Article

How biopharma can engage successfully with complex sites of care

Main challenges to patient access at complex sites of care

Due to their unique models, complex health systems pose three main hurdles to biopharma companies:

1. Operational complexity

These healthcare systems are highly matrixed. Coordinating care and patient access to therapies at these sites often requires the ability to provide meaningful education and coordination across often unconnected departments.

Unlike the traditional provider environment, complex health systems have multiple layers of stakeholders. Sometimes, entire multifunctional committees rather than individual roles make care decisions.

To coordinate with stakeholders successfully, you need to understand:

Which leaders you need to engage with
What educational gaps you may need to fill
What needs and challenges they have around access and reimbursement

Misalignment and communication gaps with reimbursement and access stakeholders may hinder the implementation of drug access and reimbursement strategies.

2. Reimbursement barriers

When sites of care manage multiple, diverse reimbursement processes across payers, it can be time-consuming and cumbersome. A variety of issues may lead to delayed or denied reimbursement, including:

Inconsistent coverage requirements across payers
Complicated, nuanced reimbursement steps
Lengthy approval or claim adjudication times

Biopharma companies can provide support to educate staff about these reimbursement issues, but it can be difficult to find and get in contact with the appropriate site of care staff within these complex organizations.

3. Access barriers

Timely access to patient support programs can be essential for patients who need specialized treatment. Yet, it can be a struggle for complex sites of care to utilize these programs to help patients. Aspects that can adversely impact patients include:

Difficulty enrolling patients in biopharma-sponsored patient support programs
Time-consuming, inefficient eligibility processes

It can be challenging for biopharma companies to identify and reach the key departmental stakeholders at complex sites of care who need education regarding these patient support program parameters and processes.

How to develop successful partnerships

Cencora’s Business Operations Specialists (BOS) help biopharma companies engage meaningfully with key decision makers at complex sites of care. The BOS are unlike field specialists, who typically engage in traditional provider environments and with departmental associates. Cencora’s BOS are senior field team associates who are experienced at navigating complex sites of care, engaging with senior leadership, including at the C-Suite level, and serving as a shared voice to facilitate awareness of your company and product.

A BOS team supports both sites of care and biopharma companies in navigating complex health systems to solve challenges such as acquisition channels, payer approval, and other reimbursement and access issues. Key activities of the BOS include:

Meeting with key leadership stakeholders at sites of care on an ongoing basis to educate on operations and logistics to support the delivery of your product
Providing onsite and virtual support to COEs to address complex therapy-related access challenges
Leveraging their expertise to educate on appropriate resolutions to complex access issues related to their internal processes and requirements
Providing senior level specialized expertise in complex medical authorizations and cross-state and regional payer nuances and requirements
Sharing updates and learnings with your company to help it to continually optimize the program and respond to market changes

This article may contain marketing statements and shall not constitute legal advice. Cencora, Inc. strongly encourages readers to review the references provided with this article and all available information related to the topics mentioned herein and to rely on their own experience and expertise in making decisions related thereto.

References

1. Definitive Health. Healthcare Insights: How many IDNs are in the U.S.? 16 April 2024. Accessed 1 August 2024. Available online at: https://www.definitivehc.com/resources/healthcare-insights/idns-us

Why you need a different approach

Complex sites of care have become prominent in recent years. Estimates show there are 1,000 IDNs alone in the United States, and the largest have more than 500 affiliated providers.¹

While many of them share common traits, these organizations are often ecosystems of themselves, with their own unique bureaucracies and processes. Navigating these diverse sites often creates major challenges for biopharma companies.

Strategic partnerships for unlocking product potential ebook

Complex sites of care such as Integrated Delivery Networks (IDNs) and Centers of Excellence (COEs) can be integral to biopharma companies’ product success. These highly matrixed health systems play a prominent role in specialized therapy delivery. They can enable biopharma manufacturers to reach these specialized providers.

But engaging with them requires accommodating the unique complexities of these sites that come from the breadth of these organizations. To collaborate with these potential partners in a meaningful way, you need to understand their needs and how you can support their providers and other unique stakeholders.