Transcription: A Conversation with Ron Lacy: How Digital Assistants Improve Patient Engagement in the Specialty Pharmaceutical Services Industry



Greg Kefer: (00:07)
Welcome to Digital Conversations. This is Greg Kefer. And today I'm joined on the show by Ron Lacy, VP of Products and Innovation for UBC. Ron, great to have you on the show.

Ron Lacy: (00:19)
Greg, nice to be here. Pleasure to join you on this podcast. Looking forward to it.

Greg Kefer: (00:23)
Cool. Well, before we start, maybe we can just talk a little bit about UBC and what the company does, and then we'll get a little bit more into the role that you have there. So what is UBC?

Ron Lacy: (00:35)
Yeah, sure. So, UBC, otherwise known as the United BioSource Corporation, we really have two sides of our business. One side of our business is your traditional clinical research organization, where we support manufacturers, pharmaceutical companies, device companies, helping them with phase two, phase three, even phase four clinical research...enrolling patients, enrolling sites, working with our clients through that clinical research. And then the other side of our business is more about patient support services. So this is everything from helping patients gain access to medications, by understanding their insurance, understanding their copays, understanding their affordability options, to educating patients. So many times patients have clinical hurdles they have to overcome. And so we're there to support those patients with understanding where are their challenges clinically. And then our third piece is really around care coordination. And we see that a lot in the emerging gene therapy type medications, where you're coordinating between, let's say the manufacturer and what they have to produce for that targeted, individualized therapy between the treatment center, between the lab. So it's a kind of a comprehensive wrap of all the coordination associated with that individualized patient care. So those are kind of the two sides of our business. Hope that that helps you understand the background.

Greg Kefer: (02:04)
Yes it does. So as VP of Products and Innovation, what do you worry about? What is your day job? What do you spend your time trying to handle over there?

Ron Lacy: (02:12)
Yeah, yeah. So really when I describe it, I say our first and foremost thing that we try to do is we step back and we listen not only what our clients are saying, but really what are the key stakeholders saying, what our patients and their caregivers saying, what are providers saying? What do we hear from the payers? And we understand and look at what their needs are. And then we go out to not just our market and our peers, and look at what's in the market and providers in our space, but look at what else is happening elsewhere. So for example, we might go from other insurance companies and we might look at the adoption and the financial industry of electronic signatures, or we may look at the adoption of chatbot technology and where we see being deployed in other parts of the market and say, how can that be used for our clients? My team is really looking at what are those solutions that we can bring. And then once we identify those, we work to bring those to life. So we work with our technology teams, we work with our clients to mold and shape, and really bring those products to life.

Greg Kefer: (03:18)
Right. So, yeah, you, you caught my attention with chatbots. We'll get to that in a little while, but the nature of this show, this podcast is a lot about technology and how technology engages and interacts with patient populations. And you touched on that a little bit.. You're not talking about somebody that gets a prescription for Vicodin, where a UBC is coming in. These are more specialty drugs. Is that a fair assessment?

Ron Lacy: (03:43)
Yeah. Traditionally the patient support services really came out of the specialty space. So specialty drugs being defined as medications that oftentimes were injectable or infused that had more difficult or challenging side effects. Many times they would have what's called a REM, and UBC is a leader in the REM space. So these are safety measures that the FDA puts in place, where between patients, prescribers, pharmacists all have to essentially be trained on what that product is going to require in terms of that patient, taking that medication and being aware of the risk associated with taking the medication. And so, yeah, we typically came out of that space where in the healthcare and pharmacy space, specialty pharmacy space, heavily fax-based heavily manual processes. So if you think about the adoption of electronic prescriptions years ago, they had a high, high, high adoption rate. And by the time they get into specialty pharmacy, it's years later, that you start to see the uptick in something as simple as what we now think of as simple as an electronic prescription, but enrollment to these medications and using these types of support services are still predominantly fax-based unfortunately. So we go out and we look at what are different ways that we can help patients become aware of these services, maybe looking at patient-directed enrollment, as opposed to physician-directed enrollment. And those are some of the ways that we think about how do we really shift and leverage technology to change what was a very manual, slow, long process to really speed, time to therapy.

Greg Kefer: (05:23)
Right. It's interesting how you described that because we've had a lot of guests on the show from hospital systems. And one of the things they often struggle with is that consumers, their patients, kind of have an expectation bar of a customer experience being set by Amazon or Walmart. And then they come into a hospital to get care for something maybe routine, and it's 10, 15 years behind. It sounds a bit like the specialty pharmacy world that you're describing suffers a little bit of that same problem where I might get a prescription for Lipitor or Vicodin or somewhat common that I just go down to my local pharmacy and get, and it's all kind of there and working, and then I've got this very special need and it's lagging. I have to find the fax machine, which I don't even own anymore. Is that kind of a fair statement?

Ron Lacy: (06:10)
Yeah. You know, from a patient perspective, we realized patients aren't faxing anymore. And typically when we're reaching out to patients, it's through phone calls, but certainly with the offices, yeah, many offices still unfortunately prefer the fax. But there are new technologies that are deployed in both spaces, both patient and office space. So things like clinical direct messaging into offices and being able to put whatever communication you need to convey back to that provider, whether it's around that care coordination I mentioned before, or, you know, simple things around additional information might be needed to support an appeal, but now from a patient perspective, other ways to push messaging to mobile devices, to the patient. And we see we're really, really strong around patients advocating for their own care and caregivers helping those patients. So when a patient wants to do, for example, a patient-directed appeal, helping them through that process is now something that we can be much, much more engaged in through the leverage of some technologies versus what historically would have been in place.

Greg Kefer: (07:16)
Right. So what would you say those core technologies that you either haven't implemented, or kind of focused on to enable these agents to work their magic? What are they, I mean, just the types of systems?

Ron Lacy: (07:29)
There's nothing magic here. I think, you know, the industry and a lot of the space is very common in terms of just first and foremost is just a sound case management system. So, understanding that you have the patient, the workflows that are expected to follow up with that patient, the interactions with the patient and their caregivers or the prescriber supporting that case. So a solid case management system has its foundation, otherwise known as a CRM system. And there's many flavors of those that are out in the market, but then you really look on top of the CRM system or the case management system. And you look into what we call connected health series of solutions. And this is everything from how you enroll patients. So electronic enrollments, and those electronic enrollments can either be in workflow as prescriptions and to pharmacies, or they can be embedded in EMRs, you start to see the emergence of some of that now with certain providers too,...How do you collect consent from a patient? And so moving to e-signature type capabilities, it used to be, if you had missing consent, you put it in the FedEx package and it would go out and you'd wait a few days and hopefully you'd get it back. Now, we've moved to e-signature capabilities where you're getting that literally while you have the patient on the phone. Likewise, continuing kind of through the path here, we have electronic benefit verification tools that have really taken a lot of time out of the process. And this is identifying where the patient has coverage. So one of the biggest challenges, when you think about these specialty medications is, what does it mean to that patient, and that family from a financial perspective? Is insurance going to cover it? If it is going to cover it, how much is it going to cost? Can they coordinate the benefits across the pharmacy benefit, the medical benefit, any kind of supplemental benefits they may have. And so electronic benefit verifications, help you find eligibility and then determine some estimates around the cost as well — what's the patient cost share is. Another example is electronic prior authorization capabilities. So many of these medications require prior authorizations to be put in place before the pharmacy will dispense. And so the industry has moved to EPA where you can let the physicians submit necessary documentation and answers to the questions that the payers have in order for the payers to adjudicate those claims and allow the patients to have access to the medication. Many other tools in place we've moved towards electronic income verification. So we use those tools for programs that we call free goods or pap programs. So when a patient is under a certain level of the federal poverty level, that qualifies them for the manufacturers free good program. And I think the thing that's really most exciting right now for us is this kind of patient-directed,..I mentioned the chatbot before, but an ability to do digital assistance. So our case managers, when they're calling the patients, no longer will the patients have to write everything down. We have the digital assistant that's working hand in hand with that case manager to really guide them through their full journey. So we're pretty excited about what that brings to the table.

Greg Kefer: (10:46)
Right. Now, my audience will know all about digital assistant chatbots, and conversational technology. I think it's dominated Digital Conversations over the past two years. But never in this context, you know. We've talked a lot on this show about what it means in a hospital workflow arena, but never in a kind of a specialty pharma world like this, where you've got smart agents with impressive dashboards and all this information at their fingertips. But this idea that you can kind of communicate with patients through conversational AI on their phones... Can you share an example of how that works, and what a digital assistant is in your mind?

Ron Lacy: (11:24)
Yeah. A great example here is one of the first things which you think about on a patient support program...is reaching out to the patient, right? So reaching out, introducing the program to the patient. So, now instead of making a cold call to the patient, and hopefully that patient remembers that their doctor enrolled them in this program, or the doctor may have told them that they were going to enroll (many times they may or may not). But if the patient is enrolled into the program, our ability to reach out before that first welcome call, and introduce the program through a digital conversation, tell them what it's about, introduce who their case manager is going to be, and put the case manager's phone number on the patient's phone,... simple things like that just makes it easy for the patient to know what to expect at the very first step. And then using it on an ongoing basis where following up with the patients at certain key triggers, whether a drug has a titration or whether you've completed appropriate authorization steps, you can use the digital assistant or the chatbot to push that information to the patient at the right times, to really help guide that patient through that journey. We're seeing tremendous results on the use of those. We see patients stay engaged, we see them providing really good feedback, and positive sentiment checks. So it's really supporting and promoting what our clients and their brands want to see when you deploy these types of services.

Greg Kefer: (12:52)
Right. So you touched on a little nugget there that I have to call out because it's brilliant. And that is, this is the phone number of the agent that's going to call you, right? And add it to your directory,... Because if you don't do that, what happens? It says spam, right?

Ron Lacy: (13:04)
Yeah, exactly. You don't answer the phone, it goes to voicemail. And then your voicemails add up. And at some point you just wait until the next time that person calls you back and hopefully you pick it up, but this gives you an alert right then and there, oh, this was my case manager calling me. And it's customized specifically for that individual patient journey. Exactly when and where they need it.

Greg Kefer: (13:27)
Right. Now, one of the things we have talked about is the notion of digital assistants that augment a call center. Again, it could be a much bigger, broader call center that's dialing like crazy. And this idea that you can offload a lot of the routine, I won't say mundane, but the kind of the repetitive tasks to a chatbot to handle that free the human up to do the higher end stuff. But this other concept I've talked about is this notion of operational precision, where if you're on this drug on this plan and you got to take the pill at 6:00 PM and then follow up with a glass of milk a half hour later,...that these digital assistants can just can run 24x7 and perform those reminders and help the patient orchestrate their plan. Is that a fair projection of how this could work?

Ron Lacy: (14:13)
Yeah, when we think about the adherence part of what we do, it's not only overcoming clinical hurdles. Like I talked about in my introduction, it's helping patients on an ongoing basis. So, you know, everybody's had the text reminder from the pharmacy that said, "Hey, your refill is due press, you know, yes, to refill." It's much, much deeper than that. And so when you think about creating that level of engagement, level of motivation to help patients stay on therapy, you got to go deeper than just a simple refill reminder. You actually have to understand what's motivating this, what are their goals? What are their objectives? And through that combination of the digital assistant asking and probing and providing those nudges, combined with our case managers that have that one-on-one connection, that's where you can really move the needle on adherence to basically achieve better outcomes for the patients.

Greg Kefer: (15:09)
Right. How do you configure the digital assistants? I would imagine that drug A versus drug B versus drug C have somewhat different dimensions that you've got to communicate. How does that part of it work?

Ron Lacy: (15:22)
Yeah. And it kind of goes all the way down to that base CRM system. It starts there. And as we look at the drug and we look at the program that we're designing for that drug, whether it's the most complex, highest-end gene therapy for rare disease, or, you know, now we're pushing into medications and support for medications that even are starting to get into the retail space that are traditionally kind of the more retail drugs, you see that our clients, the pharmaceutical manufacturers, are really looking for nimble development of those workflows and those trigger points. And so we'll define those with our clients. We'll do what we call design and strategy: define all the process flows the touchpoints when we want to reach out to the patients. And then based on those flows, we'll sit down and we'll understand, okay, we're going to do a welcome call. Let's add in a welcome mobile message. Let's do a follow-up message. So we kind of plug those messages in, to live alongside the intended patient journey that we want to design and build. So it's really starting with the overall program objectives. And then, how do we plug these mobile messages in? And in some cases, you know, it's just a mobile message. It may not be the case manager, especially as you start to look at more of the lower costs, retail products, where we're delivering the education through the mobile device, and it's not going to happen through the case manager.

Greg Kefer: (16:49)
Right. Well, I guess there's another dimension here, which is just the regulatory aspect, right. I guess, with a digital assistant, you can craft content that's precise and FDA-approved, right? There's no risk of somebody going off script or anything like that.

Ron Lacy: (17:03)
Yeah. And that's a great point too. What differentiates a digital assistant that as an intelligent conversation path that you can put in front of the patient where the patient is choosing what that path is going to look like, as opposed to an open-ended free text, where they can type in whatever we want... We steer away from those. We do not go down that path. We don't like to guess that what the patient is saying. We're not trying to allow ourselves to be open-ended like that. We really have those scripted conversations that really mirror towards the information we need to deliver to the patient, and the patient needs to convey back to us.

Greg Kefer: (17:41)
Right. I would imagine that if you were talking to a human agent, they've got a script they gotta follow anyway, right? So it's not like the agent can freeform...

Ron Lacy: (17:49)
Yeah. It's a call guide. I would just say, I mean, they're not so scripted that they don't have open conversations, but there are guide posts, that they're living within.

Greg Kefer: (17:58)
Right. Right. So where are we going next? I mean, if you look forward, okay, you're on this journey, and you're excited about it. It seems to be working. How do you see the next year or two as you expand this capability?

Ron Lacy: (18:10)
Some things that I think in this market, in this space, that are pretty exciting as it relates to use of some of these technologies, along with some of the regulations that recently have been pushed forward. So some of the data blocking rules that have come out of CMS, where patient ownership of data... If you start to think of that regulatory side and what's happening with new standards and the emergence, and the well adoption of tools like FHIR from HL7, all of the EMRs with that kind of capability plugged on top, we think there's that really strong overlap between the healthcare system and what we're able to offer both on the patient support side, as well as the research side, you know, we're really, really focused on how do we drive healthcare equity and making sure when we're helping our clients with enrollments, for example, on clinical research studies, how do we make sure we're reaching out to everybody and anybody that should be joining that study, and not just targeted one particular segment of the population. So we think it's going to open up a much broader set of capabilities to really get to the patient and let patients take much more control of these enrollments.

Greg Kefer: (19:26)
Right. Right. Yeah. I mean, we barely scratched the surface of that, but you know, clinical trials are kind of headline news these days. I think more people know what a clinical trial is than ever before because of COVID. Yep.

Ron Lacy: (19:38)
Yeah, between COVID and some of the disparities that we've lived through this year, you really start to think about how we leverage this technology to really help with those things. The number of COVID vaccines that are going to come to market that are going to have ongoing research that's going to be required for ongoing long-term safety evaluations are going to need patients to join those registries. And these are some ways that we think you might be able to really advance the enrollment of it.

Greg Kefer: (20:08)
Yeah. And everybody's walking around with a phone and they're all connected. They're not on laptops anymore, you know, and they know how to message, you know, they know how to text back and forth, and if that's what it takes to get people to engage...

Ron Lacy: (20:21)
And it's all demographics. I mean, I'm amazed at my parents in their eighties... I saw them, socially distanced, recently and stayed away with a face mask, but my dad and mom, they're both on their iphones all day long and that's what they live and breathe on, so they can FaceTime with their grandkids. And so, being able to reach that population, as well as the younger population... Everybody's got one, and that's the way things will continue to go.

Greg Kefer: (20:48)
Well I think healthcare in general, overestimates what people are willing to put up with to get into some technology. And I think lots of portals have been thrown out there, lots of apps. And I think that this conversational AI, where you're just using standard SMS and web browsers to interact with your provider, whatever, whether it's a, you know, UBC or a hospital or whatever, is the future. And it sounds like the engagement numbers that you're seeing already are proving some of that theory out. Right?

Ron Lacy: (21:15)
Yeah. I mean, we do see very high engagement rates. We have what we call our conversational or engagement rate on a program that's very, very high. We have a 95% sentiment check rate. The number of conversations per patient is multiple per month. So we're really pleased with what we see from some of our initial adoption of the platform. And we see it going on not only with what we're doing, but we see it going on elsewhere. Right. We see it at the retail stores. We see it at the, you know, like the Walgreens to the CVSs. So I think patients are very much getting used to these types of conversational chatbot engagements. And it's going to become something that you're not going to want to go download as an app; not going to go create a user ID and password. You're only going to want the message delivered to you when it makes sense for you to get it. And that's where consumerism is going.

Greg Kefer: (22:09)
That's right. Yep. You sound like I wrote that line for you right there! That's off my stump!

Ron Lacy: (22:15)
But it's what we do. It's what we deal with. And for us, we've always done this through phone calls, phone calls, phone calls to patients, and you look at how many call attempts it takes to get to them. And now we're excited about trying to, you know, turn that into one call attempt and get them on the phone first time and have a great conversation and move on to the next one.

Greg Kefer: (22:36)
Both sides of the coin, right? You've got happier patients, more engaged patients, and you're saving money on the operational side internally. So it's kind of a magic win-win! Well, Hey, Ron, this has been terrific. Really enjoyed this chat. I'm going to ask you to come back again sometime in 2021, when things are a little back to normal and maybe we're not in our respective living rooms, but thanks for being on the show.

Ron Lacy: (22:58)
Yeah. Look forward to it. And, yeah, we'd be happy to do it again. Thanks for inviting me.

Greg Kefer: (23:03)
Okay. This has been Digital Conversations. Thanks for listening to Digital Conversations. If you liked our show, you can always subscribe on iTunes and feel free to like retweet and share on your social networks. This and other episodes are available on iTunes, Spotify, and LinkedIn.com. We'll be conversing again soon with a new episode. So long.