Four Ways AI Is Changing Market Access for the Better
Authored by Ellen Cappellino, Ryan Slipakoff
What you’ll learn:
AI integration in healthcare promises a holistic improvement across the ecosystem, enhancing transparency, decision-making, and patient-care outcomes for all stakeholders.
AI-driven solutions proactively identify and resolve access barriers, shifting healthcare from a reactive to a proactive care model and improving patient health outcomes.
Through economic and operational efficiencies, AI enables improvements in resource allocation, informed decision-making, and reduced costs for payers and pharmaceutical companies, fostering a sustainable business model.
Across the healthcare landscape, a staggering 20–30% of prescriptions go unfilled, leading to a $150 billion challenge impacting patients, healthcare providers (HCPs), payers, and the choice of treatment options.
This issue, as we explored in our previous article, stems from a fragmented system where siloed processes and outdated methods create friction in patient access. Previous limitations forced companies to analyze and act on a macro plan, or population-based scale. Today, real-time, plan-based, and individualized decision-making is possible at scale. The solution is leveraging artificial intelligence (AI) and data synthesis to address these challenges proactively.
By implementing intelligent AI-driven solutions that anticipate and address access barriers, we can create a “Win4All” scenario where each key stakeholder group experiences their unique benefits.
Win 1: Patients—Improved Experiences and Outcomes
Imagine a healthcare journey where patients have complete transparency into their coverage, easily understand costs and choices, and face no process-related hurdles in accessing necessary medication. AI is making this possible through:
Coverage transparency: Patients gain clear insights into their specific coverage criteria and potential out-of-pocket costs, empowering them to make informed decisions with their HCP. No longer will they be left in the dark about whether their medication is covered or what alternatives might be available.
Simplified choices: AI tools can present treatment options in a user-friendly format, outlining potential benefits and risks without overwhelming patients. By empowering patients, they can participate more actively in their care and make informed choices based on their goals and expectations of treatment.
Seamless access: AI identifies potential coverage challenges and proactively initiates solutions like prior authorizations or affordability support, ensuring patients can get their medications with minimal delays. Eliminating the frustration and stress of navigating complex processes, patients more easily prioritize focusing on their health.
For example, a patient prescribed a specific medication for their chronic condition can, through an AI-powered platform, simultaneously see if their insurance covers it, explore alternative options if needed, and even receive reimbursement and affordability support services, all without navigating a maze of phone calls and paperwork.
Win 2: Healthcare Providers—Enhanced Decision-Making and More Time with Patients
HCPs face immense pressure to deliver quality care while managing administrative burdens. AI-driven solutions alleviate these challenges by:
Supporting treatment decisions: AI analyzes patient data and medical literature to suggest evidence-based treatment options, considering individual needs and potential drug interactions. An assessment can help HCPs stay up to date on the latest research and ensure they prescribe the most effective medications for each patient.
Improving adherence: AI tools monitor patient progress and identify the potential for non-adherence early on, enabling HCPs to intervene and provide the necessary support. This proactive approach can help patients stay on track with their treatment plans and achieve better health outcomes.
Reducing administrative tasks: AI-informed prior authorizations, more streamlined communication with pharmacies and payers, and simplified documentation processes free up valuable time for HCP offices to focus on patient care. Improving automation allows HCPs to dedicate more time to building stronger relationships with their patients and providing more personalized care.
Imagine a doctor who can instantly access a patient’s complete medical history, including past treatments, allergies, and genetic predispositions. AI can then provide relevant clinical trial data and treatment recommendations, informing HCPs on how to make the best possible decisions for the patient.
Win 3: Payers—Improved Experiences and Lower Costs
Payers strive to manage costs while ensuring appropriate care. AI-driven solutions contribute to these goals by:
Lowering administrative costs: Automating processes like prior authorizations and claims processing significantly reduces administrative overhead, allowing payers to allocate resources more efficiently and potentially being able to offer lower premiums.
Better informed coverage decisions: AI analyzes data to identify high-risk patients and develop targeted interventions, potentially preventing costly complications. Payers can achieve significant cost savings in the long run through a proactive approach.
Improved overall experience: Payers can increase satisfaction and loyalty by streamlining access and offering personalized support, resulting in a stronger reputation within the healthcare market.
AI can analyze historical claims data to identify patients who may benefit from specific preventative-care programs. Leading to early detection and treatment of conditions, this approach may ultimately reduce the need for expensive interventions and improve patient health outcomes.
Win 4: Treatments Options—Improved Experiences and Increased Revenue
Pharmaceutical companies invest heavily in developing effective treatments. AI-driven patient-access solutions help ensure these treatments reach patients by:
Supporting patient needs: AI identifies and addresses the potential clinical, financial, and administrative challenges patients face in accessing medication and improving access and patient experience. Trust is strengthened through the relationship between patients and pharmaceutical companies.
Making more precise decisions: Data-driven insights help teams optimize marketing and outreach strategies, ensuring resources are allocated efficiently. They can now target the right patients with the right information at the right time.
Reducing prescription abandonment: By proactively addressing potential barriers, the number of prescriptions that go unfilled can be significantly reduced, improving patient care and revenue. Optimal treatments reach those who need them through a more sustainable business model for pharmaceutical companies.
For example, a pharmaceutical company can leverage AI to predict which patients risk abandoning their prescriptions due to financial constraints or the need for product education. Proactive intervention with appropriate affordability programs and the right information at the right time can help patients initiate and maintain appropriate treatment.
Conclusion: The Future of Healthcare Sustainability
The potential of AI-driven patient-access solutions is vast, offering benefits for all stakeholders in the healthcare ecosystem. Patients gain greater transparency and easier access to treatment, HCPs make better-informed decisions and reduce administrative burdens, payers improve member experience while achieving cost savings, and pharmaceutical companies better support patients’ needs while increasing revenue. By embracing this innovative approach, we can create a more sustainable healthcare system that prioritizes patient care and delivers positive outcomes for all. This approach benefits everyone, building positive relationships and eliminating the spin and complications that patients, healthcare providers, and insurers often face.
While these initiatives have been aspirational for years, it is now not only possible, but being put into practice. Combining AI and a cross-stakeholder understanding of the total healthcare ecosystem, we can solve these challenges using the technology and data that most companies already own. Reach out to learn how to reduce prescription abandonment and improve patient access to therapy.
Authors
Ellen Cappellino
Executive Director, Value Access, and Reimbursement
Ellen Cappellino has 25+ years in the biopharmaceutical industry, specializing in market access and product launches, notably in oncology and rare diseases. Her experience spans leadership roles at AstraZeneca, Vertex Pharmaceuticals, and Pfizer, and a foundational role as a research pharmacist at Wyeth Pharmaceuticals. Ellen, an alumnus of Albany College of Pharmacy and Health Sciences and New York University (MBA), now serves as Executive Director of Value, Access, and Reimbursement at Klick, focusing on optimizing therapy placement.
Ryan Slipakoff
Chief Transformation Officer
Ryan is Klick's Chief Transformation Officer, driving innovation, new product development, and accelerating and augmenting Klick’s digital transformation practice. Ryan is an executive partner and sponsor for our clients as they seek to accelerate their commercial maturity, create competitive advantage, and tackle healthcare’s most complex challenges. Ryan is a holistic customer experience expert, blending expertise across strategy, technology, digital, analytics, operations, and data into harmonized solutions and offerings.
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