Homecare services for patients – a new direction for pharma?

Rebecca Aris interviews Graeme Duncan

Healthcare at Home Ltd

In our patients focus month, we speak with Graeme Duncan of Healthcare at Home Ltd on the benefits that home healthcare can bring to patients.

Home healthcare is the fastest growing sector in the health care industry, and it is estimated that it will increase significantly in the coming years.1

Advantages to homecare include improved quality of life for the patients, reduced costs due to reduced stays in hospital and increased medication compliance.

Graeme Duncan is the Group Director of Strategy &amp, Marketing at Healthcare at Home, a leading patient support organisation. They provide homecare and patient level distribution to almost 200,000 patients across Europe on a daily basis. He speaks with us on the benefits to patients of home healthcare and the benefits to the wider healthcare system.

Interview summary

RA: In what disease areas can homecare be applied?

GD: We currently operate across approximately 30 different disease areas, including Rheumatology, Gastroenterology, Oncology, Pulmonary Arterial Hypertension, Multiple Sclerosis, ERT, Transplant and Nutrition. This is growing all the time, particularly with the emergence of more rare and orphan conditions. These often specialised areas lend themselves very well to using homecare. Ensuring patients are able to access treatment and are supported are key benefits of homecare services. Many pharmaceutical companies looking to launch new treatments for rare and orphan conditions realise that homecare can enable them to rapidly develop robust banks of information and data on the value of their offering as well as ease market access issues.

RA: How can homecare services impact on the quality of life of Oncology patients, for example?

GD: In one word – SIGNIFICANTLY! There is a lot of published evidence demonstrating that patients “prefer” such services compared with traditional hospital care.

This is for a variety of reasons linked to convenience, avoiding travel and other costs, not being exposed to hospital infections and privacy benefits. However beyond patient preference there is evidence that shows patients experience less side effects and have improved quality of life as a result of homecare services. For example a study in 2009 published in the Journal of Clinical Oncology, showed significant improvements in side effects in a cohort of homecare patients when compared with a cohort treated under normal hospital pathways.2

In addition, the homecare cohort had less unplanned admissions and inpatient days.

Another example was published in the British Journal of Cancer in 2005 where a study looking at breast cancer patients on Zoledronic acid and homecare had significant QOL improvements.3

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“…there is evidence that shows patients experience less side effects and have improved quality of life as a result of homecare services.”

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RA: What impact can these type of services have on compliance?

GD: That we should have a demonstrable effect on treatment compliance is obvious. Services that are at the patient level means there are many on-going touch-points to intervene to support patients.

This includes some basic checks via homecare customer service teams and logistics teams. These teams carry out stock checks and rotations as appropriate, schedule deliveries and reminders all of which keeps the treatment front of mind for the patients. However these services are then taken right through to direct nurse interventions and remote monitoring technologies. Skilled clinicians and innovative technologies are used to tailor services to patients. Patients can be stratified based on patient assessments and they can be offered the right level of support to optimise their compliance.

“Client confidential” assessment from such services show statistically significant improvements in both persistence and adherence. This includes treatments within Rheumatology, Oncology and Multiple Sclerosis. In one study 20% more patients were persistent on treatment 6 months post initiation than were through standard channels.

RA: How does a homecare service improve treatment outcomes and reduced treatment costs?

GD: Homecare offers many benefits to all parties involve, some of which are financial. These include direct financial benefits such as schemes that are supported by the Pharmaceutical manufacturers., overt financial benefits such as VAT savings that are realised and more holistic financial gains such as reductions in inpatient and outpatient costs delivered by homecare. There is a growing evidence base that shows that homecare can reduce “bed days”, unplanned hospital service utilisation episodes and avoid hospital admissions. This later point may indeed deliver some of the largest financial benefits to the NHS.

Homecare has been shown to offer significant financial benefits and large scale savings if it were to be scaled across the UK. A report in 2010 by Dr Foster concluded that approximately £1.3bn could be saved nationally if we had a homogenous adoption of just four homecare services. In a more recent report by the CBI, they estimated that there are up to £3.4bn of savings to be made with a wide scale adoption of homecare. Put simply, homecare enables new care models and pathways to be put in place that can reduce the amount of time people spend in hospital, the number of people admitted and the frequency of re-admission. These are some of the most costly parts of NHS care.

What should not be forgotten from these analysis is that enabling patients to not be admitted to hospital and lowering their chances of being re-admitted are hard quantifiable treatment outcomes.

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“Pharmaceutical partners are now repeatedly seeking to become integrated care providers, wanting to play a bigger supporting role…”

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RA: Why do you think pharmaceutical companies are looking at homecare as part of the strategic plans now?

GD: The reasons are many and varied. However I would group them into four key drivers:

1. Differentiation – almost all pharmaceutical companies are recognising that differentiation purely through the clinical properties of the product is neither sustainable, as the time to “me-too” is reducing, nor desirable. Pharmaceutical partners are now repeatedly seeking to become integrated care providers, wanting to play a bigger supporting role and thus are investing in services alongside their product offering. A fuller proposition that includes both product and service that can touch how their medicines are administered and supported at the point of care is highly attractive to pharmaceutical companies. Homecare offers this clear opportunity. Homecare is now a part of the “core marketing strategy”. It offers the opportunity to deliver greater value and a more sustainable competitive differentiation.

2. Proof of real world value – all pharmaceutical companies are under increasing pressure to not only deliver value but to measure and report back on the value they have delivered in “real-world” settings. Payers are seeking to understand and evidence the real-world outcomes that medicines are achieving. This is no small task for products that go through traditional “wholesaler” supply chains. Once a product is within the supply chain, being able to measure the value it delivers to its ultimate recipient and payer is very hard. Homecare however makes this far more straightforward. Homecare is one of very few channel strategies that allow the tracking of a product at a patient level. Healthcare at Home can track and trace which products have been delivered to which patients, at what time and with what frequency. This patient level data enables homecare organisations to get real-world data linked to medicines adherence and persistence. It also enables opportunities to collect PROM and PREM type data each time the homecare company interacts with the patient. Furthermore, there are real opportunities to take this data and overlay payer data linked to hospitalisation and health service utilisation. Homecare is one of the most powerful ways to get real insight into real-world value

3. Specialty pharmaceuticals – with the growth in rare, orphan and specialty products, has come an increased focus on channel strategies that can add real value. The traditional mass-market model of the wholesale supply chain is not overly attractive to “specialty pharma”. If there are say 5,000–10,000 patients in total for your medicine across Europe and the drug is of high value the comfort in having a highly secure, traceable and patient level supply chain is significant. Many of these products may have monitoring requirements, a need to support the health systems to ensure patients can access them and in these scenarios homecare is an obvious choice.

4. Closer to patients – there seems to be a clear drive by pharmaceutical companies to get closer to their patients. Understanding how their medicines are taken, providing more support to their patient cohort and ensuring they start to build relationships within regulations are key future moves. Homecare is one way pharmaceutical manufacturers can achieve this within the tight regulatory environments that exist. Having a quality assured, governed supply chain that is directly interacting with their patients on a monthly, weekly, daily basis is incredibly attractive. This is being utilised during early access programs, named patient programs, compassionate use programs before launch and through a patient level supply chain post launch. The pharmaceutical partners we are working with benefit from better insights into their patient cohort and a direct communication channel.

RA: What next for Healthcare at Home?

GD: We are working on models of European expansion which will takes us into other key territories. We are exploring these in partnership with both healthcare and pharmaceutical partners.

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“…there seems to be a clear drive by pharmaceutical companies to get closer to their patients.”

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Whilst we embark on this expansion we will continue to design and deliver new clinical services and innovation in care pathways.

The final key pillar of future growth is our health informatics capability. We believe that homecare and these capabilities will offer huge opportunities for our partners and our own growth.

RA: What challenges are you faced with in branching out to other markets?

GD: We have managed to build and grow operations in Germany, Switzerland and Austria.

Understanding the regulatory picture in each of these territories and working with the relevant bodies is a key hurdle that we have overcome. We now face similar challenges in other new territories.

One of the other major buffers to how quickly we can expand is the proverbial “fear of the unknown” in certain territories that have no “homecare” heritage. It is similar to growing the homecare system in the UK during the late 1990’s, where many physicians and policy makers had little experience of it. Launching homecare services in some territories requires education and the sharing of evidence to overcome these initial concerns.

References

1. http://www.ncbi.nlm.nih.gov/books/NBK43619/

2. Alex Molassiotis, Sarah Brearley, Mark Saunders et al. Effectiveness of a Home Care Nursing Program in the Symptom Management of Patients With Colorectal and Breast Cancer Receiving Oral Chemotherapy: A Randomized, Controlled Trial. JOURNAL OF CLINICAL ONCOLOGY . 2009 vol. 27 no. 36 6191-6198.

3. A Wardley, N Davidson, P Barrett-Lee et al. Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration. British Journal of Cancer (2005), 1 –8.

Healthcare-at-Home

About the interviewee:

Healthcare at Home (HaH) is Europe’s leading homecare and patient support organisation. It has clearly established itself as the leader in the provision of complex care in the home and community and is well accepted as such in the market place. They provide homecare and patient level distribution to almost 200,000 patients across Europe on a daily basis.

This commonly involves managing the supply chain for pharmaceutical clients and delivering their medicines direct to patients in their homes or other appropriate settings.

They also provide clinical healthcare to homes and communities. Often funded by pharmaceutical partners they have a highly skilled nurse and pharmacist team throughout Europe who work to deliver training, education, medication administration and support for patients.

In addition, they deliver “real-world data” to payers and pharmaceutical partners.

Graeme Duncan is the “Group Director of Strategy &amp, Marketing” at Healthcare at Home Ltd. As a member of the main executive committee Graeme is responsible for strategy definition and planning as well as International expansion. Graeme joined Healthcare at Home in 2011 having held senior commercial roles with the likes of GSK and IVAX Pharmaceuticals before working in the technology and consulting sectors alongside organisations such as Accenture and IBM from 2004.

Will we see a growing trend in homecare?