Human Care Systems Overview

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BEHAVIOR SCIENCE EXPERIENCE DESIGN PROVEN RESULTS

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B O S T O N | L O N D O N | S A N F R A N C I S C O

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We Design, Develop and Deploy comprehensive support PROGRAMS for HCPs and Patients. Our programs are based in BEHAVIORAL SCIENCE and…

Add More VALUE To Product

Impact clinician decision making

De-risk the product

Impact patient self-management, adherence and QoL

Improve real world outcomes

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solution.This is Human Care Systems

deliver.change behaviors.

monitor & measure.

engage.

personalize.

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about.Locations & Experience

• Asthma• Back problems• Chronic Kidney Disease• COPD• Diabetes (T1 and T2)• Heart Failure• Hemophilia (A & B)• Hepatitis (B & C)• HIV• Kidney Transplant• Mood disorders• Multiple Sclerosis• Lupus• Oncology (CML, CLL, MBC,

MCL NSCLC, RCC & others)• Osteoporosis• Nephrotic Syndrome• Pain• Pneumonia• Pulmonary Hypertension• Rheumatology• Stroke

SAN FRANCISCO

BOSTON

LONDON FRANKFURT(Opening 2014)

TOKYO(via partnership)

SINGAPORE(Opening 2014)

SÃO PAOLO(via partnership)


process.The HCS System

Revenue Awareness Initiation Adherence Retention

Events Time and Trigger

identifiable inflection points relevant to

clinicians and patients

Barriers Learn, Gain Insight, Take

Action to impact clinician and patient

decisions and behaviors

Targets Inputs Results

We use an analytical system to design, deliver and measure high impact service and support to clinicians and patients.

Behavioral Science Application of literature and

experience on effective learning, decision-making

and behavior change.

Experience Design Integrated customer

experiences across channels (print, web, mobile,

salesforce, phone, etc.)

Outcomes Quality of Life, Health Outcomes Health Economics

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Map

Knowledge of stakeholder experience from understand phase

Priorities of brand team

Proposed rules-based customized solutions to address barriers and gaps to fulfill brands objectives and provide a comprehensive patient, provider, and payor solutions

Identified barriers and gaps extrapolated from the synthesized information in the understand phase

Utilizing the training in psych evaluation, research, and analysis and with the principles of social, cognitive, and behavior theories of human behavior as well as the transtheoretical model, biopsycho-socio-environmental theory, health belief model, and theory of planned behavior, the experience map is created in an iterative fashion.


Rules based customized solution

Treatment initiation

HCP prescribes Product X

Nurse Calls

Email or Mail

Text Reminders

1 2 3 4 5 6 7 8Product X Applications

Patient self-assessment

Rx

Barrier topics delivered in a multi-channel program based on patient endorsement and a pre-determined barrier ranking (developed from learning in the understand and map phases)

Treatment initiation

HCP prescribes Product X

Nurse Calls

Email or Mail

Text Reminders

1 2 3 4 5 6 7 8Product X Applications

Patient self-assessment

Rx

Barrier Assessment

Patient Identified Barriers


Return on Investment

DIABETES

12:1

RARE KIDNEY DISORDER

ORAL ONCOLYTIC

25:1 10:1• Reduced 6 month attrition

rate from 22% to 5%• Improved Market Share by

2 points• Improved adherence by 8

additional infusion sets per year

• Improved 6 month A1C by 24%

• 15 point Net Promoter Score Improvement

• Initiation rates have increased from 70% to 85% after implementation of this program

• Discontinuation rates have dropped from 40% to 15%.

• 90% of eligible countries have implemented program

• Measured adherence improvements have ranged from 10%-38% across countries


Our Clients Include…

http://www.shire.com/shireplc/


Clinical Health Psychologists

Experience Designers

SoftwarePlatform

Multi-ChannelDelivery Field Clinicians

• Trained in Clinical Psychology with subspecialty in Health Psychology

• Health Psychology is the application of behavioral science to medical health management

• Information Architects and User Experience Experts (IA/UX)

• Print and interactive designers

• Software architects and developers

• Salesforce.com administrators

• Nurse phone coaches

• Web• Mobile• Text• Email• Mail house

• Trained and Certified

• Provide in person training (i.e. home infusions, product management, etc.)

Management:• Business unit and geographic leadership

• Company leadership• Guide Medical Regulation Review

about.Team Expertise

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solution.This is Human Care Systems

We design, develop, and deploy service & support solutions to modify behavior and drive higher rates of adherence, improved health outcomes, and increased patient and HCP satisfaction. The HCS system is based on the following pillars: Behavioral science. HCS’ team of health psychologists use behavioral science to deliver programming to change adherence, patient/clinician

communications, and other self-managing and self-monitoring behaviors.o Deep and actionable understanding of patient pain points based on existing knowledge and research + systematic literature review +

ethnographic research.o Most effective programming to change behaviors:

High impact education to support learning. Cognitive behavioral exercises to change relationships between thoughts, feelings and actions. Motivational interviewing techniques to build self-efficacy and motivation.

Personalized, high-impact experiences. HCS’ technology platform personalizes program content and timing to individual patient’s events and

barriers as well as evolving over time as patient progresses through therapy.o The HCS platform combines a personalization rules engine + CRM database + interfaces to deliver personalized and integrated programs

through multiple channels. o Multichannel solutions, that feel to the patient like a coherent and personalized experience, are the most effective way to reach and

impact patient behaviors.

Change, measure and communicate outcomes. HCS’ measurement, analysis and publishing support capabilities ensure that the results of the support program are best captured and communicated.o Measured impact on Trx (brand choice + initiation + adherence).o Real world outcomes.o Studies and publishing.

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How We Work

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v v

Approach

Define Current Experience Map

Map Ideal Experience

Build & Deliver Solution

• All stakeholders• Existing research and

knowledge• Patient and Clinician &

Patient Ethnography• Literature review• Netnography• Mine data sets• Barriers & Events

• Specific to the needs of each stakeholder

• Personalized experiences for each patient

• Integrated and coherent across multiple channels

• Customize experience for each population and indication

• Deliver integrated support across multiple channels

• Change patient and clinician behaviors

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HCS Solution Framework

Events Barriers Triggers

•Logistic •Social•Physical and Cognitive •Emotional•Attitudinal/Cultural•Side effects•Provider •Health Literacy•Regimen requirements•Financial

Key milestones that occur along a timeline such as:•Symptom Onset•Diagnosis•Decision to Treat•Onset of Side Effects•Symptom Improvement•Treatment Fatigue

Things that happen that may foreshadow non adherence or discontinuation:•Severity of side effects•Financial event•Health or Personal Crisis•Missed or Delayed Refill•Patient Feels Lack of Progress•Patient Feels They Are Doing Better

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• To HCP about their patients• To reps about enrollment• To patients about adherence• To the client and HCS about the program

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Level of Support Infrastructure Complexity of Treatment

Feedback

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Design All Touchpoints vs. Events & Barriers

Event Focused Barrier Focused

Time Based• Mailing, e-mail, SMS, Phone

calls at time based inflection points.

• E.g. educate on week 4 test results.

Trigger Based• Use passive data collection

techniques, questionnaires, and HCP inputs to trigger communications.

• E.g. congratulations phone call when glucose targets reached on connected meter.

Learn• Bite-sized, personally relevant education tailored to

learning style.

Gain Insight • Cognitive-behavioral exercises to help people understand

and take control of thoughts, feelings and actions.

Take Actions • Guided experiences to build and sustain motivation, self-

confidence and resilience.

Get Feedback• Help patients & HCPs monitor progress towards goals. Help

patients gain insight from remote monitored data when available.

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Creating a Whole Experience

Goal: Design and deploy integrated individual touchpoints to deliver a coordinated, high-value experience to all treatment stakeholders

Comprehensive, differentiated

solution

Cohesive and High-Impact Experience for Patient, Clinician, Caregiver, Office Staff

Individual Brand Tactics

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Solution Architecture

Tools & Support

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results.Case Study: Biologic Adherence for Rare Kidney Condition

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Key Barriers / Unmet needs Surrounding Taking Treatment: • Injecting with Disability• Education on Condition• Building Treatment Routines• Financial Concerns• Side Effects• Disability and Emotional Concerns

results.Case Study (Biologic Adherence for Rare Kidney Condition): Challenge & Situation

Challenge:• Low initiation and completion rates during the 6 month course of therapy: 70%• Discontinuation Rate: 40%• Overcome treatment barriers in a rare kidney condition including injection fears, confusion, questioning value of

treatment, side effects, and psycho-social concerns.

Ongoing treatment1st injectionCan I afford it?Pre-RxEvents

Barriers• Poor health

from primary diagnoses

• Lack of knowledge

• Cost• Why me?• Lack of urgency• Side effects• Confused about process

• Difficult regimen• Side effects• Needle anxiety

• Cost• Side effects• Treatment fatigue• Uncertain of benefits vs. costs

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Ongoing treatment1st injectionCan I afford it?Pre-RxPatientJourney

Tactics

HCP

DTP

Enrollment brochure

Nurse linePSK

ASAP

ASAP

Topic-specific mailings: initiation and adherence support

Printed materials Electronic Phone LogisticsKey:

Interactive website: initiation and adherence support

Schedule callsAssess readiness

Initial injection support

Trouble-shooting follow up.

Overcoming barriers to adherence

Building a support network

Planning to complete treatment

Lifelong health management habits

Messaging

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Touchpoints


The Nurse Coach provides human, personalized support to patients.• Leads them through the Barrier Assessment, a

survey tool that identifies key obstacles to initiating and continuing Acthar

• Provides tailored support and guided steps to help each patient overcome his/her barriers

• Monitors the progress of each patient and provides appropriate help:

– information/resources– emotional support

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Customized Nurse Phone Interactions


Print MaterialsNurse coach mails patients targeted print materials that supplement their discussions by providing additional information for patients to refer to in between coaching calls.

Print materials:• Focus on specific barriers• Offer practical advice• Invite engagement

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Customized Print Materials


Interactive Web Portal provides a private space for patients to overcome their barriers at their leisure. Features:

• Educational information about the kidneys and proteinuria

• Interactive activities that help patients cope with taking and living with Acthar

• Guided tools that help patients develop specific plans for staying adherent

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: Digital Support


Tear SheetsPocket Guide

HCP Skills Training

• Virtual/Print Tool training

• Listening like a detective

• Identifying nonadherence

• Giving effective direction

• Responding to emotional patients

• Motivational interviewing

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Solution: HCP Training & Tools


Schedule callsAssess readiness

Initial injection support

Trouble-shooting follow up

Overcoming barriers to adherence

Assess final status & discuss next steps

Building a support network

Planning to complete treatment

Lifelong health management habits

RESULTS: 10:1 Return on Investment Initiation rates have increased from 70% to 85% after implementation of this program Discontinuation rates have dropped from 40% to 15%. 100% of patients enrolled in program are injecting on schedule.

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results.Case Study (Biologic Adherence for Rare Kidney Condition): Output and Results

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results.Case Study: Insulin Pump and CGM Adherence

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Decide to Pursue Pump

• Reimbursement• Psychosocial

issues

Order and Shipment

• Big box of supplies can be overwhelming

Training

• Lack of knowledge

• Information Overload

• Hypoglycemic events, adjusting to wearing pump

Start Pump

• Carb counting• Insulin rare

adjustments

Infusion Set Change

• Difficulty with supply orders or Billing

• Fragmented support

See Progress

• Think no longer need treatment

Pump Problem

• Frustration

Achieve Goal

• To feel healthy, have better focus, more energy (through better glycemic control)

• More freedom in their schedule (eating, sleeping)

• Fewer hypos• Prevent

complications

Events

Barriers

results.Case Study (Insulin Pump and CGM Adherence): Challenge & Insights

Challenge:• Pump users experience many barriers, particularly in the first 90 days.• 22% of pump users quit within 6 months/ 65% CGM• Poor adherence

Key Needs based off of Insights:• Less fragmentation• Small actionable bits of information• More connection to patient’s purpose for using pump• Proactive support 28


results.Case Study (Insulin Pump and CGM Adherence): Touchpoints

Pre Start Post Start

Field Clinician

Phone Coach

Ship

Orientation Call (N)

+7D +30D

In PersonTraining

+24H +3D +6D +14D +30D +60D +90D +120D +180D

CareLink Data

HL Calls Assessments

AdvancedClasses Available

Pre TrainingCall (N) Attrition Risk

Score

CareLinkReview

Transition of Care Document

MO

NIT

OR CELEBRATE

Monitoring Software

StartRight Patient Support Program


results.Case Study (Insulin Pump and CGM Adherence): Solution: Multichannel Support

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Decide to pursue pump

Pump and training materials arrive

Receive training and start pump 1st infusion set

changeAdjustment

period

INSULIN PUMP RESULTS

Reduced 6 month attrition rate for insulin pump from 22% to 5%

Improved Market Share by 2 ppts

Improved adherence by 8 additional infusion sets per year

Improved 6 month A1C by 24%

15 point Net Promoter Score Improvement

CGM RESULTS Reduced 6

month attrition

rate for insulin

pump from 61%

to 23% Improved

adherence by

20 additional

sensors per

year

results.Case Study (Insulin Pump and CGM Adherence): Output and Results

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BEHAVIOR SCIENCE EXPERIENCE DESIGN PROVEN RESULTS

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Human Care Systems Overview

Health & Medicine