Addressing Disparities in Access: Designing Patient Support Programs to Close Gaps, Improve Health Outcomes

In Partnership With: AmerisourceBergen

Recent research shows the COVID-19 pandemic has exacerbated racial and socioeconomic disparities in access to healthcare and health insurance. In fact, the uninsured rate among Black Americans climbed from 17 percent in February 2020 to 26 percent in September 2020.

Patient support programs are designed to remove barriers to care and help patients access, afford and remain on the treatment they need.

In an interview with Fierce Biotech Publisher Rebecca Willumson, Lash Group’s Shemeka Johnson, senior director of Operations, and Sabrina Ellerbe, director of Nursing, explain how manufacturers can work with patient support providers to design programs that help address these disparities and expand access to healthcare.

Rebecca Willumson: Hi there. I'm Rebecca Willumson. I'm the publisher of Fierce Biotech and I'm joined today by Shemeka Johnson, senior director of operations at Lash Group and Sabrina Ellerbe, director of nursing at Lash Group, which is part of AmerisourceBergen.

Today we'll be discussing disparities in access to healthcare and patient outcomes and how pharmaceutical manufacturers can design patient support programs that help close those gaps. I'd like to thank you both for joining me today for the discussion.

Shemeka Johnson: Hi Rebecca, thanks for having us.

Sabrina Ellerbe: Thank you.

Rebecca Willumson: Shemeka and Sabrina, before we dive in, can you each share a little bit about your background and your role at Lash Group?

Shemeka Johnson: Absolutely. My name is Shemeka Johnson and I am senior director at Lash Group and I've been in the organization for 15 years. I actually started on our front lines, working with patients and providers to assist individuals with gaining access to very important therapies. Over the last 10 years, 10 plus years, I've had the opportunity to really work with our manufacturer partners to design and implement patient support programs that are centered around bridging the gaps to access, adherence and affordability. I'm looking forward to the discussion today so thanks again for having us.

Sabrina Ellerbe: And I'm Sabrina Ellerbe, currently serving in the director of nursing role at Lash Group. My responsibilities consists of leading a national remote team of telehealth nurses, where we provide clinical adherence support services to clients across multiple disease states. My background, I too have been at Lash for quite a while. I've been here almost eight years and my background really has allowed me the opportunity to gain experience in multiple disciplines, including an internship for the Center for Innovation of Health Disparities, research, pharmaceutical research organizations, quality, telehealth operations call centers, as well as health improvement solutions.

Rebecca Willumson: Very good. Well, thank you both. Sabrina, I want to start with you. We're starting to see more reports that show disparities exist in access to healthcare and patient outcomes, an issue that's likely been intensified amid the COVID pandemic. How do racial and social factors adversely impact access to therapy and health outcomes?

Sabrina Ellerbe: Well, healthcare disparities amongst minorities are often overlooked. Factors such as financial, language barriers, geographic location, managing co-morbidities and knowledge gaps and really understanding health benefits, all really impact one's access to therapy. For example, we have or often we may see a lack of trust for medical professionals, which is really based upon those experiences within healthcare. And so we may have a patient that may not understand the information that is given to them from their provider and so therefore there may be language barriers. There may be cultural barriers. The patients may be resistant to really seek healthcare maybe due to their finances and it really only takes just one break in communication to really interrupt that adherence and that's why trust is so important.

Rebecca Willumson: Following up a bit, how did COVID intensify some of the challenges that already existed around health disparities?

Sabrina Ellerbe: Well, COVID definitely has extremely exacerbated racial and socioeconomic disparities in access to care and as well as insurance coverages. There are challenges that are related to unemployment and loss of health insurance. And some reports suggest that nearly seven million more people lost their health insurance during the pandemic from February to September. And so the uninsured rate among Black Americans climbed from 17% to more than one in four, which is around 26%.

Rebecca Willumson: Wow. Shemeka moving over to you, can you describe patient support programs? What are they? And how can patients learn more about them?

Shemeka Johnson: Yeah, absolutely. Patient support programs are really a proven avenue to closing the gap in access, adherence and ultimately health outcomes for patients. Lash Group is committed to operating in support programs that really help patients to navigate barriers so that they successfully start and they stay on a prescribed therapy. We operate more than a 100 patient support programs, where we pair advanced technologies with expert human support to really drive expedited access to therapy and create an enhanced patient experience. And there are really many ways that patients can connect in with support programs. And one of the best resources would be to inquire about these programs with their healthcare providers, especially in situations where there's a new therapy being described or prescribed. Patients that are internet savvy may also find it very easy to locate information about support programs online via the product website or even the drug manufacturer's website. And then lastly, I would say print or television advertisements and other social media platforms and outlets are another avenue in which patients could learn about available support programs, such as the ones that we offer at Lash Group.

Rebecca Willumson: Shemeka, talk to me, what do manufacturers need to consider in order to build a support program that can help to address disparities and connect patients to their therapy?

Shemeka Johnson: The patient's journey to access therapy really begins at the moment that that prescription is written. And at that moment, every past and current situation, interaction, that patient has becomes a part of that journey. Along the way there are going to be many factors that ultimately influence the patient's decision either to start or to continue on therapy. And it's important to really know and understand all of those factors that are related to the patient's actual health or their condition. And it's also important to know that not all of those factors may actually be related to the patient's health or their condition. There might be other factors such as finances, geographic location, family history, even previous experiences that will come into play and impact the patient's journey. And so with that in mind manufacturers would really want to have a thorough and informed understanding of the patient populations in which they serve.

Just understanding demographics, race, age, gender, income, those things really scratch the surface, but it takes a deeper level of understanding. Things like health literacy, financial literacy, language barriers, other social factors that may contribute to the health and wellbeing of individuals within those populations. As an example, people in our Black and Brown communities, the issue of trust in the healthcare system is prevalent. And that issue of trust is a result of historical events that have occurred as well as observations and maybe even experiences that have been passed down through generations. And so if you take that history and then you apply it to the journey of a minority patient that has just been prescribed a new therapy, you have to consider those past as well as those current factors as a part of that journey. The journey is so much larger than just the present moment and or what happened yesterday.

And to get to that level of depth, a manufacturer will need to just really pull together various experts at the professional, as well as the community level and data sources. In every community, I think you would find expert healthcare professionals and community leaders that would be more than willing to help to educate others on the makeup of the community. And additionally, partners at Lash Group such as myself, can help to mine data, consult with you on ensuring that your program criteria guidelines are inclusive and aligned to the needs of the patient population. This is really how manufacturers can set themselves apart, but also ensure that patient support programs are positioned well and align the expected patient journey to the expected patient outcome and understand then the journey will really yield the best results for your patient population.

Rebecca Willumson: A follow up on that and I can pose this to the two of you, but Sabrina, we can start with you. How does Lash Group work with manufacturers to design these programs?

Sabrina Ellerbe: Well, telehealth and nursing services really allows the clinical team to deliver that patient centered care and interventions. And so our nurses are highly skilled in really meeting the patients where they are and supporting patients on their therapy journey. Our nurses are listening, they are assessing, they're answering questions, they're evaluating the patient's understanding, they're providing education and just really assisting with navigating through those benefits. And most importantly, really helping to empower the patient to self care. And so the nurse patient relationship, it really can help shape the experience and that really starts with that first call. And so our nurses, like Shemeka touched on, we're providing that clinical education, we're monitoring the patient's adherence, but then also monitoring their ongoing disease management, whether that includes in home or onsite or maybe even virtual injection training to keep that and help keep and instill that confidence in patients to help prepare them for more complex medicines.

Rebecca Willumson: Shemeka, do you want to comment there?

Shemeka Johnson: Yeah, absolutely. I think that the patients are all always experiencing things that contribute to the journey. And when I hear Sabrina, I kind of pep up when I hear Sabrina talk about the support that the nurses provide, because I realize that interaction that our patients have, it can make or break whether the patient is going to even start and whether they're going to remain compliant. But just that, that level of support and engagement that you get from that human interaction is so, so critically important. And it really helps us as we're working with manufacturer to design their programs, it really helps us. And hearing those experiences, understanding those experiences to really help our manufacturer partners, to take that deep dive. To really understand the patient population and help to develop programs that support and align with that experience that we're looking for.

Rebecca Willumson: Shemeka, can you share an example of when you've worked with a manufacturer to make adjustments to a program to better meet the needs of a patient?

Shemeka Johnson: Yeah, absolutely. I would be happy to, I work with a manufacturer to evaluate the impacts of established financial criteria for patient assistance program. And what we were trying to study was the impact that the criteria had on patients in general in their ability to access therapy. And so together with the manufacturer, we looked at three key areas and really it was a decision making process. And the decision was, does the financial criteria need to change at all? And so I was able to pull together some data that outlined where our existing patients fell within the federal poverty guidelines. That was inclusive of all patients that had requested support through the program. And in reviewing that data, we found that a large percentage of patients were denied for assistance, were within about 5% of meeting the eligibility guidelines, so margins. The manufacturer was also able to kind of confirm that that same percentage of patients that had been denied also did not fill a script at the pharmacy or elsewhere.

And so, secondly, we sort of leverage high level benchmarking analysis to determine where the program criteria fell compared to others in the marketplace. And then lastly, the manufacturer actually partnered with their field team to really better understand the feedback from the provider community. And so we helped to consolidate all of that data, that benchmark and analysis, the anecdotal feedback, in order to really help the manufacture to make an informed decision about whether or not to adjust the financial criteria. And in short, the manufacturer absolutely did make that decision to increase the financial criteria. And while it seemed like a very small and simple change, it was obviously packed with a lot of research and a lot of consideration, but the results of it was absolutely powerful in terms of the compliance that we saw with that patient population.

Rebecca Willumson: Oh, that's fantastic. Sabrina, to kind of close things out a bit, tell me how can technology play a role in bridging gaps? What do we need to consider when using technology to connect with patients?

Sabrina Ellerbe: I recently reviewed a report regarding strengthening the patient engagement model and the results showed that the outcomes for patients who used adherent services was much greater than those that did not. And so what does that look like? Utilizing technology, it does, it plays a huge role in just being able to bridge that gap as Shemeka touched on. And so, having the ability to utilize those mobile apps, the digital engagement tools such as virtual training, can really help and increase the patient education and engagement and improve medication adherence. Just really ensuring that the patients have the support available and we want them to have it at their fingertips. And so, you think about what their needs are. We have bilingual nurses who are utilizing a language line to help navigate and break down those barriers when it comes to language.

And then also I talked a little bit about the virtual injection training and then also texting electronic signature, patient portals. And then keeping in mind that technology does support that ongoing nurse patient relationship that allows nurses to break down those barriers, eliminate the potential interruptions to medication adherence and then also keeping in mind that it's a balance. Because the very technology that we're utilizing to help patients could be the very technology that can deter patients, because it only takes one small barrier that can interrupt that patient experience. And so just making sure that we have the right people in place and our nurses are trained. And so just making sure we're meeting the patients where they are and that may change. It can change. And so we're constantly assessing that and just ensuring that we're putting the patient first in everything that we do.

Rebecca Willumson: That's great. Well that's all the questions that I have. I want to thank you both for your time today.