Personalized Medication Guidance: Tech-enabled, Human-led

WithMe Team

We’ve been hearing the volume of the chorus growing louder: pharmacists should operate at the top of their license. And to that chorus, we add our voice! We’d suggest pharmacy technicians get included in the refrain too.

But that’s easier said than done, especially with all the demand placed on pharmacists to drive throughput in retail settings. The same is true for those running traditional utilization management programs at Big PBMs -- it’s a volume game, one that’s not well-suited for forming trusted relationships nor making lasting change in a member’s health.

We know this to be the case because the pharmacists and pharmacy technicians who form our Medication Guide team make it clear why they left those settings to join the mission here at WithMe Health: they couldn’t deliver the patient care and experience that called them to their profession in the first place.

Given ample space to engage with patients in the ways our members often need, WithMe Health’s Medication Guides are putting the human back into the healthcare experience, one proactive outreach at a time. In fact, approximately 85% of the calls they make are outbound to members. It’s a customer support model flipped on its head, because it goes far beyond standard member support -- it’s high-touch, high-tech navigation experience that has been lacking in pharmacy. Until now.

And it’s why strategic partners like Castlight, a leading healthcare navigator, have brought WithMe Health into their ecosystem to close the experience gap for members.

We interviewed two of our Medication Guides, Nichole and Sami, to hear their firsthand perspectives on helping members navigate their medication journey and how WithMe’s technology makes the navigation easier for both them and the members they support.

Nichole: Understanding members’ motivations to break down barriers

WithMe Health’s Medication Guides work hard to understand and remove barriers that hinder the positive outcomes of today’s remarkable medicines. Each Guide reaches out to dozens of members every day after the WithMe Health analytics engine, driven by its comprehensive clinical and cost savings ruleset, has identified a member as potentially needing increased support.

Goals of the outreach conversations might focus on helping members access a certain medication, seek saving opportunities, or simply encourage adherence.

After forming an initial relationship with the member, “Sometimes we just call them up to make sure everything is going okay,” says Nichole Twarozek, Senior Medication Guide and Quality Analyst Lead.

“We might find they’re taking a medication that is high cost, and we let them know that less expensive options exist. Such a switch saves both them and their employer money,” Nichole says.

Nichole recalls a patient who was having difficulty getting a high-cost specialty medication. The patient kept running out of the medication and was late picking up new prescriptions.

“We got them switched over to 90-day supplies, which ensured they always had medication on hand,” she explains. “We also got them set up with a manufacturer copay assistance card, so it was more affordable for the 90 days as well.”

Frequently, she finds that many people aren’t aware of therapeutic alternatives, which are medications that are equally effective as a current medication but less costly. She points out, “Since we’re able to educate them on their options, they’re usually quite interested,” she notes of members’ openness to alternatives.

“The main thing is I want to understand their feelings, and where they’re coming from, and what they are truly looking to achieve,” Nichole says of the outreach efforts. “We always do a follow up call afterwards, to make sure they understood everything we talked about and whether there’s anything further we can do for them.

Sami: We’re different because we truly care

Samantha “Sami” Henderson’s days center around member care and support. And like her fellow Guides, she wakes up to a set of ‘tasks’ in the WithMe Health Guide App--the purpose-built operational CRM platform--for her to tackle with members who have been flagged in our system as having a clinical improvement and/or cost savings opportunity.

Many of her outbound calls, she says, are focused on adherence, making sure members are taking their medications. When she places a call, she introduces herself and quickly describes why she is calling. “I don't want them to feel like it’s like a telemarketer call,” she says. “I want them to feel comfortable talking with me.”

After laying the groundwork for a trusted dialogue, she might start inquiring about the patient’s medication usage, asking questions such as are they having any side effects? Do they have any concerns or any difficulties getting their medication?

“We’re getting to learn a little bit more about them and what their day to day looks like with their medication,” Sami says, adding that for the most part, people are receptive and don’t mind sharing that information when they know WithMe’s Guides are ‘on their side.’

After establishing rapport, she then helps them get access to WithMe’s mobile app. Oftentimes, if they haven’t already done so, members will quickly download the app while still on the phone with Guides, so the Guide can send them resources through the app’s chat feature, the history of which is stored for both Guides and members as a later point of reference.

She also notes that most people don’t expect their insurance company to call and follow up. “I feel like that’s where we are different. We truly care about our members. We want to save our members money. We want to make sure that they’re healthy. We are patient-focused and we do whatever we can to help.”

One plan sponsor happened to be on the receiving end of one of those calls recently as the patient herself. To paraphrase her, ‘I can’t believe you’re actually calling me and our employees. You’re actually doing what you said you would do.’

It’s this level of service that we aspire to and hold ourselves to. If that means our members are actually taken aback by this proactive guidance model, then we’re happy to be the ones to (pleasantly) surprise them.