How engaged do modern businesses have to be with customers? In the case of one local company, it’s to the point of helping doctors follow up with patients because the lack of post-order monitoring could be the difference between life and death.
Gary Frings, chief information officer for Exact Sciences Corp., says that’s exactly what the company does with Cologuard, its colorectal cancer-screening product, and the computer-aided fulfillment process through which the product is ordered. The prescription-only test is ordered by physicians either from the company website, from the provider’s own electronic medical record system, or by fax machine. It is then mailed to patients, but compliance remains an issue even with this noninvasive test.
About 50% of the people who are due to have a (very invasive) colonoscopy don’t have it done. Within that, there are patients who show up but haven’t done the proper prep, so compliance is a real problem.
Exact Sciences’ web portal is the primary channel for ordering Cologuard, and Exact Sciences tries to facilitate the process for patients. Patients can download and print a product order form and bring it to a doctor’s visit with all of their information completed. “People come to our website to get more information, and we have a provider version for health care professionals so they can get the information they need,” notes Frings.
However, the real differentiator is following up to improve compliance. Exact Sciences’ goal with Cologuard, which requires no special eating requirements or medication to cleanse the colon, has always been a compliance rate of 70% or higher. This requires patient outreach via follow-up telephone calls or other preferred means of communications.
Multiple attempts are made to contact patients on their preferred device while also keeping prescribing physicians informed of the patient’s cooperation (or lack thereof). “This is colorectal cancer screening, so our demographic is the over-50 group. A big part of our customer base is 65 and older or people who have Medicare coverage,” Frings says. “After we’ve shipped a kit we will follow up with the patient, so in a week or so we attempt to reach them by phone.
“After roughly 15 days we make another attempt to contact them, and then we follow up again via mail to encourage them to comply with their doctor’s prescription, complete their sample, and send it in.”
Once there is a positive or negative result, Exact Sciences communicates it to providers. If there is a positive result, not only does the company communicate electronically or by fax, it also calls providers to make sure they have the information and can quickly communicate with their patients. The company doesn’t try to play doctor, it simply partners with physicians to monitor and improve compliance.
Death sentence
With colon cancer, early detection is critical because if detected early the chances for survival are very high, but if not detected until the late stages, when symptoms often first materialize, survival rates dip precipitously. “As we crudely say, it’s almost a death sentence at that point,” notes Frings.
To make it more likely that death takes a holiday, Exact Sciences relies on partners beyond the medical profession. As part of the fulfillment process, the company had to develop study packaging to keep the product from being damaged in the mailing process. It established a partnership with UPS and has warehouse space right at UPS’s Tennessee hub so that when it receives the prescription order, it fires an electronic communication to UPS that provides the patient’s shipping information. The kit is then delivered to the patient and once patients have completed the sample, they can call UPS for home pickup or drop it off at their nearest UPS location, where it’s overnighted to Exact Sciences for processing.
Exact Sciences, which completed more than 100,000 of the U.S. Food and Drug Administration-approved Cologuard tests in 2015, is dabbling in national television advertising in select test markets. As marketing efforts intensify and more tests are ordered, the risk of not delivering the best customer experience grows more immense, especially with competition entering the market.
The company’s customers include sophisticated medical entities such as physicians, specialists, and health systems. If something goes wrong in the fulfillment process and it’s traced back to company error, the fallout could be devastating. “This is a very important kind of life-sensitive service that we provide, a test that we do,” Frings states. “If we have a failure, it can really have very significant ramifications for the patients who we’re testing. We’re very cognizant of that, and so we’re very sensitive and put a lot of emphasis on reliability, accuracy, and consistency.”
Exact Sciences has to be cognizant of those elements in everything — customer communications, lab procedures, and billing. “Commercial payers are just getting signed on but that’s a process that takes time,” Frings says. “Some people have coverage, some don’t. We try to give people information and direct them to their insurers, where necessary, so that’s also an important aspect of the customer experience.”
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The organization has made several adjustments to its fulfillment process, and one that stands out was a bit of an old-school surprise. From the onset, Exact Sciences expected most providers to use its web portal where they can electronically enter orders, track order status, and track results, but it found that health systems, especially when it comes to prescriptions, still are largely dependent on faxes.
“Even some of our large health systems that we work with still utilize faxing, and so we get those faxed in and we have to enter those into our system,” Frings says. “It’s critical that we do that accurately and follow up where there are questions. We have built some good systems to be able to follow up with providers if there is missing information or questions about an order, or if we have issues in contacting the patient. “We’ve implemented systems around that, and we’re rolling out a system to be able to use optical character recognition so we can scan those faxes and be able to automate the collection of some of that information off the order form.”
In time, Exact Sciences would prefer to be part of each health system’s electronic medical records systems. That way, they can order tests or obtain results within their EMR systems. “It takes time,” he notes. “We’ve converted many of them but we have many still to go. Over time we expect more and more of our order activity will be just that way — that they will order through their EMR.”
Exact Sciences gains feedback from surveying and interviews with ordering physicians and by monitoring feedback in its contact center. Another change was made based on feedback from physicians. “Doctors wanted to get the order status and all of that was available on our portal, but since there were many offices that were just using faxes, we would send them a biweekly order status report, a summary report, so that they could see the status of their orders — whether the kit was still with the patient or we had not gotten a sample back, or if we had received a sample, or wherever it was at in the process.
“We also developed some compliance reports for our physicians so they could see the compliance rates for their patients.”
Product pipeline
Exact Sciences is working to develop cancer-screening products for pancreatic, esophageal, and lung cancer that build on the foundation of Cologuard. The company will be challenged to replicate their processes with those products as they are rolled out. “Our primary focus within the business, for most folks in the company, is around Cologuard,” Frings says. “We need to be successful with Cologuard if we’re going to have the opportunity to address those other forms of cancer.”
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