The AI Advantage: When and Where to Apply It in Your Patient Support Program

Today’s guest post comes from William Grambley, Chief Product Officer at AssistRx.
 
William discusses four specific use cases for how AI can create efficiencies and improve patient support programs for both healthcare providers and patients. He provides three considerations that life sciences organizations should evaluate when adopting AI in their patient support programs.
 
To learn more:

• Meet with AssistRx at the Asembia Summit in Las Vegas

• Download AssistRx's latest eBook: AssistRx Q1 2025 Specialty Pharmaceutical Space Progress Report

Read on for William’s insights.

The AI Advantage: When and Where to Apply It in Your Patient Support Program
By William Grambley, Chief Product Officer at AssistRx

Life sciences organizations are monitoring how artificial intelligence (AI) is revolutionizing drug development, diagnostics, personalized medicine and more. Many organizations have been seeking opportunities to deploy AI in their patient support programs (PSPs) to create efficiencies, better patient and healthcare provider (HCP) experiences and improved outcomes.

While AI holds promise, investment in this transformative technology requires careful consideration. Organizations investing in AI prioritize responsible and ethical use. Factors like data privacy and protections, data quality and data source redundancy need to be reviewed. Further, decision makers need to carefully evaluate which AI use cases make sense for their organization and goals.

AI Applications for PSPs

Applying AI within PSPs may be less intuitive than AI’s applications across other sectors, but its impact on patients can be enormous. Understanding where, when and how AI does—or does not—power program performance is essential to getting the most out of your investment.

Consider these use cases:

• Operational Efficiency: Integrating automations into PSP systems streamlines processes and accelerates previously manual efforts. Leveraging AI in these systems can take PSP operations to the next level. For example, AssistRx uses AI in our CRM, CaseAssist, to power next best action decisions, such as best time of day to contact each patient. This technology improves program efficiency and helps staff focus on people, rather than tasks.
  
  When it comes to PSP customer interactions, however, replacing the human element with AI may not be advisable—at least for the foreseeable future. Many of today’s patients are not yet comfortable with AI interaction (e.g., chatbot). Empathetic talent with specialty therapy expertise may be better suited for this use case.
  


• Patient Coverage Determination: Many PSP providers tout AI as the optimal approach for completing benefit verifications (BVs). Though AI can be leveraged to identify patient coverage, this method relies on large quantities of historical data to predict coverage status. Because AI requires large data sets, an AI-powered coverage return may have risk for inaccuracies. In many instances, it is more effective to leverage direct connectivity with payers, PBMs and other data sources to perform BVs. Solutions like AssistRx’s Advanced Benefit Verification and eMedical Benefit Verification deliver real-time, accurate pharmacy and medical BV results in seconds—directly from the source of truth.


• Personalized Patient Engagement: AI can analyze patients across demographic and socioeconomic factors, payer- and prescriber-related adherence risk, disease state and therapy complexity, medication adherence history and more. Using this data, AI can then predict points of adherence risk and intervention needs, personalize patient communications to each of an individual’s unique needs and preferences and evolve outreach in accordance with the patient’s evolving life stage and/or disease progression.
  
  AI-powered personalized patient engagement efforts increase initiation, adherence and health outcomes while optimizing program performance, costs and efficiencies. For instance, AllazoHealth, an AssistRx solution, determines the optimal content, channels, timing and cadence for patients, proactively driving the next best action for each individual by predicting their medication behaviors and tailoring communications. By integrating AI into PSPs, the technology unlocks efficiencies—empowering talent to focus their energies on people, not tasks.


• Conversational Intelligence: For PSPs that facilitate inbound and/or outbound customer touchpoints, AI can provide valuable insights into patient and HCP dynamics, including sentiment analysis and trending needs or preferences. AssistRx’s Advanced Conversational Intelligence (ACI) solution can be incorporated into PSPs to capture conversation themes and recurring pain points and flag specific terminology—such as payer-specific activity or competitor therapy trends—to drive strategic, data-driven decisions that improve program performance and patient and HCP experiences.

Is AI Right for Your Program?

Determining whether AI makes sense for your PSP depends on several considerations specific to AI’s utility, your unique program goals and your organization’s level of comfort with possible compliance risk.

• Meeting program goals: Consider which objectives AI is aiming to achieve and whether other technologies are better suited to those goals. While AI is full of possibilities, it requires clearly defined utility and quality data. When AI fails, some vendors supplement it with manual intervention, effectively underdelivering on AI’s promises and even falling short on set objectives.


• AI data sources: AI requires extensive, robust data sets that are multi-threaded and avoid human biases. The right partner will have an extensive understanding of available data, data connectivity across systems and maintenance of data quality to achieve successful application.


• Data privacy and regulations: In our highly regulated space, safeguarding protected health information is critical. Because AI is a relatively new technology, laws at both the federal and state level are constantly evolving. Compliance with these laws requires expert monitoring and dedicated resources. For risk-averse organizations, it is critical to vet a PSP partner’s ability to navigate the landscape through both human expertise and agile, secure technology.

AI is just one focus area for life sciences organizations looking to stay ahead of the curve in 2025. In our latest eBook, we break down the latest innovations, program models and industry trends impacting patient support services. Download the AssistRx Q1 2025 Specialty Pharmaceutical Space Progress Report to learn more.

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