Patient support programs: balancing technology and pragmatism

Technology is front and center of patient support programs today, but it isn’t a silver bullet. We need to balance technology with people and processes to achieve the right equilibrium of efficiency and risk.

Stakeholder Perspectives on Innovation

Patients want faster resolution, whether it is a one-call resolution or less time needed to process a request or respond to a call. They want options and flexibility for how they interact with their programs, whether through online portals, texting or live chats. Patients today are more connected than ever before, so their expectations are increasing. 

Healthcare providers want to operate within their normal workflow, using electronic health records (EHRs), without having to perform dual data entry by accessing a different portal or send a fax for reimbursement assistance to do a prior authorization. Prior authorization is one of the main pain points for healthcare providers today; they want transparency in prior-authorization requirements, more automation and timely patient care.

Manufacturers want to facilitate patient access to products. They need differentiation from the competition and flexibility to change as the market evolves. Manufacturers want efficient and cost-effective programs, and they expect accurate results with quality outcomes delivered consistently. 

Innovation Drivers

To improve access and resolution, we must seamlessly leverage technology. The goal is to streamline each step of the process, whether electronic benefits verification, prior authorization or tools to help agents address inquiries faster. We can gain efficiency by simplifying business rules and operational processes, emphasizing patient and provider use of technology and integrating automation into the overall workflow. Once we have effectively leveraged technology, we can look at delivery models that further increase efficiencies. For example, moving administrative work to lower-cost geographies can focus U.S. agents on value-added activities. 

Pilot Program: Creative Approach to Minimize Data Entry

When it comes to evaluating and implementing technology solutions, our approach is to test our concepts via a well-informed pilot program. For example, when we were evaluating optical character recognition (OCR) technologies to help automate case intake, we made several assumptions on the time savings, processed numerous forms through the engine to optimize artificial intelligence and then evaluated results.

As we know, patient support intake still includes faxed forms. To automate, we implemented OCR that can read with 95% accuracy for typed and handwritten information. Frequently used forms were templated so the OCR engine could read each field within the form. Unrecognized forms received via fax were rejected by the engine and entered manually. Recognized forms were processed and digitized. If a field did not meet the confidence level, the record was sent for agent review in a portal. The digitized content was loaded into our CRM system to minimize data entry and accelerate the start of research.

By leveraging a pilot approach, we were able to uncover challenges with OCR that we had not initially anticipated and addressed them prior to rolling it out to all programs. For example, we found that some forms would be blurry and difficult for the OCR engine to read. Often, users would not follow instructions and would write text in the margins or not in the designated fields. We were able to put in stopgaps to address each of the challenges. After we fine-tuned our business rules to minimize data entry via technology, we explored using lower-cost geographies to optimize the process further. We then validated our assumptions via time-and-motion studies and addressed any gaps. Taking a pilot approach allowed us to refine the technology and the process to maximize efficiency and accuracy.

Design Principles to Maximize Innovation

There are several principles fundamental to maximizing innovation through the use of technology:

  • Designing from an end-user perspective is vital. 
  • Vetting solutions and running pilots allow the best of use of technology and processes to address any gaps prior to launch.
  • Using the right balance of talent, processes and technology sets the stage to optimize the process and minimize risk.
  • Incorporating change management is critical to the adoption of new technology, and data-driven insights help to continuously improve and optimize.

We need to continuously improve patient support programs, with our eyes fixed on removing stakeholder barriers. Technology plays a vital role in innovation and efficiency in this effort. However, it is necessary to pragmatically identify the right balance of talent and processes to optimize outcomes further and minimize risk for program success.

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