Like a surprising splash of cold water to the face, the COVID-19 pandemic has sobered many to the need for substantial change within healthcare.
“We’ve really had to rethink everything about healthcare,” said Nathan Mott, CoverMyMeds president. “We’ve had to experiment and ask: ‘Is there a better way?’ Now, we’ve been asking that about healthcare for a long time. But why can’t healthcare be like other industries? Why can’t we do things differently?”
And indeed, we have. In a little under two years, we saw a decade’s worth of progress sweep through healthcare. Efforts to reduce exposure to and slow the spread of the COVID-19 virus led to other, unanticipated effects on healthcare. For instance, healthcare leaders found innovative ways to use technology and hybrid delivery models to better care for patients.
These developments are but the tip of the iceberg, too. Continuing to shape patient care is the rebounding of in-person care — despite the ebb and flow of pandemic recovery — the rise of patient consumerism and potential policy changes, including pharmacy reimbursement.
And ahead, the horizon teems with possibility for the healthcare industry. To explore what’s in store in 2022, CoverMyMeds’ leaders discussed the key trends shaping healthcare in the coming year — as identified in the 2022 Medication Access Report. Presented within the context of medication access, affordability and adherence challenges, these trends include unlocking patient health data, the continued expansion of specialty medications, robust adoption of digital health solutions and the evolution of a hybrid pharmacy model.
We’ve really had to rethink everything about healthcare. We’ve had to experiment and ask: ‘Is there a better way?’Nathan Mott, CoverMyMeds president
Trend 1: Unlocking data for patients and care teams
Presented by: Nathan Mott, CoverMyMeds president
The pandemic has served as a reset button for the industry. In the long run, it may be exactly what was needed to push past the status quo and the tendency to do things just because “that’s the way they’ve always been done.”
The signs so far are promising. Payers are managing costs while maintaining quality patient care. Biopharma companies are expanding how they update providers on clinical content and new therapies beyond in-person visits. Providers are interacting with patients in new, innovative ways. Pharmacies are evolving their roles to better meet patient needs, too. And through it all, patients have also been resourceful in finding new ways to access care.
The common thread has been and will continue to be technology — especially when paired with caring humans on the other end. Whether it’s a virtual visit or online shopping for prescriptions, technology can improve transparency and choice, two increasingly important factors for involving patients more in their own healthcare decisions.
The right data at the right time across the healthcare ecosystem can make all the difference for patient empowerment. Much progress has been made here in recent years, but a lot of work remains, too — an insight made even more noticeable by the pandemic.
For instance, the 2022 Medication Access Report found that only 25% of providers and 36% of pharmacists have access to critical information like plan- and pharmacy-specific pricing, cash pricing and patient-deductible data. But to better inform medication affordability conversations with patients and help patients start specialty therapies, 56% of providers and 63% of pharmacists said they need access to patient-specific benefit information.
This is where I hope the 21st Century Cures Act Final Rule will start to make a difference as it evolves over time. Implemented at the onset of the pandemic, this act includes interoperability provisions meant to give patients more control over their own health information.
The act aims to accomplish this in two ways. First, by delivering accurate, timely and actionable healthcare data, more conveniently, to patients and their providers. And secondly, by promoting visibility of healthcare services, quality and costs to more effectively empower patients as active participants in their healthcare.
While not a silver bullet, interoperability is a major advancement — particularly for patients.
The 2022 Medication Access Report found that 90% of patients said they have electronic access to medical labs, tests, data and more through a patient portal. And 86% said they can easily share this data with providers, specialists and pharmacists.
These developments are important because of what they enable patients to do. Patients can use digital apps to gather and access their medical records, including physician notes, test results and medication and benefit information. Patients can also shop for care by comparing costs and better understanding possible treatments and expected health outcomes. And finally, patients can control which apps they use, which third parties may access their records and how their healthcare information can be used.
These moves should also enhance access to data for concierge services that can help identify what's best for the patient. With patient-centric technology enabling transparent communication between healthcare stakeholders, everyone gets a better experience.
Ultimately, the result may be more informed consumers with access to better care at a better price.
Over the next five years, specialty medicines will account for nearly two-thirds of drug launches and nearly 50% of biopharma market’s revenue.Shawn Seamans, CoverMyMeds chief commercial officer
Trend 2: Accelerating the development of specialty medications for patients
Presented by: Shawn Seamans, CoverMyMeds chief commercial officer
One of the biggest areas of growth in healthcare will continue to be specialty medications and therapies. Over the next five years, specialty medicines will account for nearly two-thirds of drug launches, lifting their share of the total biopharma market’s revenue to nearly 50%. That trend was well on its way before the pandemic, but like many things since, its growth trajectory has accelerated.
Throughout the pandemic, patients canceled or delayed many diagnostic tests and routine appointments, missing some 1.3 billion visits in 2020 and 2021. Missing these appointments can lead to conditions eventually being diagnosed in later stages when they’re harder and more costly to treat.
This “diagnosis explosion” will likely result in many patients facing advanced illnesses in 2022 that may require specialty drug treatments. Some estimates show there could be 9,000 undetected cases of breast cancer alone, resulting in $27 million in treatment costs. Increased costs can impact patients and health systems, with more advanced treatments and procedures needed for worsening conditions.
At the same time, drug development is shifting more toward specialty medications with narrow indications and smaller patient populations. While the research and development process has remained mostly unchanged for years, the industry is rethinking how to accelerate the development of specialty treatments to meet the growing need for new breakthrough therapies.
For example, large biopharma companies are using AI to help speed up clinical trials and perceive diseases more clearly. Last year, for example, one German biotechnology company announced a phase 1 clinical trial on a new anticancer molecule that it had discovered after only eight months — which is a vast improvement upon the traditional discovery process of 4-5 years.
We’re also seeing progress on two other fronts as it relates to the development of specialty medications. First, the successful completion of decentralized clinical trials may change how we recruit and conduct research. And secondly, the increasing acceptance of real-world evidence to measure therapy performance and patient outcomes will likely also see movement this year.
Specialty’s evolution will continue through product launches and commercial uptake, too. Biopharma companies are hiring chief digital officers to enhance the patient experience and improve the use of digital channels to reach consumers directly.
At the same time, patients are becoming more involved in their treatment decisions. In fact, 76% of specialty patients said they were “involved” or “very involved” in coordinating care activities. Increasingly concerned with the complexity of treatment logistics, managing side effects and outcomes, more than a third of patients said they spend more than three hours on the phone sharing information and asking questions among insurance companies, pharmacies and providers.
Driving end-to-end support to address medication access, affordability and adherence challenges for specialty patients now becomes an opportunity. But while the value of patient-centric technology solutions and services cannot be underestimated, we must also consider the providers responsible for managing the patient’s care and serving as one of their most important advocates.
The 2022 Medication Access Report found that 84% of providers with patients on specialty therapies have trouble starting patients on these complex medications, with 29% rating the process as difficult or very difficult. Nearly 1 in 5 providers spend at least three hours per patient coordinating steps to start a complex therapy.
Providers will continue to need information about new specialty therapies and integrated support to help patients get started on treatment faster — and stay on it. Technology can help by giving members of the care team end-to-end visibility into the patient journey, which will help providers quickly and easily identify how to help their patients access their needed therapies.
People are looking for assistance. We can use digital channels to help them get on and afford their medicine — and then move into optimizing for outcomes.H. John Beardsley, CoverMyMeds senior vice president of corporate strategy and business development
Trend 3: Optimizing patient care through digital health solutions
Presented by: H. John Beardsley, CoverMyMeds senior vice president of corporate strategy and business development
No treatment plan is the same, just as no patient is the same. As patients grow more involved in managing their health and reporting their data as consumers, their involvement in their healthcare will only gain momentum. We must respond with understandable, accessible and equitable healthcare solutions.
Technology can help. But it’ll be human connections that turn the tide toward a more accessible healthcare future.
Patients often face medication access challenges due to complex prescribing processes associated with specialty medications. We must respond with personalized support that meets the patient where they are, whether in their treatment journey or through the channels used to educate and engage them. To do so, we must reach patients in new ways and embrace emerging digital channels to deliver education and patient support.
The COVID-19 pandemic showed us how this can be done.
First, as stay-at-home orders forced the near-total shutdown of in-person healthcare, telehealth and other technology-driven solutions provided a critical link between patients and providers.
While telehealth appointments have dropped from peak levels experienced during the height of the pandemic, use remains steady at about 20% — significantly higher than it was before the pandemic. The 2022 Medication Access Report found that over the last 12 months, 84% of patients participated in a telehealth appointment. When asked why they chose to participate in a telehealth appointment, 66% of patients said convenience — up from 56% in 2020. Forty-five percent of patients said cost — up from 24% in 2020.
Telehealth, digital dispensing and consultations aren't new, of course, but the pandemic provided a catalyst for rapid expansion and adoption.
Additionally, expect continued growth of digital therapeutics and biopharma companion devices, which could include remote monitoring. These devices can collect and analyze data that can be used to give patients tools for better self-care and improved outcomes or even opportunities to participate in relevant clinical studies.
More and more, we see a desire among patients to understand whether a treatment’s working, whether the outcomes balance the side effects or whether other treatments would provide a better option. Digital health solutions, with the ability to aggregate data across a broad patient population, can offer patients — and their providers — an important feedback loop to optimize care plans, reduce costs and create better therapies.
However, the push for adoption of digital services must also address the evolving demographics of the patient population prescribed the most medications: adults 65 and over. Nearly 90% of adults 65 and over report taking prescription medicine, compared to 75% of adults between 50 and 64 and 50% of adults between 30 and 49. Adults 65 and over are also more likely to be taking multiple prescription medications. Addressing affordability and adherence challenges for this population will likely need both traditional and digital solutions.
Today, we can use these emerging digital channels as part of a hybrid delivery model to help people access and afford their needed medicine. Digital channels also provide an opportunity to help patients adhere to their medicines — whether that help arrives through managing side effects or patient expectations around the efficacy of their medication. When patients are better informed of the various pros and cons of their therapy, they’re better able to make decisions about which therapy is best for them and their condition.
The pandemic has helped people realize there may actually be a better way to deliver healthcare — one built around patient choice and convenience.Jim Rowe, CoverMyMeds president of pharmacy and affordability
Trend 4: Delivering on convenience and patient choice via hybrid pharmacy services
Presented by: Jim Rowe, CoverMyMeds president of pharmacy and affordability
The pandemic has helped people realize there may actually be a better way to deliver healthcare — one built around patient choice and convenience.
Digital pharmacies are one area to watch. Though they’ve been growing in popularity for several years, digital pharmacies gained significant traction during the pandemic. Offering convenience and a consumer-friendly online presence, digital pharmacies perform well with simple maintenance prescriptions.
However, questions remain about whether they’re equipped to handle the needs of patients requiring complex specialty medications. This question will be tested in 2022 as in-person healthcare visits are expected to continue increasing — leading to an increase in new diagnoses and more prescribed therapies.
This may finally be the catalyst to push healthcare to become more consumer-friendly, like other industries, and to build around the patient experience.
Even though patients can now go to the pharmacy to pick up a prescription or talk to the pharmacist, they may choose not to — opting instead for home delivery or virtual consultations. Adopted out of necessity during the pandemic, mail order and home delivery are now expected by customers across all pharmacy settings.
For instance, patients most often receiving their medications from local pharmacy delivery programs increased from 13% in 2020 to 21% in 2021.
Today, patients have more choices to meet their pharmacy needs. At the same time, patients expect the same level of convenience with their healthcare as they do with other products and services.
We’re seeing that play out with increased reliance on pharmacy automation, including central fill models that create efficiencies for dispensing prescriptions and allow for the scale of direct-to-patient delivery. Technology can also enable pharmacists to spend more time interacting with patients by quickly and accurately doing the heavy lifting on repetitive tasks.
As we found in the 2022 Medication Access Report, 54% of pharmacists felt they didn’t have enough time to adequately complete their job. Among the reasons pharmacists felt they lacked time to complete their job adequately, 73% cited time-consuming administrative tasks. This primes the market for continued innovation and adoption of pharmacy technology that can help save time and lead to better patient care.
And, as pharmacists continue to provide more and more patient care — as they’ve proven they can do during the pandemic — optimizing operations to provide robust clinical services through a unique mix of in-person support and digital engagement will be just as critical.
To learn more about the medication access, adherence and affordability challenges driving trends in healthcare, read the 2022 Medication Access Report.