Patient-centricity

The foundation of building a sustainable healthcare access ecosystem in Southeast Asia

Southeast Asia’s healthcare access ecosystem is now at a critical juncture. To improve access for the long term, Joseph shares why healthcare stakeholders in the public and private sectors must enhance sustainability around the key aspects of finance, treatment and health systems.

Joseph Saba, Co-founder and Chief Executive Officer, Axios International

Southeast Asia’s healthcare landscape has irrevocably changed. Due to the demographic shifts the region has been experiencing – such as ageing populations1 and the rise in non-communicable diseases (NCDs)2 – governments and healthcare

1 https://www.who.int/southeastasia/health-topics/ageing 2 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7371561/ stakeholders must now reassess3 healthcare expenditure and reforms to not only improve health ecosystems in terms of equitable access, but also sustainability.

However, a major challenge to these is that the healthcare ecosystem has not evolved in tandem with broader socio-

3 https://www.adb.org/sites/default/files/publication/684701/adbi-wp1220.pdf economic development4, especially in Southeast Asia’s emerging markets. This challenge was exacerbated further due to COVID-19, which spotlighted the gaps5 within the region’s healthcare access ecosystem.

4 https://iigh.unu.edu/publications/articles/health-andhealthcare-systems-in-southeast-asia.html 5 https://www.brookings.edu/blog/order-from-chaos/2021/01/14/covid-19-in-southeast-asia-regional-pandemic-preparedness-matters/

Southeast Asia’s healthcare access ecosystem is now at a critical juncture. To improve access for the long term, healthcare stakeholders – both in the public and private sectors – must focus on enhancing sustainability around the key aspects of finance, treatment and health systems. Achieving this requires placing patient-centricity at the core, namely by striving to achieve better health outcomes for them.

Supporting patient involvement at every step

Generating better outcomes for patients requires supporting them throughout their treatment journey – even at the very beginning. This can be done by ensuring that access needs to be a core component of every pharmaceutical company’s overall strategy. It is a crucial step before implementing any access solution; it must be considered during the planning process and not just as an afterthought.

Providers need to deploy more patient-centric approaches that involve patients throughout their healthcare journey. This can be done by ensuring those solutions are specifically tailored to them and consider them as individuals, as access is being redefined from a short-term, one-off strategy to a long-term solution.

To do so, patient-based solutions must focus on the entire patient journey, starting with access to diagnosis. Before being able to access6 treatment, many patients face a long process to get referred to the right specialist, get misdiagnosed or cannot afford the diagnostic tests – especially for rare diseases. Improving diagnosis access thus requires disease awareness and physician capacity building, in addition to giving patients more financial support to access diagnostic testing.

6 https://www.who.int/southeastasia/news/detail/0409-2018-countries-in-who-south-east-asia-regionresolve-to-make-essential-medical-products-accessibleaffordable-to-all

Additionally, solutions must also consider treatment affordability. Many people in Southeast Asia are particularly vulnerable in terms of healthcare financing7 and governments have been working on health financing reforms8 to reduce dependence on out-of-pocket payments. As much as these efforts are important and significant, they are not sufficient to cater for all health care needs. The private sector can play a supportive role here via cost-sharing programmes9 and tools that measure patients’ financial capabilities10 to help determine how much monetary assistance patients need to follow through on their treatment in the long term.

Healthcare ecosystem stakeholders can also offer services to support patients throughout their treatment journey to ensure patients receive the full course of treatment and maximise treatment benefits. This is as non-adherence rates are rising across the region, even in more mature markets like Singapore11 and Malaysia12. If left unchecked, the long-term effectiveness of treatments would be compromised and may critically affect a population’s overall quality of life. Better health outcomes for patients can be achieved by making adherence interventions more effective, as studies13 note that doing so can potentially generate more impact on a patient’s health – more so than making improvements in specific treatments. This is as medical advances would inevitably face obstacles in fulfilling their potential

7 https://www.who.int/southeastasia/health-topics/healthfinancing 8 https://www.researchgate.net/publication/49787717_ Health-financing_Reforms_in_Southeast_Asia_Challenges_in_Achieving_Universal_Coverage 9 https://axiosint.com/accessinthailand 10 https://www.liebertpub.com/doi/abs/10.1089/ pop.2012.0049?journalCode=pop& 11 https://journals.sagepub.com/doi/ full/10.1177/2010105820933305 12 https://www.researchgate.net/publication/332804991_ Interventions_on_Improving_Medication_Adherence_in_ Malaysia_A_Mini_Review 13 https://pubmed.ncbi.nlm.nih.gov/12076376/ to reduce illness burdens, especially for chronic cases, if a system that addresses adherence determinants does not exist. Essentially, treating diseases successfully requires doing more than just improving access to medications. This is why interventions are essential. A multi-sectoral approach will help improve medical outcomes by making it easy for patients to track and manage their treatment via Patient Support Programs (PSPs).

Another focal point is ensuring robust compliance with access initiatives. Unsafe medical care contributes to poor patient outcomes, a challenge that is especially pertinent in emerging markets14 within Southeast Asia. Patient access programmes must go beyond being just well-designed. Program management must fully comply with the region’s best practices in standard operating procedures (SOPs), data security conformity with General Data Protection Regulation (GDPR) and local data privacy policies in each country, patient consent, and pharmacovigilance15 .

Going digital to support access initiatives of burdened healthcare institutions

Existing healthcare infrastructures, particularly hospitals, are now being stretched to their limits. Simultaneously, populations are growing and healthcare demands are rising – pressure points growing even before COVID-19, which has further exacerbated this dire situation16 . Hence, the proliferation of digital tools and solutions outside of hospitals (namely, those that can complement existing services) must be raised.

Today, digital healthcare solutions are being promoted in advanced

14 https://academic.oup.com/intqhc/article/27/4/240/2357347 15 https://www.who.int/teams/regulation-prequalification/ regulation-and-safety/pharmacovigilance 16 https://www.internationalaffairs.org.au/australianoutlook/southeast-asias-responses-to-the-covid-19-pandemic/

markets like Singapore17 and even in more emerging economies, such as Thailand18, which uses more advanced technologies such as 5G to improve telehealth services. More can be done to stimulate similar advancements but promoting the use of digital tools that can enable effective out-of-hospital services must also be taken on by private sector healthcare ecosystem actors to help reduce patient reliance on in-hospital services. This is a crucial step in building a digital ecosystem that connects different stakeholders in the patient’s journey in the programmes they are in – including the patient themselves, the physician, the pharmacist, the pharmaceutical companies, civil society groups such as charities, as well as labs and distributors.

When designing digital solutions, patients must remain at the core; patient centricity must be maintained amid

17 https://www.edb.gov.sg/en/business-insights/insights/thehealthtech-boom-in-southeast-asia-big-strides-and-newopportunities-for-healthcare.html 18 https://techwireasia.com/2020/12/thailand-aims-to-bethe-new-apac-medical-hub-leveraging-smart-health/ the move to making processes faster, simpler and easily accessible for them and to improve engagement between healthcare system stakeholders. This can ultimately lead to an increase in adherence in health programmes.

Diagnosis, access and adherence programmes that are digitally delivered and personalised can also facilitate and expedite the patient journey. While ensuring the human interaction still plays an important part, the greater proliferation of data can help improve decision making and programmes improvements. Real-world insights gleaned from access programmes can help deliver breakthrough insights on disease evolution, treatment, patients’ perceptions, outcomes and cost.

The three core pillars of healthcare access sustainability

The creation of an access ecosystem can generate greater financial, treatment and health system sustainability. Here, multi-sectoral collaboration is crucial in supporting governments that have long been stretched in improving access by themselves.

When access initiatives are designed with the patient in mind over the long term, we can attain the following three pillars of healthcare sustainability:

Financial sustainability

By designing initiatives that are personalised to the patient, the financial support provided is no longer limited to budget constraints of the government, pharmaceutical company or the patient. The multistakeholder collaboration allows the initiatives to be financially sustainable and can be scalable over time to reach as many patients as possible, while the patients don’t eventually need to pay out-ofpocket amounts that are beyond their means.

Treatment sustainability

By addressing both affordability and adherence challenges, more patients can stay on their prescribed treatment for as long as medically necessary, ensuring they are getting the maximum benefit from their treatment. At the same time, physicians would have a greater capacity to treat more patients.

Health system sustainability

By complementing the healthcare system with patient management mechanisms implemented outside of health institutions (i.e., hospitals), burdens can be lifted from the healthcare system, enabling it to cope with the increasing older population, improves the cost-effectiveness of healthcare interventions, ensuring better health outcomes, and allows the healthcare system to expand, keeping the expenditures in proportion to the GDP sustainable.

When we address access holistically, we achieve this trifecta of sustainable access. We have seen this first-hand in Axios-managed Patient Support Programs. For instance, we collaborated with a multinational pharmaceutical company to develop their 'access to medicine strategy', ensuring that access was not an afterthought. Together we designed a shared payment access programme. The programme

Financial Sustainability

Treatment Sustainability

PATIENT CENTRICITY

Health System Sustainability

is focused on improving access to treatment for selected haematological and gastroenterological conditions. It was important to go beyond just reimbursement and identify a more tailored approach that segments the patient population.

This programme uses Axios’ Patient Financial Eligibility Tool (PFET) that considers both formal and informal income sources – enabling patients to complete their prescribed treatment even if they can’t afford to pay for it in full. By understanding the individual patient's circumstances, we can define a quantity of payment comfortably within their means and ensure that only those who need the support benefit from it. The company was able to reach its average discount goal without reducing the price. At the same time patients only paid what they could afford – and so it became financially sustainable.

The cost-sharing has significantly reduced the financial burden, resulting in larger patient enrolment in the programme with more patients able to stay on treatment, which significantly improved the duration of treatment, reaching optimal medical outcomes. In fact, in 75 per cent of cases, a higher-than-expected duration of treatment was reached. Concurrently, this led to broader healthcare provider satisfaction and so enrolment accelerated. Here, treatment sustainability was reached.

The programme was then able to scale globally – now supporting patients in Asia, Africa, Europe, Middle East and Latin America. For some countries, our suite of digital tools has connected patients to their healthcare providers outside of the hospital care setting while integrating stakeholder coordination into one seamless ecosystem, which became essential during the pandemic. With many more patients able to access and stay on treatment longer, while having an out-of-hospital support system to complete the HCP efforts, the burden on the healthcare system is lighter, especially as patients adhering to treatment means less complications and less hospitalisations. By doing so, we keep the healthcare system sustainable and ready to extend care to more patients.

Access success requires building a sustainable ecosystem

Southeast Asia's healthcare access ecosystem is being strained to the point that it cannot quickly adapt to patients' ever-evolving needs. The region's population is growing at a rate of knots, and the increasing population density means the healthcare system cannot rely solely on hospital care anymore; Because hospitals are not equipped to care alone for patients living with lifelong conditions or chronic diseases requiring long-term treatment forever. The patient must return home at some point, so there is a considerable gap in care because HCPs cannot be everywhere. If patients are on treatment that requires technical expertise like a self-administered injection, they need to be supported, or adherence rates will drop, patients will not get the full medical benefits from the treatment, and their condition could worsen. We must build and extend healthcare capabilities beyond the hospital while keeping patients connected to facilitate the patient journey. By conservative estimates, the pandemic has accelerated the digital transformation of healthcare by at least five years, and technology is essential to integrating all components of a multi-faceted ecosystem that reaches patients wherever they are. Patient support programmes include medication management and counselling, significantly improve care and overall patient experience in chronic disease states, especially with complex therapies. The goal is to generate more, improved health outcomes for the region's patients in the long term, supported by a robust network that plays to the strengths of every collaborating stakeholder.

True healthcare access sustainability can be achieved through such outcomes, but a multi-sectoral, multidimensional response must support the process. This call has to be taken actioned by access specialists in both the public and private sectors and by placing patients at the centre of their healthcare access strategies.

AUTHOR BIO

Joseph Saba is Co-Founder and Chief Executive Officer of Axios International, a global healthcare access company with 20 years of specialized experience developing practical and sustainable solutions to patient access challenges in emerging markets. Under his leadership, the company has launched a number of successful drug access programs and developed innovative access strategies and new models for healthcare systems strengthening.

The Medical City

Communicating in times of crisis

Martin P Samson, Chief Operating Officer, The Medical City

Winston Churchill once said never let a good crisis go to waste. The wisdom behind that statement is perhaps never truer or more applicable today than it did 76 years ago as he uttered that now famous statement at the end of WW II. As the world helplessly grapples with the pandemic, it is increasingly clear that every country, international body, and corporation worldwide were blindsided by it and are now requiring an overhaul of the textbook business contingency and recovery plan it put together. No organisation, to this day, can claim that their business continuity program considered the crippling effects of the pandemic on its operations. In fact, I suspect that no corporation, no matter how sophisticated, can say that their business continuity plan effectively helped them weather the pandemic's bleakest impact. As for the Philippines, a study on the adverse effect of the pandemic conducted by the Asian Development Bank (ADB) on four countries showed that the pandemic's worst effect was felt here among the Micro, Small and Medium Enterprises (MSMEs) and their employees. On a global scale, determining the total number of businesses worldwide that permanently shut down because of COVID-19 is unimaginable. In the US alone, in 2020 that number is nearly 100,000. With the surge of infection continuing to rise unabated in most parts of the world, the figures for 2021 will surely be greater.

Even first world countries with well funded government agencies solely dedicated to forecasting the coming of the next catastrophic infectious diseases have been caught flat-footed by the virus. With infection figures at more than 220 million worldwide with casualties of approximately 4.55 million and multiple mutations that seem to defy and penetrate vaccine protection, experts to this day are still trying to understand how best to outrun this disease. While the number of waves or surges that can be expected is still the subject of debates. One thing is clear, COVID-19 and its deadly impact will not be behind us anytime soon. Suffice it to say, this is a pretty darn serious situation. The kind of "good crisis" in some grotesque sense, that Churchill may have been alluding to.

A crisis in communication

Nothing creates profound fear in people's hearts more than the unknown. Especially when all that is publicly available so far is either life threatening or life ending. Such is the dire condition that practically accompanied eventual lockdowns and border closures all over the world as covid ravaged relentlessly every corner of the globe. For the Philippines, the imposition of the world's longest and possibly strictest lockdown, as its government's sole strategic monumental response, started on March 15, 2020. Such action coupled with the newness of the virus and the scarcity of accurate information from reliable sources on how to effectively deal and manage COVID-19 infection, especially in the healthcare setting, cast the darkest shadow of paranoia one can imagine, on the population.

Amidst the unlikely scenario of this horrific public health crisis, we at The Medical City (TMC) found an opportunity to flourish where others only embraced despair. Having become acutely aware that the lack of valuable communication allowed confusion and panic to proliferate in the community or worse, that the information vacuum was fast filling up with misinformation. The Medical City set about furiously developing relevant content in what may well be the greatest number of creative communication materials it ever produced on a single public health subject matter within a short period of time, in its more than 50-year history. In a mere 18 months, TMC generated and shared 536 materials in various formats through all its social media platforms to reach the widest audience possible.

These communications have influenced some of the country's big private healthcare institutions as well as government action, to some degree. But more importantly, TMC's communication campaign from the

beginning to this day helped to fill a gaping void for a community thirsty for valuable information to ease their worst fears about this virus.

At the height of the first surge, private hospitals acted independently of other institutions in dealing with the overwhelming number of patients with COVID-19, arriving at their emergency rooms. This isolated approach did not give people a full capture of how badly the situation was deteriorating. To paint the big picture, TMC was the first private healthcare institution to publicly announce that its COVID-19 emergency room was filled to capacity and could no longer accommodate patients. This move was later followed by other big private hospitals. And for the first time, the public was collectively made aware how serious and untenable the situation was fast becoming at healthcare institutions, public or private. It underscored the demand for appropriate government agencies to participate and conduct a more coordinated approach instead of abandoning private healthcare institutions to work it out on their own. This eventually catalysed the national government to create a unified system for managing among others, emergency room demand for patients with COVID-19. TMC was also first to publish the census of its COVID-19 cases and other relevant statistics to highlight the urgent need for people to do social distancing and practice all other proper safety protocols.

While others lament that social media made a significant impact on spreading fear and panic related to the COVID-19 outbreak, The Medical City used its official Facebook page (https://www.facebook.com/TheMedicalCity) to keep people safe and informed during the crisis. Full-length versions of all the materials posted on Facebook were even uploaded to our YouTube channel (for the videos) and the TMC website (for the articles).

The Major Themes

The communication campaign focused on the following major segments; (1) AskTMC (2) Safe Zone for All (3) DOCumentaries (4) Get Vaccinated (5) I Am Vaccinated.

AskTMC and parts of DOCumentaries featured TMC's own infectious disease expert, Dr. Karl Henson, answering frequently asked questions from an information-starved public. For the first time, people were able to listen and see an actual expert talk about their worst fears on the coronavirus and provide answers based on expert medical opinion. The goal was to create the country's own version of a Dr. Anthony Fauci, an expert in infectious diseases, who provided reliable information to correct public confusion.

COVID-19 is not the only pandemic

As the first surge waned, the Safe Zone for all messaging was created to sound the alarm on the growing number of the unhealthy but non-COVID population who continued to stay away from hospitals out of fear, neglecting much needed medical follow ups and

AUTHOR BIO

I am a lawyer by education and profession. In 2012, I was hired by The Medical City to be its Chief Legal Officer and by 2018, I was offered the opportunity to be its Chief Operating Officer. A position that helped me discover my true passion. treatments. A recipe for a second pandemic, this time from stroke, heart attack, end-stage cancer, and other illnesses that are otherwise manageable if treated early.

TMC supported its call to return to hospitals by creating the 2 systems within 1 hospital complex. This allowed non-COVID patients to come for medical treatment without fear of exposure. Other institutions followed shortly. This initiative, recognised by PR Asia for Best PR Campaign for Healthcare and Pharmaceuticals and Best COVID-19 Related Response, bested 400 other entries from across Southeast Asia, South Asia, and the ANZ regions.

When vaccination became a reality, TMC was at the forefront in encouraging the public to get vaccinated. Its "Get Vaccinated" and "I am Vaccinated" campaigns were produced with individuals speaking in several dialects to ensure the widest reach possible in a nation of 7,000 islands and multiple dialects. The material was so innovative, the Department of Health (DOH) borrowed it for their own purposes.

Then until now, knowing what we didn't know was just as important and we made sure never to be reckless with the information we shared. TMC pushed the envelope towards helping people live with the reality of COVID-19 but it was always careful to always be facts based.

Did we make a difference? At the end of 2020, a share of voice analysis revealed that five out of every 10 individuals who read any information or watched news about COVID-19 will say they saw a The Medical City content on the subject. Among all pieces of content published about the leading hospitals’ response to the pandemic, The Medical City garnered the biggest share of voice. Bigger than four of the country's other big hospitals combined. Our online engagement metrics have also seen all time high numbers, with 1.8 million minutes of COVID content viewed, 40 million reaches of which 507,000 are new, and 66,900 new unique conversations generated.

As we try to predict how this COVID narrative ends, The Medical City's story will not be nearly complete without including the individuals who tirelessly work because they care, our medical and non-medical frontliners. From the beginning of the pandemic, TMC has proudly proclaimed that in its hospital are the bravest and the kindest people you will ever meet - that message conveys the unspoken truth about healthcare frontliners, and the burden now forced upon them to bear.

This crisis continues and the end is not nearly in sight. But when you hold people's feet to the fire, in this case, organisations, some will burn but others turn golden.