of outcomes for an oral specialty agent with a specialty pharmacy network, measuring access and adherence data for hub patients against outcomes for those who went direct to the specialty pharmacy.
Best practices for interjecting value
The key to adding value throughout the hub experience is focusing on value across the continuum, from program design through outcomes measurement. “Injection points” for value throughout the patient and provider experience include:
- Decision to treat: Once the decision to treat has been
made, shift the focus to efficacy and speed, flexing to
integrate with the prescriber workflow and offering
product education for the provider, portal enrollment
and site management services.
- Impact point: days to dispense metric
- Enrollment: Depending on the enrollment requirement
and customer needs, enrollment — or a request for
assistance — is the first opportunity for a manufacturer
to leverage the value of streamlined access. Enrollment
is where patient engagement begins (with welcome kits
and affordability program opt-in) and where providers
can benefit from e-prescribing and other services
available within online portals. It is also where online
co-pay card programs can be introduced to offer
patients, physicians and pharmacies instant access to
- Impact point: days to dispense and abandonment metrics
- Prior Authorization: When required by a payer, PA presents one of the first and most optimal points at which seamlessness in the patient journey can be achieved. Electronic Prior Authorization (ePA)
capabilities built into provider portals allow providers
to initiate — and receive responses to — real-time PA requests. Moreover, ePA requests can be submitted with enrollment to further streamline the HCP workflow and expedite the patient’s time to therapy. This integrated solution also allows support program providers to provide PA tracking and denial follow up assistance to reduce the burden on the healthcare provider’s office.
- Impact point: days to dispense, payer denial metrics
- Assessment and Action: From Benefit Verification to
determining a patient’s cost-share responsibility, this is
where assessing a patient’s situation and the resulting
program appropriateness will take place, as well as
where additional stakeholders — payers and specialty
pharmacies — may be introduced. It is at this interaction
level that the benefit streamlined coordination becomes
evident, as multiple support requirements and options
can be managed and referral to specialty pharmacy
triage or nurse educators takes place.
- Impact point: days to dispense, abandonment, payer denial metrics
- Logistics: From enrollment tracking to drug distribution
management, the hub as a single access point means
centralized processes for ongoing support. This is where
patients and providers receive reassurance of access to
- Impact point: days to dispense, abandonment, duration of therapy
- Adherence: Adherence programs increase patient
compliance, and therefore brand performance, with
services from refill reminders to continued product
education. Within the hub model, adherence programs
are supplemented by the manufacturer’s ability to
intervene when access challenges arise for continuous
- Impact point: duration of therapy, brand loyalty
Choosing a provider
Benefit design that accommodates different brands with different needs is critical to a program’s success. Support program service providers should be able to tailor a program to stakeholder and manufacturer needs, from simple to complex. Lash Group has proven success in developing early brand loyalty while reducing long-term cost, aligning our resources with brand objectives and strategy. We’ve helped manufacturers:
- Build a marketshare through patient conversion and adherence
- Create market differentiation—with consumers and physicians
- Increase the share of voice and loyalty within the key physician base
- Optimize patient access while preserving profitability
- Build disease and drug awareness through patient education
- Leverage technology to impact uptake and demonstrate value to payers
- Leverage technology to streamline and expedite time to therapy
- Offer increased efficiencies reduced administrative burden for providers through e-services like our FlexConnect Copay program and ePA portals