How to successfully transition patient solutions providers

Switching patient solutions providers, also known as hub providers, is a big decision for any pharmaceutical manufacturer or life sciences organization. The transition can be a hefty lift for your team and your newly selected provider due to the amount of assets that need to change hands.

However, a successfully transitioned switch to a new patient solutions provider can improve the healthcare provider experience as they prescribe your product. A patient solutions provider with robust e-support solutions—such as e-prior authorization and e-benefits verification—can streamline the process and move patients through the patient journey faster, improving uptake and adherence, as well as increase the opportunity to move market share.

Patient and healthcare provider (HCP) experience is directly impacted by the quality of your patient solutions provider. The reimbursement and clinical expertise your patient solutions provider brings to the table can make the difference between a patient or HCP experience marred by uncertainty and an experience that encourages brand loyalty and improved clinical outcomes. It’s the caliber of your talent, coupled with technology that allows them to focus on people while technology drives process, that propels your program to gain market share and transform lives through access to therapy.

Making the decision to change patient solutions providers should be based on a number of factors that weigh against the lift of transition. You may need to switch if:

Your current partner is not consistently meeting service level agreements (SLAs). Unfortunately, overpromising and underdelivering is a common problem when it comes to serving the complicated pharmaceutical industry. SLAs should be considered the minimum threshold of delivery. If your provider isn’t meeting these standards, it’s time to switch.

What to look for instead: Not meeting SLAs is akin to breaking contracts with your organization. Your new provider should not only be able to meet current SLAs, but also advise what they would do differently to better serve your patients and providers. Expect case studies and references to attest to their capabilities. In addition, is the new provider willing to put fees at risk if SLAs are not met?

Changes in vendor leadership and/or key points of contact. Business partnerships rely on the strength of relationships to thrive. Changes in leadership or key contacts can cause confusion in your provider’s organization, slow down delivery due to ramp period and alter the way you work with your vendor. This sometimes trickles down to your patient experience, and not always in a positive way.

What to look for instead: Proven longevity of company leadership and account management ensures you have an opportunity to build trusting relationships with your patient solutions provider. The longer you work with your chosen partner, the deeper their knowledge of your organizational culture/vision grows, and the more efficiencies you gain.

Cost of vendor upgrading systems. Some providers pass on system upgrade costs to their clients, increasing the amount clients pay year to year from what was initially agreed upon. Switching patient solutions providers to a partner committed to maintaining the highest quality systems without passing those costs on to clients will help your bottom line in the long run.

What to look for instead: Your patient solutions provider, as it adjusts to ever-changing patient and provider preferences and ever-evolving technology, should consider upgrading systems as part of the cost of doing business. In addition, the system needs to have a “open code” concept in order to easily add on or apply new technology applications. Though offering enhancements may incur a fee, infrastructure changes should not be considered an upgrade that becomes a new expense for clients.

Disruptions in services due to system upgrades and bug fixes. Disruptions in services can be detrimental to the patient and provider experience. Both sets of end users have high expectations of what their experience should be, and any derailment from these expectations can result in perceived unreliability, access challenges, etc., that lead to therapy switching.

What to look for instead: Patient solutions providers should have a documented policy for how system upgrades and bug fixes will be carried out with minimal impact to your program. For best results, patient solutions services should be conducted at two or more geographically different locations, preferably in different time zones. This ensures that if a disaster or outage impacts one location, the other location can ramp up and compensate for the down location. This process should hold for system upgrades and bug fixes so no impact is felt by your end users.

Inability to scale and deliver on program volume. As your program grows and your product moves through its product lifecycle, your patient solutions provider should be able to shift its technology and people resources to adequately serve patients and providers. As the product matures, there may be more opportunities to leverage automatic processes that increase speed to therapy, improve operational efficiency and let talent focus on enriching the experience.

What to look for instead: A patient solutions provider that has invested in both people and technology resources will be able to balance your program facilitating a cost savings, as well as visibility into the patient’s stage in their journey. Your patient solutions provider should also be able to make recommendations for which points in your product’s lifecycle these resources should be distributed. For example, at the launch of your program, human expertise will be the most impactful to your program. An established product, conversely, may have the best results from a program with technology driving most of the process to allow talent to focus on engagement.

Inefficiencies in process due to use of legacy systems. Legacy systems can be limiting, especially as the industry increasingly demands interoperability. For example, systems that are home grown or were acquired by patient solutions providers that are “hard coded” for every transaction or process step are costly to upgrade and require hours of testing to make sure all “bugs” are identified and fixed. These outdated systems do not provide the real-time capabilities available today and are difficult to retroactively integrate new processes and capabilities.

What to look for instead: Look for a patient solutions provider with a strong technology foundation. The more your provider can operate with an entrepreneurial mindset—one that is not held back by legacy systems—the more they will be willing to configure and adjust their processes to the latest developments that can differentiate your brand and provide you with actionable data insights and trends.

Transition Best Practices

Once you have decided to transition to a new patient solutions provider and are considering what the transition will look like, your primary concern should be continuity of service to patients, caregivers and healthcare providers. Their experiences should always be your top priority, as these will have the most direct impact on your brand’s reputation in the market and the success of your product.

Consider the time of year of your transition. If you have a large population try not to transition during the re-enrollment period. There may be patients that are lost to follow up. Information may have already been given about the new benefit year coverage. Additionally, the patient or HCP may repeat or re-submit information to the new organization.

Another poor practice is to transition at the start or middle of a sales campaign. A slower period for your patient solutions team allows both the old and new provider to leverage a standard data import process and create a mapping template that lays out the entire transition. To ensure clarity and confidence in data and reporting, take into consideration the amount and type of data you will need to transition. Is the data actionable and of use for the near future? Older data can be transitioned during a Phase 2 or mapped later for comparative analysis. Create a comprehensive glossary of terms to ensure correct mapping and that definitions for data are aligned. For example, clear definitions of the start point for benefit investigation turnaround time need to be defined. Will you define it as when the form is received or when missing data is completed?

Another concern is how to handle patients in flight. Proactive and responsive processes to transition in-flight patients are crucial. There should be a plan in place that accounts for prescriptions coming in from the healthcare provider, direct-to-specialty pharmacy enrollments, etc. With so much data being moved, patients can be easily get lost in the shuffle, so it’s critical to map out the path for in-flight patient and provider scenarios and then develop safety net processes to track and follow each prescription and caller.

Further, any integrations your new provider needs should be fully tested as part of your transition to ensure the seamless timing of integrations in preparation for go-live. Often, specialty pharmacies have limited IT resources, so building in enough time to ensure these integrations are ready can be more time consuming than initially anticipated.

There are several timing considerations to take into account when planning transition, including your current sales objectives and roadmap, your contracts with current vendors, physician/office availability considerations and the advantages of a phased transition approach. A phased rollout with your new patient solutions provider can help you prove that this investment was worthwhile with every success. It also sets your new patient solutions provider up for success, allowing for pivots, reprioritization and the opportunity to address any issues piecemeal and with limited disruptions to your patients, caregivers and providers.

Choosing one patient solutions provider to service multiple brands can result in significant cost savings for your organization. If you can have alike rules across several products—for example, if they serve the same disease state or if support alike program business rules—you have the opportunity to develop one CRM instance to support the portfolio, reduce the number of full-time employees (FTEs) dedicated to a single program and have more automation in place. Using this strategy and building a team of centralized FTEs on the front-end allows you to create more of a “franchise” organization across multiple products and achieve economy of scale.

Whether you are switching patient solutions providers for one product or several, your new partner should be able to fill in all the gaps your previous provider fell short, as well as provide a refreshing new perspective that re-energizes your team and your brand. First and foremost—in the decision to change a patient solutions provider and throughout the transition—is the need to provide continuity of service to patients, caregivers and healthcare providers, so be sure your new partner shares this vision.

About the author

Jan Nielsen directs strategy and operations for the AssistRx Patient Solutions portfolio, including access and patient support services, the non-commercial pharmacy, and the quality and corporate training departments. Nielsen has more than 30 years’ experience as a clinical and operational subject matter expert with a background in critical care, hospital management and specialty pharmaceutical commercialization services.