From next best action to the next era in patient services: A Q&A with patient experts

Every pharma company considers it core to their mission to improve patient lives. Yet when we look across the industry, there is still so much emphasis on engaging healthcare providers (HCPs) first, making patient engagement an afterthought. What’s needed for pharma to expand its course and empower the people who need their therapies most?

We’re seeing a convergence of change now that could be the momentum pharma leaders need to achieve their vision for patient engagement. From AI-powered personalization to regulatory changes to healthcare barriers to competition for differentiation—these factors all point to the need to empower patients directly, not just as a strategic advantage, but as a business imperative.

ZS experts Asheesh Shukla, Tanya Shepley, Karthik Sourirajan and Arvind Kumar explore why this is the moment to overcome mindset and business barriers to achieve the potential of patient services at scale—starting with an understanding of patient power, grounded in empathy and humanity.

ZS: You’ve pointed out that the life sciences industry has been chasing the opportunity in patient engagement for 30 years. What's changed now that makes engaging with patients so critical for pharma companies?

Tanya Shepley: Engaging with patients has always been critical, but the opportunities and channels through which the industry can now do that have continued to evolve. We find ourselves on a new horizon with the ability to create more meaningful and direct connections with patients.

Asheesh Shukla: The classic pharma commercial model is influencing physicians to change their prescription writing behavior. It’s still effective, but it’s plateauing in terms of the yield it produces. It needs to be contextualized to include insights on the patients those physicians treat and complemented by patient clinical care models.

Karthik Sourirajan: Building on this, pharma has been focusing on healthcare provider (HCP) engagement for the last 10 years or so, applying techniques like next best action. But if every company is doing the same thing, then nobody is differentiated, right? And pharma markets are super-crowded, which means that products from a clinical perspective are becoming a lot more nuanced. That means you need to differentiate your products beyond just clinical factors. Patient engagement is the way to differentiate—it is a way to put the patient at the center, to build on growing patient power and to win in the market.

ZS: Karthik, could you say a little bit more about how reaching patients can help change the differentiation game for pharma companies?

KS: Let’s take the psoriasis market as an example. Efficacy is very similar across therapies—resulting in 95%, 91% and 97% skin clearance. They are all reasonably tolerable and patient access is roughly similar as well. So, what's the difference? It shows up at an individual patient level. Is my onboarding, fulfillment and adherence process smooth? How am I supported throughout my therapy onboarding and adherence journey? Preventing drop-offs once the prescription is filled is extremely valuable. I’ve heard from pharma executives that the value of keeping one patient on a therapy is the equivalent of getting three new patients on a therapy.

ZS: When we talk about patient power, what does that look like today?

TS: Patients are now willing and able to directly determine their healthcare choices more than ever. We’ve seen a lot of progress there, especially in some of the large direct-to-consumer platforms that have launched around obesity treatment, for example. If we look at oncology today, 50% of cancer patients sought a second opinion before their treatment, and among that 50%, 35% ultimately selected a different oncologist based on that second opinion. We’re going to see more and more of the individual’s power to directly affect their healthcare choices across therapy areas. As their desire to make personal choices increases, there are still a ton of built-in systemic barriers preventing patients from accessing certain therapies.

We’re seeing more of a shift in our conversations with industry leaders to, “How do we remove these points of friction? How can life sciences companies intervene and provide more support?” That’s also what we see in the research that we’ve done. Physicians are looking for partnerships with life sciences organizations to remove administrative burdens.

ZS: How do we overcome barriers and burdens for patients? And how does that relate to overcoming barriers for healthcare providers, as well?

TS: Those administrative burdens actually exist for both patients and providers. From a healthcare providers’ perspective, addressing prior authorization benefits verification takes about two business days’ worth of work for the office staff for a week’s worth of patients. More than 80% of physicians rate that as an extreme burden for their practice. That’s just one area where we can start removing burdens. We are working with multiple pharma companies to predict areas of lag and to identify how we can intervene.

ZS: How do empathy and context play a role in removing those barriers?

TS: The time delay that some individuals experience when trying to get on a treatment can have a really negative effect. When we were doing research with individuals on this topic, one of the quotes that stuck with me is that people feel like they’re quarterbacking their own care. Being able to meet people where they are to set their expectations, help them understand the steps in the process and where the points of delay are—that’s as beneficial to helping patients get their treatment as it is to keeping them on that treatment. Karthik made some really good points about the value of keeping patients on therapy: We see a high number of people dropping off even before they get the treatment in their hands.

ZS: Karthik, how can pharma overcome the roadblocks that have been preventing the industry from delivering optimal patient experiences?

KS: Every pharma company has a mission to help improve patient lives. But the way they’ve been doing this is by focusing on engaging the physician to reach the patient. And when it comes to the patient, they have taken a bit of an average approach to direct-to-consumer activities or patient services that’s calendar-based engagement.

Now is the time for pharma to commit to changing that mindset and put the patient at the center. In this new era, pharma will commit to truly understanding the individual patient’s needs and the barriers they face as they go through their diagnosis and therapy journey. Whether it’s directly through personal touches like patient services or through field reps, digital channels, direct-to-consumer (DTC) ads or other approaches, how will they bring the entire ecosystem together with the patient at the center instead of the physician at the center?

This starts with a focus on capabilities across the end-to-end patient engagement ecosystem: How do pharma companies think about data, technology and AI coming together to actually bring this vision to life? It’s important to not over-index on just one part of the capability—just because AI is the buzz, let’s not over-index on AI. You need AI to uncover individual patient needs, but you also need last-mile technology to bridge the pull-through gaps and address the needs of individual patients.

ZS: What are other ways that pharma can overcome these barriers to better support patients?

AS: The industry doesn’t talk about it much, but this is an important counterintuitive example. There are going to be cases where certain patient segments will not respond to a therapy and yet pharma companies will still spend energy to target these segments. One way patient engagement helps here is that you actually find, using clinical data and real-world data, the patients who will benefit from your therapy instead of focusing on the patients who will not respond.

TS: We need to focus on the social drivers of health to understand the needs of the patient segment beyond whether they are commercially insured or government insured. Informing initiatives with social drivers of health can help pharma meet patients where they are by helping them find their connections to care and thinking about them from a whole-patient perspective.

AK: Different stakeholders come together within pharma organizations to serve that one patient. These stakeholders do not always have the right set of information because they’re working on different technology, and they do not have the right datasets. Can we bring all the stakeholders together on connected technology to make a meaningful impact for the patient? A modular, connected platform can change this by orchestrating processes across disparate technologies, integrating data and creating shared visibility. By connecting stakeholders on a single foundation, this kind of platform empowers proactive engagement, streamlines workflows and ensures that every role—from the HCP to the access team—has the right insights at the right time to make a meaningful impact for the patient.

ZS: What are some of the ways that we’re helping companies achieve faster value from their investments in patient services?

AS: We start with three things. One, we help pharma companies design their patient engagement programs to focus on becoming more efficient and optimizing their spend while enhancing the patient’s experience. Two, we enhance pharma’s existing programs. We make these programs more precise by directing them to the events that matter the most, the moments that matter the most and the patients who matter the most. Through our patient drop-off risk stratification work, we help predict what events may ultimately result in patients being noncompliant, either because they haven’t started therapy or they’ve stopped it. Third, we bring in platforms and technology that will establish and sustain a nonlinear cost-of-serving model, which historically has been very human-driven.

TS: Historically, pharma’s solution to building patient programs has been to hire more people. Today, you can't just add more headcount. You must be able to scale patient programs through technology and other methods that extend what people can do.

ZS: What are some examples you’ve seen of pharma companies driving value through their patient services today?

TS: Top of mind in the industry is AbbVie and its immunology portfolio, particularly because the organization took the added step of sharing the outcomes for its patient support on its patient engagement. Not only did AbbVie share the impact of helping patients stay on therapy to get better outcomes, but also the overall healthcare cost reductions those patients experienced for other comorbidities or related healthcare. We are seeing other organizations achieving similar impact with patients as they build their maturity level in this space.

KS: Another example is from a medium biotech company that saw plateauing impact with HCP engagement, even with strong AI and tech capabilities. In response to market changes and competition, the company prioritized investing in patient engagement to improve fulfillment and retention. It took the approach of, “We have insourced patient services and we have a lot of data about individual patients, in addition to data about their HCPs and their payers. How do we create much sharper intelligence about our patients?”

Focusing on their fulfillment and adherence challenges, they built an AI-driven approach to better identify the nonclinical barriers patients are dealing with that the company can actually remove via tailored interventions. The model identified which patients were at risk of drop-off and what the individual patient level barriers were. The company then created tailored interventions for each barrier, spanning tactics across different functions—patient services, field and marketing.

The pharma company started to see that identifying individual patients at risk of drop-off and removing their key nonclinical barriers increased their fulfillment and adherence rates. It began these interventions within a larger specialty market. Based on the success the company saw there, it expanded this program to rare disease where there were just a few hundred or thousand patients—and the program started working there, as well. The key was using an AI-forward approach while considering the end-to-end view so they could demonstrate business impact. This idea was not about measuring field or patient services effectiveness; it was about creating better experiences for patients that improved fulfillment and adherence.

AS: One other solution that’s worth mentioning is not prevalent yet across the industry but is relevant to certain therapy areas. That’s the direct-to-patient version of patient services. Both Lilly and Novo Nordisk are demonstrating most of the growth they’re seeing in their obesity franchise today because their direct-to-patient segment is growing their patient population. These nontraditional patient services are complemented by very strong demand generation, telemedicine, fulfillment and distribution through network and post-fulfillment services. And we are seeing this approach drive significant value in the marketplace. These types of solutions could become more prevalent if we see a direct-to-consumer advertising ban in the U.S. Pharma companies will have to explore other opportunities to reach patients.

ZS: How do we help pharma deliver personalized services to patients at the right time in their journey and at scale? This ties in with the technology we’ve been discussing, as well as how critical the timing is to catch people before they drop off.

AS: First, context matters. This relates to the timing and the empathy part of where the patient is in their treatment journey. And second, the nature of intervention matters, as well as who intervenes. Using this perspective, we reconstruct the patient’s treatment journey in real life with as little lag as possible by mining third-party data and other publicly available information. We also mine any curated datasets that pharma might have invested in learning about those patient journeys and complement this with our understanding of behavioral data. Combining this with our understanding of the treatment journey to manage the condition allows us to build real-time simulations of the journeys and the right interventions in a compliant way. We map these appropriate interventions with the right content and delivery channel. And we connect all of this through a combination of technology, whether it’s AI or Salesforce or custom-designed patient engagement solutions with patient consent and preference built in.

AK: By empowering case managers with modern digital tools, integrated datasets and proactive insights, we enable them to engage patients before they drop off therapy. With the right intelligence embedded into their workflows, case managers can focus on high-touch patients who need them most, driving more effective and timely interventions.

TS: That’s an important point. Technology in this space isn’t about replacing the human element—it’s about creating not only more meaningful touch points but granting you the ability to scale as your patient population grows. How do we become more efficient in each engagement while still delivering the right level of care? We need to get to the patient’s lived journey through data and intervene at the right touch point. And we need to prioritize that intervention for the patient and then empower the case manager, the field reimbursement manager or the nurse navigator to bring that human connection to the patient.

ZS: Last question: What needs to change now to truly transform patient engagement? How can we jump-start this process?

AS: What fundamentally has to change is pharma leaders at the CEO, GM and franchise level must realize that their product portfolio depends on not only engaging the HCP community, but also their ability to engage patients in a meaningful way.

What we are doing to jump-start that thinking is demonstrating how pharma’s commercial model is getting the HCP to put pen on paper to write the script, but many of those patients are still not getting on the therapy. If you don’t have a care-centric or case-centric model, you’re going to see top-line impact on your business.

We talk a lot about patient power based on what’s happening with care delivery, second opinions and other options. But patient power is also the patient asking for specific products, having a significant influence on the HCP who is writing the prescription for those products.

The strategic initiative for pharma leaders is to truly understand that patient engagement is not only a top-line agenda for them but also a sustainable agenda. They need to combine that understanding with confidence in these capabilities—a lack of confidence is what has stopped them historically from pursuing this as an agenda. Pharma leaders can meaningfully align this to their brand strategy as they’re thinking about brand planning or launching a product in the marketplace. Their end-to-end patient offerings—the experience, the intelligence we just talked about and more—will become integral to the launch and success of the product.

KS: Pharma companies can start small. Every single successful transition we have seen so far where the companies are now best-in-class started with small-in-class, if you will. Let’s solve one problem and continually build upon that. I believe that AI is the first and the easiest big jump with the data that you have and can become the motivation to take on the rest.

When HCP next best action came into place, it took about six, seven years for people to get on the bandwagon. Can we learn from this to say, “If I build out my AI-forward approach to patient engagement sooner, I can realize value sooner.” And the value is 20% to 30% reduction in leakage in fulfillment and retention, depending on the therapy area that we are talking about. The business urgency is there. Are you going to be the late adopter or are you going to take the leap of faith?

TS: The differentiation between products and what’s coming to market is very small and more plentiful in those products when we look across pipelines. That’s the reason to not sit on your heels and really take advantage of creating competitive differentiation in patient engagement and patient services now.