DeWayne Manning of Archbow Consulting joins The IDI to discuss hub services, those ubiquitous offerings from pharmaceutical manufacturers designed to create a single point of contact with patients. Where are hub services headed, and how can manufacturers and market access help?
Hub services sound great in theory. But in practice, hub services can be a challenge for the patient and the manufacturer.
DeWayne Manning is a partner with Archbow Consulting and an expert on hub services. DeWayne has more than 25 years of experience advising clients on specialty products, reimbursement, patient access programs, business process optimization, technology integration, and data management
Follow DeWayne Manning on LinkedIn.
Follow Valuate on LinkedIn or visit us at ValuateHealth.com.
Ira Apfel: Hello and welcome to The IDI, a podcast by and for market access professionals. I'm your host, Ira Apfel. Each episode we conduct in-depth interviews to help you optimize your value strategy and commercialization and help people access the healthcare they deserve. The IDI is presented by Valuate Health Consultancy, follow Valuate on LinkedIn or visit us at valuatehealth.com to learn more. Today on The IDI, hub service s, those ubiquitous offerings from pharmaceutical manufacturers to create a single point of contact with patients. Now, hub services have been around since the early 2000s, and initially, they focused mostly on financial assistance for patients, but with the rise of specialty drugs in recent years, things have changed. Today, hub services address the whole patient journey. Everything from onboarding, to education, to adherence.
Hub services sound great in theory. Who wouldn't want a single point of contact with the company that manufactured your lifesaving drug? But in practice, hub services can be a challenge for the patient and the manufacturer. As drugs get costlier and more complex, the financial and educational components are more challenging. Even getting patients to know about the existence of hub services can sometimes be difficult. And what about access issues? What if the patient doesn't have access to a computer and can't log on to a hub service? So, hub services are helpful, but there's room for improvement and there are opportunities too, as my guest today will tell you.
DeWayne Manning is a partner with Archbow Consulting, the sister company of my employer, Valuate. DeWayne has more than 25 years of experience advising clients on specialty products, reimbursement, patient access programs, business process optimization, technology integration, and data management. I'm going to ask DeWayne about where hub services started and where they're headed, where the biggest opportunities for improvement are how manufacturers and market access can help. So, without further ado, here is my IDI with DeWayne Manning. DeWayne Manning, welcome to the podcast.
DeWayne Manning: Thanks, Ira. Excited to be here today and speak with you. Appreciate the opportunity.
Ira Apfel: Sure thing. So, let's start this off with a little bit of background on you. How long have you been working with hubs? And give me a sense of how far we've come with them and what's changed over the years? What's gotten better?
DeWayne Manning: Yeah. So, I've been dealing with hubs since the inception of the business. The early-mid to late 90s, we started to see the evolution of hubs essentially coming out of the need for the specialty products to require a higher level of touch, which traditionally had been provided by the pharmacies. When we saw the emergence of hubs coming forward more as a partnership with manufacturers and helping to support really the strategies of the brand and move that forward. Early phase, the early days you really saw the hubs focused around the very complex, maybe a buy-in bill product. And obviously, the need for a higher level of services made a lot of sense.
You've seen them, over the years, evolve from the very complex high-touch models to more of the broader base therapeutic areas like immunology or neurology where there's a much larger patient volume. The engagements tend to be a little bit more straightforward around the reimbursement, and the types of services necessary. The end goal still remains the same, to surround the patient, the provider, and caregiver with a menu of services that they can engage with and really be supported with. And so, the model is not a lot different than the overall goal, but the expansion and the size, the number of providers, the attention that the patient services area - hub, as we call it - continues to receive is the growing part in that.
Ira Apfel: What are some of the differences? You say the model, basically, has stayed the same over all these years. I am wondering, though, what's changed most? And the first thing that comes to mind is technology. I'm wondering if technology's really driven things.
DeWayne Manning: It's helped. I think the unfortunate part with healthcare, at least in the area that I've seen in my career, is there's been a slower adoption than you would like. I was speaking at a conference last week around patient services and someone equated it to healthcare banking, right? Back in the day, you had to go in to see the teller. Nowadays, you can do everything from your phone or an ATM machine. We would hope that... And we've not gotten there with technology, but we made a lot of advancement with the utilization and the adoption of technology in supporting and building of these programs.
So, it's a combination, you'll hear in our space today, of technology and talent. So, technology and people at the end of the day really supporting it. I think we made some good strides in technology, and I'm hopeful that we'll continue to get there because certain parts of what we do, there's still a little bit of extra human engagement. Sometimes you think technology could take over to include things like enrollment processes that are very paper driven to this day.
Ira Apfel: What do patients most want in hubs, and has that changed over the years?
DeWayne Manning: The interesting part about this is sometimes patients don't always know the hub exists. They learn about the services many times through their physician, maybe sometimes through their insurance companies, but the physicians are a big driver of the education here. But you do have patients and caregivers that do research and identify some of the programs that are out there today. I think most patients in the healthcare setting, oftentimes they're looking for support and they're looking for engagement that gives them answers. It's a very big world of healthcare. You could have been diagnosed with something you didn't even expect to be diagnosed with, and then now you're put on a biologic that you have no idea what it's about.
So, you've got the, "What's this drug do? And how does it operate?" And come to find out you need to see if your insurance pays for it. And if they pay for it, what's the copay? And all of the complexity. So, I think they're looking for solutions and parts of the process that really engage and help them along the process, which is the model that the hubs are really built to provide. The hubs get a piece of that. They don't oftentimes deal with it end to end, but that's really... I think they're just looking for answers and guidance and really that subject matter expertise that folks in the space can provide them and guide them through the process, both at inception and on an ongoing basis if necessary.
Ira Apfel: You said something at the onset that was interesting to me. You said that sometimes they don't even know, the patients don't even know that these hubs exist. So, I'm wondering if that's the biggest challenge for manufacturers, to alert them and figure out the best way to alert patients that hubs exist. And also frankly, that physicians can talk up a hub to a patient as well, because that seems like a key challenge too.
DeWayne Manning: As we know, most of the time it's the physician's practice that's educating the patients or caregivers to some of the services that might be out there today. I mean, look, if you go to brand.com of whatever manufacturer, in all likelihood there's going to be some level of direction in the brand.com site that talks about patient service offerings, if they have them, whether they're financial programs, whether they're reimbursement programs, whether they're educational programs. I think the manufacturers have done a good job of the awareness at the website. I think oftentimes the patients don't really know what to expect until they make that engagement.
And so, there's a myriad of ways that they've come to understand about this, whether it's brand.com, whether it's through groups that they may have joined because they have a unique disease and there's a group out there that... Social media and the internet are big on helping people become informed. And then, the practices, they'll help them as well. So, they're getting a variety of channels that they're learning about this. But sometimes, they are very, as you might expect, very naive when they come to the programs about, really, in all fairness, what they're set up to do and manage at that point.
Ira Apfel: Yeah. It sounds like they're overwhelmed because they've just had some diagnosis or what have you, and they're trying to figure things out. So, what's the first thing that a hub should do, assuming that a patient is going to come there completely confused, maybe a little overwhelmed because they just had this diagnosis, and also they might have just stumbled upon this strange hub. So, I'm just wondering, what should a hub do to make that patient feel welcome?
DeWayne Manning: Yeah. We use the term, slow down for a minute and begin to understand the needs of the patient. Oftentimes, we jump immediately into, "Will your insurance pay for that?" And many times they're looking to talk to somebody. So, I think the thing our manufacturer partners and our hub partners need to really spend some time on is the investment in that engagement and not make it, what I call, a transactional engagement and more of a relationship engagement. I believe everyone would tell you that's what they're looking to build. But that's where the investment needs to be made to understand that... We hear this often, no two patients are the same, no two journeys are the same. Oftentimes, you'll continue to hear me use the term caregiver, because it's not always the patient, but what the person is looking for, what they need to understand, and really just getting a baseline for what needs to happen on that particular call. And potentially, as you go through that engagement, what ongoing needs to happen. So, that awareness, and providing some sense of comfort and calm.
As you said, they've got a lot of things going on and they talk to a lot of people. One of the things we discuss in building solutions for our manufacturer partners and they're talking to many folks. They're talking to their pharmacy, they're talking to the hub, they could be talking to their payer, they could be talking, obviously, to their practice and maybe multiple practices depending on the complexity of their diagnosis. So, lots of things coming at them. So, I think the one thing up front, and I believe every program will tell you it's their goal, is to really get a sense of stability and really understand the needs of that patient or caregiver.
Ira Apfel: I think with every industry, not just healthcare and pharmaceuticals, every industry, there's this drive to bring in technology because technology can, theoretically, make things closer and easier for people and drive out some costs as well. How big of a challenge is it for hubs to maintain that human touch that you talked about? To keep those live operators, if you will, who can talk to people and guide them through the hub process and the process of being newly diagnosed, or a caregiver, as you pointed out? Versus just saying, "Okay. Here's a website, you just figure out yourselves." How big of a challenge is that right now for hubs?
DeWayne Manning: I think we're in a much better place than maybe we were four or five years ago because of the technology where we can engage with it in things like in electronic benefit investigation and some of the requirements around financial programs where you can do some qualifications electronically. So, I think that the hubs are doing a great job of leveraging and implementing those types of technologies that can drive that efficiency. And then, working to provide that off ramp or that exit lane, if you use that analogy of when they need someone, they can have them. I will say that depending on whether this is a specialty, whether it's a rare or ultra-rare product, the way the programs engage and build can be different.
If you have a high volume, lots of patients rolling through it, the leveraging of technology with that offering becomes very important. If you have a diagnosis or a therapeutic area with, I'm just making up the number five, 600, 1000 patients, the leveraging of technology may not be as important to that program, and it is about that human engagement at that one-on-one single point of contact case management solution. So, the volume... The size of the population, the different characteristics and attributes of the product that patient journey depends on, today, really looking at what the design of the program needs to look like. But leveraging technology where they can, all of the programs look to do that. But you'll see it leveraged in certain types of therapeutic areas a bit more than you will in some of the more rare type of therapeutic areas out there today.
Ira Apfel: Sure. And I know there's more and more very unique specialty drugs and drugs for rare diseases coming online. I'm wondering how tough is it to get someone trained who can operate a hub and operate as a guide, an educator, if you will. Is that a big problem, a big challenge right now?
DeWayne Manning: Yeah. I think healthcare is no different than any other industry. The people oftentimes end up definitely being the folks delivering the solution. And so, I think that goes back, as manufacturer partners and patient services partners work together, it's that investment in training. It's that investment in quality upfront, it's an investment and an understanding on what that journey looks like. And that design and strategy piece, determining the importance of these types of things. And by understanding what that journey looks like, and to your point, Ira, what type of engagement are we looking to build? Then, we begin to build a profile for the type of individual we need to have engage with this patient.
We see nurses sometimes are hired, we see social workers sometimes, we see general healthcare background call center individuals. So, it is a process. So, in our view that starts early with ideation and design and the things that go into it. And then, layering in what that program model needs to look like and then putting the right folks within the model to ensure that that engagement is at the highest level it can be. But to your point, and again, healthcare is not immune from this as much as we'd love it to be, getting the right people is tough for everyone.
Ira Apfel: Yeah. I would imagine so because you're talking about potentially a rare disease, it's a little bit different than saying, "I need a refund on that shirt I bought off of the internet." Or something like that. So, really a little bit about myself and my shopping habits the other day. Anyway, moving on, though, to technology. I did want to touch on this a little bit because I was just playing with this last night, ChatGPT, last night for my own purposes. And I'm wondering if something like ChatGPT, AI or what have you, if that will impact hubs? And if so, will it be positive or will it make it even less personal? Because I can tell you, playing around with something like ChatGPT, it seems real in a way, but you can tell it's off. And I'm wondering about these new innovations that could come out.
DeWayne Manning: Well, I think that the industry very much needs to be aware of them, and it's hard to not be based on everything that's going on today. I think that healthcare is oftentimes a bit of a slower adopter because of regulatory compliance, all of the different things that go into the provision of information back to patients. What is it? Is this going to create an adverse event? So, there's a high level of scrutiny and diligence that goes into any of these types of tools that can sometimes slow down the process. Do I feel there's going to be value in these types of solutions down the road? Absolutely. I read last week about a physician that wrote an appeal letter to an insurance company through one of the AI solutions that's out there today and submitted it, and ultimately won the appeal.
So, the ability to, again, utilize technology to streamline efficiency, where applicable, and allow the right level of engagement through the program is the day in and day out goal of every one of these. There's a lot of noise now with all of this AI stuff, and I don't mean noise in a negative way, but I think it's imperative that everyone understand and define the right tool for your business. There are different AI tools out there. There are now AI solutions that will actually call an insurance company and have that conversation with the insurance company on the behalf of the hub.
So, we're starting to get to these types of solutions where humans don't have to be necessarily involved in the tasks that don't require them to be engaged there. But I think we definitely need to be aware, I think we need to be looking to see where it can be applicable. But I do sense that we'll be a little slower to move on these in certain areas because the last thing you can do, I think, in many industries. But we're very cautious in healthcare about putting out information that is going to be a challenge or create problems for the organization at the end of the day.
Ira Apfel: What do you think is the biggest mistake that hubs make, particularly a hub that's getting set to launch? If you could give them one piece of advice before they go live, what would you tell them?
DeWayne Manning: Yeah. I don't know if it's a mistake, but I think... And I would almost challenge this to both the manufacturer and the patient services providers. It's really ideally to have an aligned vision on what you're building and launching. And you would think that, "That's crazy, DeWayne. Everybody ought to be able to have that." But I would suggest that sometimes the patient services provider is reacting to the manufacturer's vision and not being a bit more consultative on what's reality. You have a big vision, but at the end of it all, can you deliver on it? And I think the manufacturers sometimes, because they have multiple stakeholders internally and they've done a number of different things, they feel like there's no ability to give on that vision. So, I think it's just really ensuring, to the best of the abilities, there's a good, strong, solid alignment, especially in a launch, of what the engagement needs to look like, key performance indicators, what's the training, is everybody really ready to go?
And then, as they launch that program, I think the one challenge that we sometimes see is there's not enough attention to the proactive management of what's going on. Because obviously, now the phones are ringing, or the faxes are coming in, or the enrollments are coming through the portal, et cetera. So, the game has started. And so, having really arrived proactively to where you can identify areas of strength, what's working well, but also areas of opportunity where patient services providers can sit down with their manufacturer partners in advance of them coming to them and identifying areas for improvement. So, it's good alignment out of the gate. And then, proactive management once you've gone through that launch to stay ahead of the game and be able to use the software and be able to adapt to the changing environment as we know that things change as you hit the go button on some of these programs.
Ira Apfel: Sure. What do you think is the future of hubs? What do you think we'll be seeing in a year or two, or five?
DeWayne Manning: Yeah. We get assets for many folks in the industry and consultants, it's part of what we spend some time on. I do envision technology, where applicable, having a larger role in the engagement. I do envision a bit of an opportunity for patients to, what I'll call, self-serve, as I used that banking analogy a little earlier. I'll engage when I need you and I want you to be there when I need you. I'll be able to get some really solid engagement without solutions, without having to speak to somebody on the phone or interacting with folks. I think we're going to see that down the road. Some of this is dependent on others within the ecosystem, the payers and their ability to open up and some of the gateways for access to some of the benefits data and access into the EMR and communication.
And so, ideally, everyone's working for that more integrated journey. And I'll say I'm not sure we're going to actually get there, because sometimes in the US we have a number of disparate technologies that don't all work together. So, I don't feel we'll ever lose the people part of the business. I think healthcare is a lot about the people, but I do envision a bit of a more seamless integration of technology and people in the coming 24, 36 months to drive at the highest level of engagement that we can.
Ira Apfel: DeWayne Manning, thank you so much for being on the podcast today. Really appreciate you coming on.
DeWayne Manning: Thank you. Have a great day.
Ira Apfel: Thank you so much. That's it for this episode of The IDI. Thanks again to my guest, DeWayne Manning. Be sure to follow DeWayne on LinkedIn or learn more about him by visiting archbow.com. And be sure to follow The IDI on Apple and Spotify or wherever you listen to podcasts. And to learn more market access insights, follow Valuate on LinkedIn or visit us on the web at valuatehealth.com. Thanks for listening.