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Human Care Systems provides comprehensive patient and HCP support programs for biopharm and medtech companies and provider and payer organizations in the rare disease market. We help organizations reach patient and HCP initiation, adherence and retention goals by integrating a proprietary intelligent stakeholder algorithm. The result is Real World Outcomes: optimized patient quality of life, HCP brand preference and brand ROI
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HCS Confidential
BEHAVIOR SCIENCE EXPERIENCE DESIGN PROVEN RESULTS
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B O S T O N | L O N D O N | S A N F R A N C I S C O
HCS Confidential HCS Confidential
We Design, Develop and Deploy comprehensive support PROGRAMS for HCPs and Patients. Our programs are based in BEHAVIORAL SCIENCE and…
Add More VALUE To Product
Impact clinician decision making
De-risk the product
Impact patient self-management, adherence and QoL
Improve real world outcomes
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solution.This is Human Care Systems
deliver.change behaviors.
monitor & measure.
engage.
personalize.
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about.Locations & Experience
• Asthma• Back problems• Chronic Kidney Disease• COPD• Diabetes (T1 and T2)• Heart Failure• Hemophilia (A & B)• Hepatitis (B & C)• HIV• Kidney Transplant• Mood disorders• Multiple Sclerosis• Lupus• Oncology (CML, CLL, MBC,
MCL NSCLC, RCC & others)• Osteoporosis• Nephrotic Syndrome• Pain• Pneumonia• Pulmonary Hypertension• Rheumatology• Stroke
SAN FRANCISCO
BOSTON
LONDON FRANKFURT(Opening 2014)
TOKYO(via partnership)
SINGAPORE(Opening 2014)
SÃO PAOLO(via partnership)
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process.The HCS System
Revenue Awareness Initiation Adherence Retention
Events Time and Trigger
identifiable inflection points relevant to
clinicians and patients
Barriers Learn, Gain Insight, Take
Action to impact clinician and patient
decisions and behaviors
Targets Inputs Results
We use an analytical system to design, deliver and measure high impact service and support to clinicians and patients.
Behavioral Science Application of literature and
experience on effective learning, decision-making
and behavior change.
Experience Design Integrated customer
experiences across channels (print, web, mobile,
salesforce, phone, etc.)
Outcomes Quality of Life, Health Outcomes Health Economics
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Map
Knowledge of stakeholder experience from understand phase
Priorities of brand team
Proposed rules-based customized solutions to address barriers and gaps to fulfill brands objectives and provide a comprehensive patient, provider, and payor solutions
Identified barriers and gaps extrapolated from the synthesized information in the understand phase
Utilizing the training in psych evaluation, research, and analysis and with the principles of social, cognitive, and behavior theories of human behavior as well as the transtheoretical model, biopsycho-socio-environmental theory, health belief model, and theory of planned behavior, the experience map is created in an iterative fashion.
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Rules based customized solution
Treatment initiation
HCP prescribes Product X
Nurse Calls
Email or Mail
Text Reminders
1 2 3 4 5 6 7 8Product X Applications
Patient self-assessment
Rx
Barrier topics delivered in a multi-channel program based on patient endorsement and a pre-determined barrier ranking (developed from learning in the understand and map phases)
Treatment initiation
HCP prescribes Product X
Nurse Calls
Email or Mail
Text Reminders
1 2 3 4 5 6 7 8Product X Applications
Patient self-assessment
Rx
Barrier Assessment
Patient Identified Barriers
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Return on Investment
DIABETES
12:1
RARE KIDNEY DISORDER
ORAL ONCOLYTIC
25:1 10:1• Reduced 6 month attrition
rate from 22% to 5%• Improved Market Share by
2 points• Improved adherence by 8
additional infusion sets per year
• Improved 6 month A1C by 24%
• 15 point Net Promoter Score Improvement
• Initiation rates have increased from 70% to 85% after implementation of this program
• Discontinuation rates have dropped from 40% to 15%.
• 90% of eligible countries have implemented program
• Measured adherence improvements have ranged from 10%-38% across countries
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Clinical Health Psychologists
Experience Designers
SoftwarePlatform
Multi-ChannelDelivery Field Clinicians
• Trained in Clinical Psychology with subspecialty in Health Psychology
• Health Psychology is the application of behavioral science to medical health management
• Information Architects and User Experience Experts (IA/UX)
• Print and interactive designers
• Software architects and developers
• Salesforce.com administrators
• Nurse phone coaches
• Web• Mobile• Text• Email• Mail house
• Trained and Certified
• Provide in person training (i.e. home infusions, product management, etc.)
Management:• Business unit and geographic leadership
• Company leadership• Guide Medical Regulation Review
about.Team Expertise
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solution.This is Human Care Systems
We design, develop, and deploy service & support solutions to modify behavior and drive higher rates of adherence, improved health outcomes, and increased patient and HCP satisfaction. The HCS system is based on the following pillars: Behavioral science. HCS’ team of health psychologists use behavioral science to deliver programming to change adherence, patient/clinician
communications, and other self-managing and self-monitoring behaviors.o Deep and actionable understanding of patient pain points based on existing knowledge and research + systematic literature review +
ethnographic research.o Most effective programming to change behaviors:
High impact education to support learning. Cognitive behavioral exercises to change relationships between thoughts, feelings and actions. Motivational interviewing techniques to build self-efficacy and motivation.
Personalized, high-impact experiences. HCS’ technology platform personalizes program content and timing to individual patient’s events and
barriers as well as evolving over time as patient progresses through therapy.o The HCS platform combines a personalization rules engine + CRM database + interfaces to deliver personalized and integrated programs
through multiple channels. o Multichannel solutions, that feel to the patient like a coherent and personalized experience, are the most effective way to reach and
impact patient behaviors.
Change, measure and communicate outcomes. HCS’ measurement, analysis and publishing support capabilities ensure that the results of the support program are best captured and communicated.o Measured impact on Trx (brand choice + initiation + adherence).o Real world outcomes.o Studies and publishing.
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B O S T O N | L O N D O N | S A N F R A N C I S C O
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How We Work
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v v
Approach
Define Current Experience Map
Map Ideal Experience
Build & Deliver Solution
• All stakeholders• Existing research and
knowledge• Patient and Clinician &
Patient Ethnography• Literature review• Netnography• Mine data sets• Barriers & Events
• Specific to the needs of each stakeholder
• Personalized experiences for each patient
• Integrated and coherent across multiple channels
• Customize experience for each population and indication
• Deliver integrated support across multiple channels
• Change patient and clinician behaviors
1 2 3
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HCS Solution Framework
Events Barriers Triggers
•Logistic •Social•Physical and Cognitive •Emotional•Attitudinal/Cultural•Side effects•Provider •Health Literacy•Regimen requirements•Financial
Key milestones that occur along a timeline such as:•Symptom Onset•Diagnosis•Decision to Treat•Onset of Side Effects•Symptom Improvement•Treatment Fatigue
Things that happen that may foreshadow non adherence or discontinuation:•Severity of side effects•Financial event•Health or Personal Crisis•Missed or Delayed Refill•Patient Feels Lack of Progress•Patient Feels They Are Doing Better
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• To HCP about their patients• To reps about enrollment• To patients about adherence• To the client and HCS about the program
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Level of Support Infrastructure Complexity of Treatment
Feedback
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Design All Touchpoints vs. Events & Barriers
Event Focused Barrier Focused
Time Based• Mailing, e-mail, SMS, Phone
calls at time based inflection points.
• E.g. educate on week 4 test results.
Trigger Based• Use passive data collection
techniques, questionnaires, and HCP inputs to trigger communications.
• E.g. congratulations phone call when glucose targets reached on connected meter.
Learn• Bite-sized, personally relevant education tailored to
learning style.
Gain Insight • Cognitive-behavioral exercises to help people understand
and take control of thoughts, feelings and actions.
Take Actions • Guided experiences to build and sustain motivation, self-
confidence and resilience.
Get Feedback• Help patients & HCPs monitor progress towards goals. Help
patients gain insight from remote monitored data when available.
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Creating a Whole Experience
Goal: Design and deploy integrated individual touchpoints to deliver a coordinated, high-value experience to all treatment stakeholders
Comprehensive, differentiated
solution
Cohesive and High-Impact Experience for Patient, Clinician, Caregiver, Office Staff
Individual Brand Tactics
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Solution Architecture
Tools & Support
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B O S T O N | L O N D O N | S A N F R A N C I S C O
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results.Case Study: Biologic Adherence for Rare Kidney Condition
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Key Barriers / Unmet needs Surrounding Taking Treatment: • Injecting with Disability• Education on Condition• Building Treatment Routines• Financial Concerns• Side Effects• Disability and Emotional Concerns
results.Case Study (Biologic Adherence for Rare Kidney Condition): Challenge & Situation
Challenge:• Low initiation and completion rates during the 6 month course of therapy: 70%• Discontinuation Rate: 40%• Overcome treatment barriers in a rare kidney condition including injection fears, confusion, questioning value of
treatment, side effects, and psycho-social concerns.
Ongoing treatment1st injectionCan I afford it?Pre-RxEvents
Barriers• Poor health
from primary diagnoses
• Lack of knowledge
• Cost• Why me?• Lack of urgency• Side effects• Confused about process
• Difficult regimen• Side effects• Needle anxiety
• Cost• Side effects• Treatment fatigue• Uncertain of benefits vs. costs
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Ongoing treatment1st injectionCan I afford it?Pre-RxPatientJourney
Tactics
HCP
DTP
Enrollment brochure
Nurse linePSK
ASAP
ASAP
Topic-specific mailings: initiation and adherence support
Printed materials Electronic Phone LogisticsKey:
Interactive website: initiation and adherence support
Schedule callsAssess readiness
Initial injection support
Trouble-shooting follow up.
Overcoming barriers to adherence
Building a support network
Planning to complete treatment
Lifelong health management habits
Messaging
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Touchpoints
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The Nurse Coach provides human, personalized support to patients.• Leads them through the Barrier Assessment, a
survey tool that identifies key obstacles to initiating and continuing Acthar
• Provides tailored support and guided steps to help each patient overcome his/her barriers
• Monitors the progress of each patient and provides appropriate help:
– information/resources– emotional support
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Customized Nurse Phone Interactions
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Print MaterialsNurse coach mails patients targeted print materials that supplement their discussions by providing additional information for patients to refer to in between coaching calls.
Print materials:• Focus on specific barriers• Offer practical advice• Invite engagement
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Customized Print Materials
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Interactive Web Portal provides a private space for patients to overcome their barriers at their leisure. Features:
• Educational information about the kidneys and proteinuria
• Interactive activities that help patients cope with taking and living with Acthar
• Guided tools that help patients develop specific plans for staying adherent
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Digital Support
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Tear SheetsPocket Guide
HCP Skills Training
• Virtual/Print Tool training
• Listening like a detective
• Identifying nonadherence
• Giving effective direction
• Responding to emotional patients
• Motivational interviewing
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: HCP Training & Tools
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Schedule callsAssess readiness
Initial injection support
Trouble-shooting follow up
Overcoming barriers to adherence
Assess final status & discuss next steps
Building a support network
Planning to complete treatment
Lifelong health management habits
RESULTS: 10:1 Return on Investment Initiation rates have increased from 70% to 85% after implementation of this program Discontinuation rates have dropped from 40% to 15%. 100% of patients enrolled in program are injecting on schedule.
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results.Case Study (Biologic Adherence for Rare Kidney Condition): Output and Results
HCS Confidential
B O S T O N | L O N D O N | S A N F R A N C I S C O
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results.Case Study: Insulin Pump and CGM Adherence
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Decide to Pursue Pump
• Reimbursement• Psychosocial
issues
Order and Shipment
• Big box of supplies can be overwhelming
Training
• Lack of knowledge
• Information Overload
• Hypoglycemic events, adjusting to wearing pump
Start Pump
• Carb counting• Insulin rare
adjustments
Infusion Set Change
• Difficulty with supply orders or Billing
• Fragmented support
See Progress
• Think no longer need treatment
Pump Problem
• Frustration
Achieve Goal
• To feel healthy, have better focus, more energy (through better glycemic control)
• More freedom in their schedule (eating, sleeping)
• Fewer hypos• Prevent
complications
Events
Barriers
results.Case Study (Insulin Pump and CGM Adherence): Challenge & Insights
Challenge:• Pump users experience many barriers, particularly in the first 90 days.• 22% of pump users quit within 6 months/ 65% CGM• Poor adherence
Key Needs based off of Insights:• Less fragmentation• Small actionable bits of information• More connection to patient’s purpose for using pump• Proactive support 28
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results.Case Study (Insulin Pump and CGM Adherence): Touchpoints
Pre Start Post Start
Field Clinician
Phone Coach
Ship
Orientation Call (N)
+7D +30D
In PersonTraining
+24H +3D +6D +14D +30D +60D +90D +120D +180D
CareLink Data
HL Calls Assessments
AdvancedClasses Available
Pre TrainingCall (N) Attrition Risk
Score
CareLinkReview
Transition of Care Document
MO
NIT
OR CELEBRATE
Monitoring Software
StartRight Patient Support Program
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results.Case Study (Insulin Pump and CGM Adherence): Solution: Multichannel Support
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B O S T O N | L O N D O N | S A N F R A N C I S C O
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Decide to pursue pump
Pump and training materials arrive
Receive training and start pump 1st infusion set
changeAdjustment
period
INSULIN PUMP RESULTS
Reduced 6 month attrition rate for insulin pump from 22% to 5%
Improved Market Share by 2 ppts
Improved adherence by 8 additional infusion sets per year
Improved 6 month A1C by 24%
15 point Net Promoter Score Improvement
CGM RESULTS Reduced 6
month attrition
rate for insulin
pump from 61%
to 23% Improved
adherence by
20 additional
sensors per
year
results.Case Study (Insulin Pump and CGM Adherence): Output and Results
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HCS Confidential
BEHAVIOR SCIENCE EXPERIENCE DESIGN PROVEN RESULTS
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B O S T O N | L O N D O N | S A N F R A N C I S C O