Strengthening the Link with Consumers and Providers
For years, life sciences companies that operate in the United States employed a fairly straightforward process to enhance their commercial viability in the domestic marketplace: Educate physicians about a product and maximize payor reimbursement for it. The model emphasized operational functions such as direct sales and marketing to physicians, with significant budget expenditures for selling and marketing activities. The wider potential of customer communication and support functions such as patient education programs and reimbursement support (and their associated data) were minimized, if leveraged at all.

With the advance of health care consumerism and the resulting shift in purchasing power, clinicians are expected to see their role in the prescribing process change from "director" to "coach." Life sciences organizations, in turn, will need to rethink their approach to communicating with both physicians and consumers and meeting their information needs, particularly in the key areas of reimbursement services and customer support.

Consumerism's Impact on Reimbursement Processes

In a consumer-empowered health care market, the availability and credibility of product pricing, quality, and outcomes data (e.g., if a patient complies with a prescribed drug regimen it will have a commensurate ROI on his or her health) is expected to become essential to consumers' decision-making ability, as well as the reimbursement process. This is placing pressure on providers, payors and life sciences companies to increase the transparency of and access to this information.

Life sciences companies will need to identify new ways to reach and influence consumers throughout their entire care decision process – from information gathering through product purchase and reimbursement, and even into adverse event management. In the near future, the industry could see consumers and physicians contacting reimbursement call centers more frequently or accessing reimbursement information via web sites. Life sciences companies should, therefore, align their operational strategies for both physicians and patients with these emerging trends. In addition, companies should enhance efforts to educate audiences about product value, costs and reimbursement, as well as the more traditional issues of efficacy, safety and administration. In many leading companies, Reimbursement Support functions are beginning to play a role in this process by working with and participating in focused provider discussions with Medical Affairs to present a comprehensive story on the economic and clinical benefits of their products.

Changing Service Expectations

Today's consumers are translating the service expectations they have developed for industries such as consumer goods and financial services into the health care arena. They are expecting answers to their questions and are exerting their growing clout in doctors' offices and in pharmacies. These new (and growing) consumer demands present life sciences companies with a unique opportunity to deliver key messages about their products and services and present themselves as a trusted partner in a patient's overall treatment plan.

While many life sciences organizations have begun to bolster their customer support capabilities, many more have not. Less-prepared organizations continue to provide limited patient-oriented information and, in many cases, rely on third-party call centers to define the strategy and image of their organization, thus foregoing the opportunity to engage directly with their customers. This approach will no longer suffice in a consumer-oriented market. It is time for life sciences companies to take control of their customer service and reimbursement support functions, either by insourcing the capability or better defining their service-level agreement with third-parties/outsourcers. We suggest that companies consider implementing the following strategies to help ease the transition:

1. Boost the organization's service support Life sciences companies should improve customer support for reimbursement assistance, existing coverage, coding and payment issues. (This is particularly important for high-priced biologics and chronic therapies, where a customer's lifetime value is high.) At a minimum, companies should train reimbursement hotline personnel to be more adept at addressing patient issues. Reimbursement service offerings should be extended beyond answering prior authorization and coding questions and encompass access to care both in the form of alternative channels and free product for under- and uninsured patients. Companies also should expand their online reimbursement support capabilities, such as offering reimbursement web sites for consumers and physician office staff. Another way to enhance online reimbursement support capabilities is to partner with payors and general health web sites to provide content for consumer decision-making tools that clearly communicate the effectiveness and risks of specific drugs.

2. Bolster overall data collection through all customer contact points Using call center data more effectively and leveraging that data across the organization could enhance a life sciences company's customer support and reimbursement functions. Although there are regulatory limitations on using some patient-oriented call center data for promotional activities, there are other ways that companies could leverage this valuable information to respond to customer needs, particularly if data is integrated and communicated among functional areas. For example: * Companies could profile payor behavior, particularly when coverage is being improperly denied. * Reimbursement services could share the profiles with Managed Markets and Marketing to address denial issues and potentially improve coverage. Such information gives valuable insight into how payors are behaving toward on-label and off-label indications. Life sciences companies also could profile physician behavior to better understand educational needs around product information, such as use against not-yet-approved indications. It is critical to share this information with the field sales force so physicians and their staff can be properly trained to maximize utilization. Similarly, companies could profile patient behavior and measure their buying behaviors and decision-making processes. This information could then be used to identify data gaps and develop targeted educational programs. Finally, life sciences organizations could measure the reimbursement rates of physicians who purchase product directly and track instances when they are earning a negative margin on the product. This data subsequently could be used to identify payors who are reimbursing at an incorrect rate and, when shared with Pricing, feed into discounting strategies to prevent lost revenue.

3. Expand financial assistance programs for patients In addition to standard Patient Assistance Programs, life sciences companies should explore offering other financial assistance options for consumers. For example, they could provide financing/payment plans directed at patients without insurance or those with high-deductible insurance plans. Or, they could partner with philanthropic organizations to create funds to support a disease state and therapy. This could minimize revenue loss by retaining patients who might otherwise choose not to seek treatment. Patients who don't have drug coverage but who make too much to qualify for Medicaid or a Patient Assistance Program often find themselves in a difficult financial situation when they are prescribed a high-price therapeutic. These patients could be offered financing programs either through third-party credit providers or by the drug manufacturer itself. This is a relatively new phenomenon in the pharmaceutical and life sciences industries but a well-developed practice in the field of dentistry and for certain elective procedures, such as LASIK eye surgery. Care Credit, for instance, is a GE Money company that offers financing for LASIK, cosmetic surgery, dentistry, veterinary medicine, hearing aids and other procedures.1

4. Better educate patients on reimbursement issues and pitfalls Life sciences companies should incorporate reimbursement and product value information, where appropriate, into the consumer promotional mix. Some pharmaceutical companies already are providing consumer education around reimbursement but there is room for improvement. For example, companies should communicate product effectiveness in lay terms to support the consumer decision-making process. Additionally, they could institute patient education programs through self-service channels such as web sites to assist consumers with increasing decision complexity. Also, companies could collaborate with trusted web portals such as or the to dispel rumors and provide credible information. This approach might minimize the number of patients calling the reimbursement hotline with basic questions that could be addressed by easy-to-use online educational tools.

5. Educate physicians on reimbursement services and how to support consumer decisions Life sciences companies could complement current promotional messages to physicians and their staff with product value and reimbursement information and educational tools to help patients understand treatment options. Additionally, companies could actively promote claims appeal services to physician offices via the field sales force, web site and other channels to help minimize lost revenue. Building strong, lifelong relationships with patients and providers can help life sciences companies protect market share and reduce product switching. We have seen companies recognize the value of adopting such a strategy and implementing it, either by establishing their own reimbursement support call centers or outsourcing the function. Unfortunately, we have also seen other companies fail to recognize the true opportunity at hand. With more and more privacy safeguards being put in place, customer requests for information and assistance may be the single greatest opportunity to develop a lifetime relationship with those who prescribe and those who use treatments.

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1 "NeoStem Announces CareCredit, a GE Money Company, to Offer Clients Financing Payment Options for Stem Cell Collection and Banking," Business Wire, 7 May 2007. ( –)