Today’s best adherence programs emphasize the critical role of patient engagement in driving success. In my first article, I discussed the overall value of patient adherence programs and how implementing best practices for program design can make your programs more relevant to patients.
Taking this approach one step further, engagement programs can and should occur on many levels and within the various stages of adherence programs. Let’s explore how.
Understanding the product
Building patient engagement begins with a comprehensive understanding of the brand and the product. First and foremost, it is necessary to have a discussion about various factors that define a drug going to market, including indication (use of drug), therapy duration, side effect profile, distribution channel, and cost, before you can develop a patient adherence or support program. Consider, for example, how the level of engagement will vary greatly between specialty drugs, conventional products, and long-term or short-term therapies.
Remember: Adherence solutions are not “one size fits all.” For every brand, there can and should be a different approach. The level of services, types of services, and positioning of services will first be defined by the product.
Selecting the optimal channels
Once you have an understanding of the product, you can begin to evaluate the best channels for engaging with your patient. Adopting an omnichannel approach, whereby you provide many channel alternatives and let patients determine their channel of preference, is ideal. Just keep in mind that an omnichannel approach differs from multichannel — it involves not solely offering a variety of pathways, but serving patients with equally beneficial resources in each one.
Your investment and the product type influences the level of engagement, which in turn determines channel/communication type. For instance, 24/7 live nurse support — a necessary protocol for certain treatment protocols or serious health conditions — is vastly different than sending out basic text message reminders to take a medication, and the engagement within these programs should be recognized as such. Similarly, therapies that are dosed at varying intervals (once per month, every three weeks, etc.) require a different approach than a drug dosed at once daily. Conventional drugs treating asymptomatic diseases would likely focus on reminder-type messaging (perhaps with some disease management/wellness reinforcement), whereas an approach to an infused biologic product that may have a more serious side effect profile may try to optimize a full patient engagement strategy, pairing an experienced health care coach to interact, on an ongoing basis, with patients to assist them to remain on therapy and make it to their next infusion appointment.
Recognizing the ways patients define your program
Although the product and investment determines level of service and engagement, at every point, the patient profile should be assessed. Consideration should be given as to how individual patients want to be engaged (or not) and at what level. This holistic understanding of a patient’s history, current condition/medical situation, and mindset will determine how a patient engages in meaningful conversation. These factors will ultimately play a role in determining whether patients are likely to be compliant in adherence programs. In fact, putting yourself in the patient’s shoes to get a 360-view relates back to one of the most basic principles of designing effective adherence programs — to be aware of any and all potential barriers to adherence.
The typical patient profile (considering demographics, medical history, etc.) and the nuances of individuals themselves can influence engagement design and program services. These may entail more specialized services that go beyond more traditional medical care/support. Consider, for instance, a Hepatitis C drug prescribed orally: on paper, it may be “simple” to stay on the treatment, but because a subset of patients with this health condition could be more likely to have a history of drug addiction — a finding that could be uncovered in the patient-profile research and discovery stage — these patients may need the added support of a social worker to stay engaged in the program and adherent. In certain cases, the patient profile is as simple as recognizing the typical patient tendencies, such as in vaccinations that require a multi-dose regimen, where staggered timing can make it difficult for patients, like students going back to school or frequent travelers, to stick to the routine.
All in all, these various factors, considering both the product and the patient, will help you develop a well-rounded program that sets the stage for compliance. Along the way, remember to track and measure your successes and areas of improvement, and patient and product challenges. Doing so will allow you to continually innovate and successfully implement patient engagement tactics in the future.
Today’s most successful adherence programs focus on the patient, not the product
Developing successful patient adherence programs is a win on all fronts. Each year, a lack of patient adherence costs the U.S. healthcare system an estimated $290 billion. Indeed, payers benefit in the long run from reduced costs of healthier patients. Yet there are other far-reaching benefits beyond the potential billion-dollar savings. Patients who comply with medication and treatment programs often experience improved health outcomes, and these documented treatment programs can increase the amount of physician drug referrals and repeat prescriptions.
While the traditional approach to patient adherence has been a one-way street — that is, communicating to a patient about what he or she needs to do to stay on a treatment regimen — focusing on a more holistic approach that encourages conversation with the patient can greatly improve the success of your adherence programs.
This approach begins with program design. By ensuring that your program encompasses all facets of a patient’s unique healthcare situation — which includes not only the patient’s health condition and particular medication, but also the patient’s support system or caregivers, socioeconomic status, level of health literacy and other factors — you can set yourself up for success.
Let’s explore the best practices for connecting with patients and the ways you can make your adherence programs both relevant and customizable to the participants’ needs and preferences.
Step 1: Engage with the Patient
It may seem obvious, but it’s often overlooked: Your adherence program can only be as successful as the patients who are enrolled and engaged with it. That means making it easy for patients to learn more about your program and providing multiple access points for patients to register.
This step often begins with a physician. Many patients may not even be aware that these support programs and resources exist for their particular condition or while taking a certain medication. A prescribing physician can be an excellent gateway to acquiring patients for your programs who are interested and engaged from the start. Tap into this resource by reaching out to physicians who prescribe your medication, and share information and materials about the benefits of your program and the complementary support it provides to their patients. This can even prove to be a competitive differentiator. Later, once the program is underway, it’s critical to keep the communication with the physician open and to provide the physician with concise updates on the progress of a patient in a program.
By knowing your audience and recognizing the levels of engagement, you can recommend and deliver a multifaceted program that reaches the patient (as well as his or her caregiver, when necessary) and the physician.
Focusing on engagement from the start reminds us how the best adherence programs are patient-centered, not exclusively product-focused. In the next steps, we’ll explore the ways participants can help drive the conversation, and not be solely a listener, in these programs.
Step 2: Make Your Program Relevant
First things first: ditch the script. Whenever possible, your adherence program should feature applicable content delivered by flexible guides. Allowing your agents to use their own words within the guidelines of approved messaging is much more well-received by a patient than a script read word-for-word on a call.
Furthermore, have you considered the critical role your agents play in making your programs relevant? Your agents are more than message-deliverers; they are supporters, educators, and advocates, and they provide resources that are useful and helpful to each patient’s full scope of care. Consider the ways you can best match your agents with the content they deliver — for example, is healthcare background necessary? If so, would a certain healthcare specialty or other experience (such as social work or psychology) be most beneficial? Once you’ve found the appropriate match, allowing your patients and agents to develop one-to-one coaching relationships throughout the course of your program can pay dividends in improving patient satisfaction and compliance with the program.
Consider this example of a cancer adherence or support program. The nature of this type of program lends itself to having a qualified agent who is intimately familiar with the complexities of cancer care, such as an oncology nurse. While sharing the expected side effects of the treatment itself is important, it is crucial for the nurse to also become a complete resource to the patient — creating opportunities for two-way conversation in order to help the patient overcome their health challenges. That might mean answering questions or providing resources about how to cope with side effects (and directing back to the physician where appropriate), providing nutrition and stress management tips, or even assisting with the coordination of transportation or questions regarding insurance coverage.
Without a doubt, one of the key values of adherence programs that emphasize engagement is that the content itself is relatable and considers health literacy. Engagement-focused, patient-centered programs convey content in easily understandable, conversational terms; they stay fresh over the course of a program; and they empower patients to be involved in their care.
Step 3: Customize Your Program
Personalizing your adherence program can go a long way in achieving better outcomes. The program’s communications — or more specifically, the conversations that take place — should be customized to enhance engagement, increase the program’s success rates, and ultimately, improve the patient’s health.
Early on in your program, conversations with the patient can uncover personal barriers to adherence — physical, emotional, practical, or otherwise. These barriers can range from undesirable side effects (“This drug makes me feel nauseous”) to indifference (“It doesn’t matter if I really take this drug”) to cost (“I can’t afford to take this drug”). A personal relationship with the patient can allow an agent to pick up on those cues in conversation, so that these barriers can be addressed throughout the full course of the program.
Because patient side effects and adverse events can vary throughout a treatment regimen, it’s crucial for the agent to have that personal relationship with the patient so they can guide them through the treatment protocol, while also listening carefully to report key data that offers valuable insights to improve the patient’s health and, in the long run, potentially even improve the drug itself.
Once you have designed and implemented an adherence program that is engaging, relevant, and customizable to the patient, be sure to measure your program data to evaluate its success versus the developed outcomes criteria. Work with your client to understand the measures of success in their eyes. The data collected in your program can yield valuable insights to help you enhance your programs in the future.