Pharma is retracting control over the patient experience. What does this mean for the hub model?

When patients prescribe complex therapies, such as specialty drugs, cell and gene therapy or high-cost biological agents, the treatment route is rarely direct.

Filling a prescription can involve a series of dazzling professional pharmacies, as well as third-party administrators, insurance barriers and piles of paperwork. Each step in the process is a potential point for failure.

Often, this is ultimately the case. In fact, nearly one-tenth of the prescription was abandoned, while expensive drugs and out-of-pocket costs exceeded $500, this portion rose to 60%. Patients may get guidance in the process, but when they need it most, it is often scattered, inconsistent and difficult to navigate.

We need to make the whole process easier – and we are better than ever. Advanced technology provides pharmaceutical companies with the infrastructure they need to align visibility and control the patient experience.

For the first time, manufacturers can see where patients are experiencing obstacles in real time – without compromising privacy – and take action before the patients walk away.

How to develop a service center into the first era of patients

Pharmaceutical companies have long relied on “hub” models to support patients initiating or continuing drug treatment. This includes outsourcing patient services to third-party call centers designed to help patients obtain medications prescribed by physicians, overcome insurance barriers, and participate in financial assistance programs.

When a prescription is required, patients face a range of administrative burdens: insurance approval, refusal of coverage, Copay Shock, paperwork cycles, delays in admissions, and more. For patients who prescribe high costs or specialty therapy, positive or negative interactions with the pharmaceutical company can determine whether the patient is following their treatment plan.

Over the years, this setup has provided scale and expertise that helped pharmacies manage patient needs in the fragmented healthcare sector. However, as therapies become more complex, patients expect higher standards of support, so traditional hubs need to evolve. Too many parts of the system are plagued by outdated workflows, manual processes and isolated systems that can lead to expensive delays, patient exits and widespread frustration.

Supervision of customer experience is limited to retrospective performance reviews, rather than real-time insights that patients need. By the time these numbers reach the pharma team, the correct window has been closed. When patients give up prescription therapy, everyone feels pain: patients give up essential medications, their health worsens, prescribers get frustrated, and pharmaceutical companies lose consumer trust, revenue and momentum in improving care.

Good news? Things are changing. As technology matures and pharmaceutical companies hope to help patients get what they need, traditional hub models begin to shift.

Today’s AI and automation tools can now make HIPAA-compliant revisions to personal identity data at scale, allowing organizations to extract meaningful insights without compromising patient privacy. These technologies have opened the door to real-time, compliance visibility into what is happening across patient access plans – enabling Pharma to step in, see effective approaches and take on greater responsibilities to improve the experience.

In some cases, pharmaceutical companies are choosing to provide technology stacks such as phone and call recording infrastructure, even if other elements such as personnel are still outsourcing.

One approach is to adopt a hybrid hub model that preserves data and technical infrastructure internally while outsourcing front-line staffing. This approach can provide more reliable insights into customer sentiment, compliance challenges, and service quality and sustainability.

Additionally, when market events occur, such as FDA safety alerts, this approach allows the company to immediately identify the patient or provider’s concern and adapt. It also allows AI to handle transactional tasks such as validating insurance benefits while maintaining high-profile, sensitive interactions with well-trained professionals.

More and more manufacturers are adopting a similar approach. With the right technology, Pharma now has both the tools and opportunities to have meaningful ownership of the patient experience and integrates control and visibility throughout HUB operations.

3 more patient-centered strategies

We are entering a new era of broad digital innovation and possibilities. However, technical tools alone are not enough to deliver on the promise of patient-centered care.

Pharmaceutical companies need to think critically about human supervision and what is not needed and develop a thoughtful strategy to balance supporting employees, processes and technology.

To this end, the industry should adopt the following three rules to improve the pharmaceutical support model:

1. Requires data transparency. Outsourcing hubs tend to operate as black boxes, providing quarterly summary and surface-level quality inspection metrics while locking in other insights. This approach is largely due to the strict regulatory barriers designed to protect patient-identifiable information. But these restrictions no longer exist. Compliance data analytics tools now make it possible for pharmaceutical companies to maintain regulatory standards while gaining real-time visibility into patient conversations, call center interactions and experience trends. Addressing the level of insight will require greater consistency, negotiation and shared responsibility of suppliers and stakeholders in the healthcare ecosystem with suppliers and stakeholders. But regardless of the structure of the service operations, a clear ownership agreement is required, defining expectations for data sharing and building infrastructure for real-time monitoring and insights, monitoring and taking insights from every part of the process.

2. Strengthen governance before deployment. AI adoption is accelerating, but in many organizations, governance lags behind implementation. Without clear compliance, standards for mitigating bias and security, even the most promising tools can become liabilities, especially in highly regulated and privacy-sensitive industries such as Healthcare. Before implementing any AI solution, pharmaceutical companies must ask key questions about training on solution models, how to monitor their performance, and the level of human surveillance. The questions they should ask include: Who trained this model? What is the process of humanity? How do we monitor bias, drift or compliance issues? Many life science organizations are now establishing formal AI governance committees to evaluate procurement decisions, evaluate model training data and define performance standards. This needs to become a universal practice.

3. Balance automation with empathy. Some touch points in the hub journey are traded, while others are human. The ability to distinguish them is crucial. Check the benefits verification form or set up a Copay assistance program? AI can help to process these tables quickly. Guide patients to diagnose severely or have anxiety about side effects of medication? This is the work of human sympathy, critical thinking and emotional intelligence. The most effective strategies integrate automation with human support, retain technology for repeatable and transactional tasks and keep people in the loop with the highest bets and sensitivity. We should ask a question like this: Is this the right solution for this patient group? Which contact points require human contact? Maybe we accidentally add friction instead of removing it?

As access barriers are cleared, what happens next?

Now, manufacturers have a path to greater visibility and direct accountability.

AI can now mark where patients are stuck – from admission delays to drop calls, while also promoting new, compliant ways to analyze these interactions at scale. However, solving the problem is only the first step.

Transforming insight into actions requires people to retrain partners based on what is actually important to their patients, redesign workflows, and redefine success, not just the easiest thing to measure or monetize.

If we seriously improve patient access and long-term health, pharmaceuticals must go beyond the rapid repair designed to improve the next earnings report. Advance requires long-term investments and strategies for companies to own data, manage their technology and support systems around real-world patient needs. We have the tools on hand. Now it's time to get the job done.

Photo: Claudenakagawa, Getty Images

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