CareMetx
Building a Better Access System... One Patient at a Time

The proliferation of specialty medicines that treat complex, long-term diseases has fueled the growth of the patient access industry. Due to the cost of these medicines, access can be daunting, with numerous pre-treatment administrative hurdles that can include a benefits investigation, prior authorization and enrollment into manufacturer-sponsored copay or patient assistance programs. For patients, the delays caused by these hurdles can have a significant impact on their health or even allow their disease to further progress.

Patient access organizations,commonly referred to as “Hubs”, since they provide a centralized resource to coordinate the patient onboarding process, have been helping patients overcome the barriers to treatment.

CareMetx, a Bethesda, MD-based company, was founded by a team of patient advocates in 2011 to accelerate the time to therapy by overcoming the manual and time-consuming legacy technologies like telephones and fax machines that linger on as core operational features in the healthcare industry. For manufacturers, the legacy, manual processes increase the cost burden to provide access solutions.

In the face of these challenges, it has become imperative for hubs to migrate from analog systems to various e-service transactions capable of automating large portions of the patient onboarding process.

Leveraging Technology to Improve Outcomes

“We made a strategic decision several years ago to fully embrace the challenge to automate a material portion of our operational offerings,” says Mark Hansan, President and CEO of CareMetx. “As a result, we are in front of the pack for the race to provide manufacturers with a superior set of access solutions that use technology and real-time connectivity to reduce access frictions and enable a superior patient onboarding experience.”

CareMetx has automated the entire front-end process of traditional hub services with a robust suite of e-service transactions, including e-consent, medical benefit verification (MedeBV), prescription drug benefit verification (RxeBV), electronic prior authorizations (e-PA), electronic copay enrollment (e-Copay), and many others. In addition, observing the proliferation of Salesforce as the dominant CRM for manufacturers, the company can also deliver its transactions as turn-key Salesforce apps. This allows manufacturers to seamlessly place CareMetx technology directly into call centers or provider portals that are built in Salesforce communities.

Despite the company’s success in changing the traditional approach of hub services, CareMetx understands that automation has its limits. “The industry isn’t ready for full automation, but each patient deserves the highest level of support. So, in instances where technology hits a roadblock, we have embedded intelligent "Off- Ramps" into our solutions that can get the patient to a designated team for completion of the service,” said Hansan. “After our team completes their work, results are digitally returned to the requestor’s native technology whether an EMR or Portal to ensure a closed-loop fully digital experience. We are moving towards eliminating the phone and fax in the process." says Hansan.

Making It Easy for the Provider to Access Your Brand

Having such a unique approach, CareMetx has set the goal of building the hub of the future (HOF).

Given the advent of e-services, real-time data connectivity and the proliferation of new therapies, manufacturers are seeking innovative access partners who can consistently deliver superior outcomes for patients

In the HOF model, traditional Hub services are ushered out of the call center and placed directly into the provider’s native technologies, taking the form of digital, on-demand transactions embedded in the provider’s EMR. Currently, in a pilot project with a leading EMR company, CareMetx has embedded its e-service transactions directly into the EMR workflow. This empowers doctors to process an electronic BV and ePA while rendering their day-to-day activities within the EMR.

Preparing for Age of Durable Therapies

Not stopping here, CareMetx is focusing on creating a new access model for therapies, derived from emerging breakthroughs in cell and gene treatments. “These ultra-high-cost treatments cannot be shoehorned into conforming to the current access model,” says Hansan.“In 2019, we launched a new division called OutcomeRx, to help patients navigate the unique challenges of these medicines.” Hansan continued, “patients can’t afford a 20% copay on a million dollar treatment. We had to develop innovative patient management services, proprietary technology, new pay-for-performance contracts and even customized financial products to help ensure access to these miracle, life-saving treatments.”

“We are proud to be bringing manufacturers and payers together to help reinvent the patient access industry for both specialty products and now cell and gene therapy,” says Hansan. “We are at the very forefront of creating new models with our e-enabled Hub, our Hub of the Future and our OutcomeRx capabilities. I am proud of the progress we have made but know there are still too many barriers for patients in need of access to treatments".

“I like to say that we won’t stop until a patient can get access to a drug with “a push of a button”. It will take all of us including payers and manufacturers, to make this happen. By working together, we can ensure the future healthcare system puts the patient first and delivers the care we all deserve.