Developing Integrated Multichannel Patient Relationship Management Programmes

Developing Integrated Multi-Channel Compliance Programmes Len Starnes Head of Global E-Business Primary Care, Bayer Schering Pharma

Basic assumption

Channel specifics

Behavioural modelling

The business case

Data protection and privacy

Putting it all together

Agenda

Basic assumption

Isolated channels SMS & mobile Internet & email Contact centre Case manager VAT Pack & devices Direct mail Patient

The integration of multiple interventional channels is more effective in reducing patient non-compliance than the sum of the impacts on non-compliance produced by each of the channels operating independently

Rationale… Integration provides more complete and coherent knowledge of a patient’s needs Allowing earlier identification of likelihood of non-compliance Thus enabling more appropriate and more timely interventions to be made

Integration in practice Patient signs-up for ‘daily tips’ on coping with SEs Patient calls asking for advice about a severe SE Patient downloads a PDF on SEs management Application software accessed by a case manager All patient interactions and interventions logged Case manager alerted to SEs issue and makes appropriate interventions Secure patient database Patient

__________________________________ Collection Integration U tilization Increase compliance Improve health OCs Increase QOL Benefits on 2 levels Personalized patient data __________________________________ Collection Integration Utilization Aggregated, annonymized patient data Improve knowledge of market dynamics and patients’ needs

Channel specifics

Channel efficacy 5 4 1 3 1 1 1 Patient's decisional balance (pros vs cons) 5 3 1 3 1 1 1 Socio-economic factors 5 3 3 3 3 1 1 Stage of disease 4 4 3 5 5 1 1 Disease and treatment information 5 4 3 3 3 3 1 Drug handling 5 4 3 3 3 3 1 Side-effects 1 4 4 2 1 5 5 Forgetfulness Nurse support Contact centre Voice automation technology Internet & email Direct mail SMS & mobile Pack & devices

Channel triple constraints Efficacy Regulatory freedom Cost

Behavioural modelling

Integrated systems can be made smarter by incorporating constructs from behavioural models such as the Transtheoretical Model of Change to enable them to identify a patient ’ s ‘stage of readiness’ to become non-compliant and to propose stage-specific interventions

Do you want a system that is intelligent enough to make all the decisions? Or

Do you want a system that is sufficiently intelligent to enable case managers to work more effectively, but does not supplant their expertise?

The key question is: how smart should the system be?

The business case

Develop a robust business case

Use multi-year models for long-term therapies

Keep models simple

Make conservative assumptions

Data protection and privacy

Databases must be owned and operated by 3 rd parties

Hosting environments must be certified as secure

Single pan-European databases may be deployed

Only case managers may access personal patient data

Imperative to have programme signed-off by Corporate Data Protection Officer

A huge issue… but by no means insurmountable

Putting it all together

Health warning Integrated compliance projects are not for the faint-hearted

Programme objectives Reliably identifying a patient’s risk status Ensuring the patient is always on the corresponding interventional timeline Shifting the patient to a lower risk status and corresponding interventional timeline

Week 1 Week 2 Week 3 Week 5 Week 4 Week 1 Week 2 Week 3 Week 5 Week 4 Week 1 Week 2 Week 3 Week 5 Week 4 High risk Low risk Medium risk Interventions & timelines Visit Phone call Mailing

Establish a project team Project manager/owner (PM) Lead case manager Channel specialist(s) Medical & additional case managers Corporate Data Protection Officer Business analytics & finance IT functions External consultants Project management specialist IT professional Core Extended External vendor

Creating the framework High-level scoping document Channel A Business requirements document Channel B Business requirements document Channel C Business requirements document TMC Business requirements document IT specifications document

Milestone tasks: channel-specific business requirements Internet www.brandx.yz Patient support area

How can you reliably verify a visitor’s identity?

Does all session logfile data constitute useful knowledge?

What session visit interactions represent actionable knowledge?

The business requirements document ‘ Records will be entered into the system software when a patient orders support material from the brandx.yz patient support area’… Typical e-channel functionality statements ‘ Brandx patients will be verified by matching data from the existing patient support database with that extracted from the brandx.yz database’.... ‘ All support material requests will be alerted to users’…

Milestone tasks: behavioural modelling Transtheoretical Model of Change (TMC) widely used in health behaviour change interventions Used to predict likelihood of non-compliance and to provide guidance on stage-specific interventions TMC-based software programs can assist case managers such as call centre agents or nurse support staff James Prochaska

TMC integration options

Develop a TMC-based algorithm and an ‘always in control’ software program For non-HCP case managers such as trained call centre operators Or

Use TMC constructs in a ‘reminder and guidance-only’ software program For experienced HCP-case managers

Example Biogen Developed intelligent call centre counselling software based on a TMC-predictive model* Probably of drop-out p = 1/(1 + e -z ) where z is an index derived from 4 patient-specific predictor variables: - Pros of treatment - Cons of treatment - Educational level - Disability * Berger BA et al, Journal of the American Pharmacists Association, Vol 44, No 4 July/Aug 2004

Crucial sub-task: identification & ranking of risk factors etc etc etc Decisional balance Depression Educational level Side-effects Relative ranking How important is the predictor relative to others? Practicality How practical is it to make an intervention? Impactability How much impact can we make on this predictor? Weight How strong a predictor of non-compliance is it? Is it modifiable Yes or no? Risk factor

Key algorithm inputs: overall risk-factor weighting RF1 20% RF3 10% RF2 25% RF4 30% RF5 15%

Milestone tasks: software selection, development and customization The good news IMCP software is essentially the same as low-level CRM software The bad news It will almost certainly require significant customization

Choices Heavyweights Proprietary Develop from scratch Open Source

Using and accessing the system in practice Case manager: call centre agent Accesses system directly and continuously Case manager: nurse Does the nurse have access to the internet? Does the nurse use a laptop? If yes, does she take it on visits? Would the nurse prefer to use an offline solution (PDA)?

The user interface