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Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
Valuable Patient Support
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Valuable Patient Support

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  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  • Transcript

    • 1. Valuable Patient Support
    • 2. <ul><li>About the speaker </li></ul>Matthew P. Hall , CEO Human Care Systems, Inc. Direct: 617.649.2118 Mobile: 617.501.1818 [email_address] www.humancaresystems.com Matt founded Human Care Systems (HCS) in 2008 in order to impact one of the largest levers in healthcare: patient self-management. HCS was spun-out from the Kerdan Group, a biopharma and medtech consulting firm. Matt co-founded Kerdan in 2001. Prior to Kerdan, Matt ran several healthcare related businesses, worked in venture capital and was a consultant at Bain &amp; Company. Matt has lived and worked in the US, Europe, Japan, South Africa, and South Korea. Matt has a BA with honors from Williams College.
    • 3. <ul><li>Narrow, transactional interactions don’t build durable value. </li></ul>
    • 4. <ul><li>Deep, engaging relationships grow in total value. </li></ul>
    • 5. <ul><li>Why this matters to biopharma and medtech </li></ul>All stakeholders - the high co-pay US patient, Japanese regulator, EU National Payer and physician in Brazil – want one thing: solutions to meaningful health problems, where the potential upside is worth the cost, risk, hassle and unknowns of the therapy . You might call this the ‘total value equation.’ The opportunity is to pull one of the levers that can impact the equation: diagnostic or therapy, clinical practice, patient self-management, reimbursement. Valuable Patient Support is about a new type of relationship with patients and families, as well as clinicians. This entails a move from narrow, transactional interactions with these stakeholders to deep, valuable relationships.
    • 6. <ul><li>The Total Value equation </li></ul>Levers to impact Value Equation: Real World Outcomes Change diagnostic or therapy Change clinical practice Change patient self-management Change reimbursement Costs (financial, hassle, safety) Total Value =
    • 7. <ul><li>Self-management can have huge impact </li></ul>Source: New England Health Care Institute, Client Conference, May 20, 2008 Health Determinant
    • 8. <ul><li>What doesn’t work </li></ul>What doesn’t work
    • 9. <ul><li>What doesn’t work (or won’t work for long) </li></ul>Incentives (a/k/a ‘behavioral economics’): In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. As soon as the monetary reward is removed, undesired behavior resurfaces. Reminders and other one-off tools: By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Generic education: Dense information that lacks interaction and misses opportunities for real internalized education, insight and knowledge assimilation. As a result, patients feel reactive, overwhelmed, and confused.
    • 10. <ul><li>Generic education is not an effective intervention </li></ul>
    • 11. <ul><li>Ad agencies deliver messages to averages </li></ul>Would you ask an ad agency to form a relationship on your behalf with your spouse, children or business partners? Why not? Standard ad agency approach: 1. Start with the objective of “building the brand.” 2. Get an agency to create “the big idea” that would get the brand noticed and admired. 3. Understand the averages of your customers. 4. Push out messages in maximum volume to those averages. Often these messages are seen by target customers as intrusive, empty and cluttered.
    • 12. <ul><li>‘ Build it and they will come’ only works in Hollywood </li></ul>© Universal Pictures
    • 13. <ul><li>‘ Build it and they will come’ , a case study </li></ul>Remote monitoring has been searching for a business model for 20+ years. Computer chip makers, telephone companies, handset manufacturers, health IT, medical device manufacturers and many others have tried, and so far largely failed, to make remote monitoring a success.    Conservatively, $25b in capital has been consumed to-date in remote health monitoring. The core problem has been focus on measurement, not on actionability and value to the physician and patient. While that data holds great promise, the ultimate link to changed outcomes and health economics has been tenuous. What is needed is integrated and actionable lenses for clinicians, patient knowledge and the ability to take the right self-care actions to manage the disease and improve the numbers.
    • 14. <ul><li>What works </li></ul>What works
    • 15. <ul><li>Focus on ROI </li></ul>ROI driver ROI basis Increase clinician willingness to initiate therapy <ul><li>Provide tools and training necessary to get patients and physicians comfortable to start therapy </li></ul>Cause clinicians to pay for service <ul><li>Reimbursement and/or time savings to clinician </li></ul>Cause patients/family to pay for service <ul><li>Peace of mind and control to patients/family </li></ul>Increase reimbursement <ul><li>Improved health economics </li></ul>Increase approval rates/indications <ul><li>Reduced risk and increased visibility and control </li></ul>Make your solution the obvious first choice for therapy therapy <ul><li>Emphasizes therapy easy to use message </li></ul>Fulfill regulatory requirements <ul><li>If required by REMS or other post-marketing surveillance/support requirements </li></ul>
    • 16. <ul><li>Deliver Total Value </li></ul>
    • 17. <ul><li>What works </li></ul>Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family
    • 18. <ul><li>“ Target-populations” vs. real people </li></ul><ul><ul><li>“ I panicked immediately when I got diagnosed and there’s a lot of sites that are just too much information …” </li></ul></ul><ul><ul><li>48 y.o. Type 2 Diabetes patient </li></ul></ul>“ There is so much out there, but it’s hard to figure out what I really need to know. So many of the websites just scare you with all the horror stories. It would be great to have a program that made sure I learn what I need, but also just made me feel like I’m not on my own . My family is helpful, but they don’t know about these things.” 50 y.o. Pre-Transplant patient “ Sometimes you can feel bombarded with the information – there is so much. It is not helpful. I don’t look at it and say ‘oh yeah, this is for me , this is made for me.’” 32 y.o. Multiple Sclerosis patient
    • 19. <ul><li>Value driven communications </li></ul><ul><li>Effective change does not happen ‘on the average’. It happens for the individual. </li></ul><ul><li>Value needs to be operationally defined: Value to whom? What is valuable to patients? To families? To clinicians? </li></ul><ul><li>Driven needs to be operationally defined: Driven to what outcome? What transformative, robust science drives the communication? </li></ul><ul><li>Communications need to be defined: Communications that are effective are based in trust, affiliation, consistency, and empathy. </li></ul>
    • 20. <ul><li>What’s needed is relationships with people </li></ul><ul><li>Have compelling clinician and patient engagement strategies and form authentic service relationships to accompany clinicians, patients, and families in their experiences </li></ul><ul><li>Avoid relying on common-denominator, top-down market and segmentation data that objectifies target population </li></ul><ul><li>Rely on sophisticated quantitative and qualitative research and analysis of human experiences </li></ul><ul><li>Transform relationship and experience by collaborating and sharing value </li></ul><ul><li>Train all involved internally (MSLs, field force and others), focusing on experiential learning / training </li></ul>
    • 21. <ul><li>Chelsea’s story: Personalized support in MS </li></ul>User scenario: Chelsea is a 28 year-old married mother of two. She works in sales and is an avid runner. Following experiences of leg numbness, Chelsea visits a neurologist who diagnoses her with MS. Dimensions of Change Examples Guided Intervention Modules Outcomes Cognitive This must be a mistake, Chelsea thinks. I don ’t want to end up in a wheelchair! (Confusion, Denial, Misconception) <ul><li>Myth-Busting Exercise </li></ul><ul><li>Cognitive Orientation Exercise </li></ul><ul><li>Early Phase Education </li></ul><ul><li>Internalization Exercise </li></ul>Chelsea learns that every person with MS has a different experience and outcome. She accepts that she has MS. (Balance, Integration) Emotional It seems to Chelsea that her world has stopped. Sometimes she feels numb, and sometimes she trembles with rage. (Shock, Anger, Fear) <ul><li>Shock CBT Exercise </li></ul><ul><li>Anger CBT Exercise </li></ul><ul><li>Fear CBT Exercise </li></ul><ul><li>Emotion Education </li></ul>Chelsea moves through two stages of grief. She learns that, with initiative and proper care, she can manage MS. (Hope, Openness) Behavioral Chelsea doesn ’t follow the treatment plan. She Googles her symptoms and changes doctors. (Avoidance, Compensation, Displacement) <ul><li>Avoidance CBT Exercise </li></ul><ul><li>Goal Re-Orientation Activities </li></ul><ul><li>Barriers to Adherence Exercise </li></ul><ul><li>Adherence Problem Solving </li></ul>Chelsea follows her doctor ’s orders and makes appropriate subsequent appointments. (Self-Care Action, Safety Monitoring) Environmental Chelsea wonders how she can succeed in sales or stay active with MS. She tests her friendships and fears abandonment. (Questioning Self-Concept, Strained Relationships) <ul><li>Values Clarification Exercise </li></ul><ul><li>Relationship CBT Exercises </li></ul><ul><li>Social Media Activities </li></ul><ul><li>Social Learning / Modeling Videos </li></ul>Chelsea joins an online MS support group, redefines her identity, and finds new hobbies. (New Community, Self-Discovery)
    • 22. <ul><li>Chelsea learns self-management skills from a coherent program delivered through multiple integrated channels </li></ul>Chelsea, continuing to engage through multiple channels, builds appropriate action into her life via Behavior Modification Theory Chelsea decides to try the website associated with the program where she experiences effective education, based on Pedagogical Science Chelsea gains insights into thoughts and feelings that might be getting in her way, using the tools of Cognitive Behavioral Therapy Chelsea might initially learn of the program through a clinician, disease advocacy group, pharmacy or DTC Take Action Engage Gain Insight Learn
    • 23. <ul><li>What works </li></ul>Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔
    • 24. <ul><li>Medical should play core role </li></ul><ul><ul><li>Objective : Build lasting relationships between companies and physicians, with improved patient care and Quality of Life at the core of that relationship. </li></ul></ul><ul><ul><li>Roles &amp; Responsibilities : </li></ul></ul><ul><ul><ul><li>Help the busy, stressed physician manage the patient with the right therapy, at the right time, in the right dose with the right self-management support. </li></ul></ul></ul><ul><ul><li>Metrics : </li></ul></ul><ul><ul><ul><li>Number of patients treated according to label. </li></ul></ul></ul><ul><ul><ul><li>Percent of patients with &apos;preferred&apos; (e.g. tier 2) access to the therapy. </li></ul></ul></ul><ul><ul><li>Process &amp; Tools : </li></ul></ul><ul><ul><ul><li>System to effectively engage each target clinician. </li></ul></ul></ul><ul><ul><ul><li>Timely info to answer specific clinician questions – smart informatics platform. </li></ul></ul></ul><ul><ul><ul><li>Deliver effective programming and tools to help the doctor help the patient learn self-management. </li></ul></ul></ul>
    • 25. <ul><li>Global role of Medical </li></ul><ul><li>United States. Biopharma must show added value to payers/employers, and show prescribers a meaningful differentiation to prescribe. Finally, FDA is increasingly requiring risk management programs where enhanced support must be provided to patients, prescribers and pharmacists. </li></ul><ul><ul><li>Medical should be the ‘value-champion’ in the US with all key stakeholders, and take the lead on safety programs and studies. </li></ul></ul><ul><li>Europe + Japan, South Korea, Australia, Singapore, Canada. All industrialized National Payer markets are looking for therapy management to improve outcomes and cost efficiency. EMEA, MHLW and other regulatory bodies are increasingly requiring risk management programs where enhanced support must be provided to patients, prescribers and pharmacists. </li></ul><ul><ul><li>Medical should take strong role, in partnership with HEOR, to ensure well conceived and executed health economics strategies for each affiliate. Medical should also own risk management programs. </li></ul></ul><ul><li>Emerging Markets . Across most emerging markets, there is need to engage and show truly greater value to the holy trinity of largely self-pay patients, powerful neighborhood pharmacists and physicians. This is critical for both brands and branded generics. At the same time, regulatory bodies and physician groups are clamping down on ‘added value’ practices of the past ( e.g. CFM 1939 in Brasil). Mobile phone penetration offers natural channel. </li></ul><ul><ul><li>Medical can play a core role in delivering a premier experience to self-pay patients, productively engaging the pharmacist, and differentiating to the physician. </li></ul></ul>
    • 26. <ul><li>What works </li></ul>Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔ ✔
    • 27. <ul><li>Proven and effective behavioral science </li></ul><ul><ul><li>Classical Conditioning deals with events that come before a behavior (often called triggers or antecedents ). </li></ul></ul><ul><ul><li>Operant Conditioning deals with events that come after a behavior (positive or negative consequences ). </li></ul></ul><ul><ul><li>Social Conditioning deals with how we learn collaboratively and interdependently, with and from others ( modeling and working-through ). </li></ul></ul><ul><ul><li>Cognitive Behavioral Therapy deals with idiosyncratic relationships between thoughts , feelings , and actions . </li></ul></ul><ul><ul><li>Critical Pedagogy deals with processes of education and internalized knowing. People learn best when new information is timed (happens at key inflections) , integrative (easily processed), and directly relevant to nuanced personal experiences . </li></ul></ul>Behavior Modification Therapy Cognitive Behavioral Therapy Effective Pedagogy Thoughts Feelings Actions Classical Operant Social Integrative Personal Timed
    • 28. <ul><li>Overcoming the barriers to effective patient self-care requires proven tools </li></ul><ul><ul><li>Cognitive behavioral therapies (CBT) are the most-studied empirically supported techniques in psychology, according to the American Psychological Association. </li></ul></ul><ul><ul><li>The basis of CBT is that thoughts and feelings impact actions: </li></ul></ul><ul><ul><ul><li>CBT techniques have also been shown to improve outcomes in a wide range of serious and complex diseases, such as: Metabolic ( e.g. diabetes), immune-mediated ( e.g. HIV), cardiovascular ( e.g. cardiomyopathy, heart failure), neurological ( e.g . MS, Huntington’s, epilepsy, Parkinson’s), muscular-skeletal ( e.g. osteoarthritis, fibromyalgia), pulmonary ( e.g . asthma, COPD, tuberculosis), hematologic ( e.g. hemophilia, sickle cell), gastrointestinal ( e.g . celiac, Crohn’s, bowel syndromes), oncologic ( e.g . breast, carotid, prostate, and other conditions ( e.g. chronic fatigue syndrome), as well as surgeries ( e.g. transplants, coronary artery bypass), and other procedures ( e.g. dentistry). </li></ul></ul></ul><ul><ul><li>CBT has been studied and shown to be effective when delivered via a wide range of channels, including: computer interface, paper materials, games, nurses, diabetes educators and physicians. </li></ul></ul>
    • 29. <ul><li>Computer-assisted Cognitive Therapy </li></ul>Source: Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, Otto MW. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. American Journal of Psychiatry . 2005; 162:1158–1164.
    • 30. <ul><li>New program development </li></ul>Identify major patient pathways and inflection points in patient experience using focus groups, expert interviews. Identify major adherence target behaviors for patients using focus groups, expert interviews. Identify cognitive, emotional, behavioral, social barriers to adherence. Collapse core psychological themes in non-compliance among target patients, using quantitative and qualitative research methodology, framed in terms of patient need. <ul><li>Match patient needs to behavioral program to delivery method ( i.e. , video, education, story, cognitive reframing, behavior planning, tool use). </li></ul>Apply proven behavior science program of “Explore”, “Insight”, “Action” with standard protocols. <ul><li>Test with user and clinician usage and feedback as well as outcomes and health economics. </li></ul>
    • 31. <ul><li>Patients &amp; physicians report range of non-adherence causes </li></ul>Sources: BCG analysis; Harris Interactive 10,000 Patients Survey, 2002. Sometimes forget to use or refill Don ’t want the side effects The drug costs too much Don ’t think I need the drug Can ’t get prescription filled, picked up, or delivered Don ’t know how to use the drug Other PATIENT VIEWS Reasons why patients don ’t fill prescriptions or comply with therapies (patient views) (Percentage of patient respondents citing each reason) Source: Human Care Systems Physician Survey, 315 physicians, 2010. . PHYSICIAN VIEWS Reasons why patients don ’t fill prescriptions or comply with therapies (physician views) (Percentage of physician respondents citing each reason) Cost/co-pay Side effects Forgetfulness Lack of motivation and self-confidence Doesn ’t think he/she needs drug Underlying emotional issues Doesn ’t think drug works Other Patient is suspicious of pharmaceutical companies Doesn ’t understand how to use/administer drug Lack of productive family involvement Can ’t get prescription filled, picked up or delivered
    • 32. <ul><li>Each adherence barrier has drivers from behavior science </li></ul>Behavioral Drivers Adherence Barrier Doesn ’t understand how to use/administer drug Information processing style, misconceptions, emotionality, self-efficacy Lack of productive family involvement Avoidance, relationship skills / strain, stimulus control, living environment Can ’t get prescription filled, picked up or delivered Social capital, problem-solving, communication, self-efficacy Doesn ’t think drug works Defense mechanisms, interpersonal skills, learning style, social capital Underlying emotional issues Cognitive skills, mind / body relationship, life environment Doesn ’t think he/she needs drug Defense mechanisms, cognitive-emotional skills, life environment Lack of motivation and self-confidence Self-efficacy, social capital, mind / body relationship, cognitive skills Forgetfulness Emotionality, defense mechanisms, cognitive dysfunction Side effects Cognitive skills, mind / body relationship, self-efficacy, stimulus control Cost/co-pay Cognitive skills ( coping ), emotionality ( anger ), problem-solving ( prioritizing )
    • 33. <ul><li>Efficacy evidence: Medicine adherence </li></ul>In a trial of medicine adherence (refills) among 50 diabetic patients (42 completed), HCS significantly improved adherence. Trial conducted March 1, 2009 to August 31, 2010 in United States
    • 34. <ul><li>What works </li></ul>Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔ ✔ ✔
    • 35. <ul><li>What makes family important to patient behavior change? </li></ul><ul><ul><li>In behavior science, social environment (e.g., family) is critical in behavioral environment formulas. </li></ul></ul><ul><ul><li>Degree and quality of interpersonal attachment drives individual behavior change in a social environment. </li></ul></ul><ul><ul><ul><li>Variables such as affiliation, liking, identification, time spent together, trust, proximity, shared experience are all powerful predictors of behavior change. </li></ul></ul></ul><ul><ul><ul><li>Knowing and using such variables properly in behavior change algorithms is critical. </li></ul></ul></ul><ul><ul><li>Family systems maintain behavior patterns , whether they are healthy or unhealthy. </li></ul></ul><ul><ul><ul><li>Family roles, thought / feeling / behavior patterns, communication styles, and expectations are all critical to patient health, well-being, and adherence. </li></ul></ul></ul><ul><ul><li>Anyone can learn behavior science. It’s often counter-intuitive, but based in robust research. It works best when everyone knows how it works. </li></ul></ul>
    • 36. <ul><li>What makes family involvement go wrong? </li></ul><ul><ul><li>Because family is emotionally invested in patient health, they are often disproportionately reactive rather than responsive and effective in their support attempts. </li></ul></ul><ul><ul><li>Family members have their own daily hassles and stressors normal to life. These are exponentially compounded by stressors related to caring for an identified patient. </li></ul></ul><ul><ul><li>Loving someone with a serious health condition is known to be a top cognitive, emotional, and behavioral stressor. The supporter’s stress is often unacknowledged , complicating already unhealthy family patterns. </li></ul></ul><ul><ul><li>Family members fail to attend to their own basic self-care , complicating the ability to effectively support the identified patient. </li></ul></ul><ul><ul><li>Support, empathy, compassion, and communication skills are often neither learned, nor intuitive . </li></ul></ul><ul><ul><li>Family members don’t realize how they participate in, reinforce and maintain problematic health and self-care behavior in the patient. </li></ul></ul>
    • 37. <ul><li>What can make family involvement go right? </li></ul><ul><ul><li>Understanding roles, clear strategies, and goals for family member success, and the interdependence of those goals . </li></ul></ul><ul><ul><li>Learning and practicing easy, proven skills related to respect, support, empathy, compassion, and communication. </li></ul></ul><ul><ul><li>Weighting and manipulating basic variables (e.g., reinforcers, consequences) in behavior environments more effectively. This may include de-emphasizing the identified patient as the family problem. </li></ul></ul><ul><ul><li>Teaching family members how to tell when the patient needs empowerment, boundaries, advocacy, emotional support, or logistical help. </li></ul></ul><ul><ul><li>Teaching and practicing easy behavior science interventions that are rooted in mutual, systemic benefit. </li></ul></ul>
    • 38. <ul><li>Case Study </li></ul>Kidney Transplant
    • 39. <ul><li>Pathways and inflection points for the kidney transplant patients </li></ul>“ I need a transplant” “ They found me a kidney” Surgery and Recovery “ I’m going home” “ I still have to actively manage my health” <ul><li>Difficulties of dialysis and health management </li></ul><ul><li>Fear of death, surgery, failure </li></ul><ul><li>Building a community at dialysis center </li></ul><ul><li>Preparing for transplant </li></ul><ul><li>Anxiety about finding a kidney either from family or waiting by the phone </li></ul><ul><li>Often dealing with other health issues ( e.g. diabetes, heart disease, etc.) </li></ul><ul><li>Mix of excitement and anxiety </li></ul><ul><li>Living donor: </li></ul><ul><ul><li>Schedule surgery </li></ul></ul><ul><ul><li>Prepare for surgery </li></ul></ul><ul><ul><li>Guilt, fear, gratitude around donor </li></ul></ul><ul><li>Cadaveric kidney: </li></ul><ul><ul><li>Rush to get to the hospital </li></ul></ul><ul><ul><li>Let friends and family know </li></ul></ul><ul><ul><li>Reschedule other things going on </li></ul></ul><ul><li>Fear of surgery and complications </li></ul><ul><li>Fear for living donor’s surgery </li></ul><ul><ul><li>Preparing for life after going home – learning about – wound care, diet, going home, warning signs of rejection </li></ul></ul><ul><li>Mixed emotions: </li></ul><ul><ul><li>Relief of being home </li></ul></ul><ul><ul><li>Fear/anxiety about possible rejection </li></ul></ul><ul><ul><li>Social isolation of recovery </li></ul></ul><ul><ul><li>Financial stress </li></ul></ul><ul><li>Difficulties of recovery </li></ul><ul><li>Challenge of starting a new routine </li></ul><ul><li>Continuing the routine </li></ul><ul><li>Frustration/boredom around the routines </li></ul><ul><li>Disappointment that kidney health is still a big part of life </li></ul><ul><li>Feeling that some parts of treatment are not important </li></ul><ul><li>Financial burden of medications, especially if insurance coverage ends </li></ul><ul><li>Managing co-morbidities </li></ul><ul><li>Continued fear of rejection or need for a second transplant </li></ul>
    • 40. <ul><li>Develop program for kidney transplant patients </li></ul>Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
    • 41. <ul><li>Effective pedagogy: interactive, engaging education </li></ul>
    • 42. <ul><li>Develop program for kidney transplant patients </li></ul>Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
    • 43. <ul><li>Cognitive Behavioral Therapy: exercises to explore emotions around self-care </li></ul>
    • 44. <ul><li>Develop program for kidney transplant patients </li></ul>Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
    • 45. <ul><li>Behavior Modification Therapy: process and tools to take action </li></ul>
    • 46. <ul><li>Q&amp;A </li></ul>Questions?

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