Electronic Health Reporter

By Josh Marsh, vice president and general manager Sonexus access and patient support, Cardinal Health. 

Every patient’s journey through the healthcare system is different, but patients on specialty medications need extra support with navigating both high costs and overcoming barriers to access. For specialty patients, streamlining access to care is especially critical.

Looking back at 2023, below are five industry trends that have made a big impact on both the patient and provider experience. These trends – some positive and some negative – have shaped the patient journey over the past year and provide insight into how the patient services hub industry will evolve in the new year to come.

Digital assistant chatbots allow for increased flexibility and efficiency

Over the past year, artificial intelligence (AI)-powered digital assistant chatbots have played an important role in removing obstacles that prolong and complicate patient access to life-changing therapies. Chatbots allow for flexibility in the patient’s schedule by assisting with tasks and providing information without the need to pick up the phone.

These tasks include filling in missing health data, uploading insurance cards and answering questions about certain services available, all while simulating human conversation. Many physician offices prefer chatbots, due to the ability to communicate with the patient services hub without major disruption to their workflow. This allows providers to allocate more time to other parts of the patient’s health journey.

The digital assistant chatbot’s 24/7 availability gives flexibility to both patients and physicians, and makes a real impact on improving patient access and speed-to-therapy. The key to an effective digital assistant chatbot experience is to ensure that the technology is powered by a human when necessary, resulting in a custom-fit patient experience.

In cases where a more complex issue needs to be solved for the patient or provider’s office, a live team member should be able to seamlessly take over from a digital interaction. This experience can still be delivered virtually via the digital assistant chatbot, or the patient can be connected via phone.

Alternate funding programs pose problems to patient access to specialty medications

Alternate funding programs (AFPs) appear to be beneficial by identifying and connecting patients with financial assistance opportunities, but these programs can actually hinder patient access to therapies. AFPs create additional access barriers for patients by, at times, masking the coverage for a specialty product on a commercial insurance plan.

When a product that was previously insured is masked from a patient’s plan, AFPs direct patients to free, manufacturer-sponsored patient assistance programs (PAP). PAPs are established for those patients who don’t have insurance or who are considered underinsured due to meeting certain Federal Poverty Limit (FPL) limits, to allow them access to the specialty medication at no cost.

By pushing actively insured patients to these programs, AFPs actually limit access to care for those more vulnerable populations for which PAP programs were designed to assist. Patient services hubs should educate their internal teams on how to identify AFPs as well as utilize speech analytics to automatically flag patients who could be negatively impacted, to ensure intervention occurs. As we’ve seen AFPs grow as a trend in 2023, patients and providers should be aware of their potential negative impacts.

The true digital hub balances automation with human interaction

As recently as a few years ago, many patient service providers relied on the illusion of a digital hub, promising an automated experience without delivering actual solutions and services that streamline outdated processes. In 2023, the true digital hub took off, digitizing the patient journey from beginning to end. Where providers once used faxing to enroll patients, they are now assisted by digital tools that electronically manage enrollment via eRX submission and automate patient health data entry.

The once slow and time intensive process of verifying patient insurance benefits over the phone has now been replaced with direct connections into payers that retrieve the same information in the click of a button. Prior authorizations which required multiple faxes and phone calls are now streamlined through ePA tools that allow providers to submit electronically, directly to more than 90% of payers.

However, there is no one-size-fits-all approach to digitizing the patient journey at the hub. The difference is how the patient services hub partner connects the dots in the journey between using digital tools and adding human interactions. Balancing both human and tech elements make the hub a true digital experience that focuses on individual patient needs.

The hybrid hub model unites manufacturers and patient service hub providers

 A continued trend seen this year with pharma manufacturers is an increased desire to operate their patient services hub within a hybrid model. For most pharma manufacturers, fully outsourcing patient services and support to a third-party hub provider makes sense. However, in 2023, we saw an increase in more manufacturers seeking out a hybrid hub model solution. Such a hybrid model provides flexibility for the manufacturer to add on some resources and technology into the larger patient services platform. This has been a great opportunity for manufacturers to take a more hands-on approach. This model will only increase patient access to therapies in the coming year, as the hub provider and manufacturer can combine resources and expertise to further streamline and accelerate the patient journey.

Generative AI and machine learning automate the patient journey

There is no question that gen AI and machine learning have already made a significant, positive impact on the specialty patient journey in 2023. As we look ahead to 2024, we will continue to see more focus on AI/ML to further automate the patient journey and how different types of AI-powered technology can be utilized to enhance the experience of patients and providers at the patient services hub. We’re already seeing that optimization through streamlined on-boarding of patients, point-of-care workflow automation, clinical education via digital assistant chatbots, and speech analytics that identify key trends or risks that the patient is potentially facing in their journey to gain access to their specialty medication. Patient services hubs should be, at a minimum, exploring how AI/ML can automate unnecessary manual steps within their internal operations and in their external facing products and tools that touch patients and provider offices.

In the new year, all five of the trends that have had a large impact in 2023 will continue to transform the patient and provider experience and innovate how all stakeholders across the healthcare ecosystem come together to deliver patient care.