“The pandemic changed everything. We jumped forward five years in a very short time,” says Philip Ysebaert, enterprise account director at UPS Healthcare. While this is true for many areas of life, Ysebaert is talking specifically about the dramatic rise in home treatments and direct-to-patient (DtP) services over the last year.
COVID-19 led to an acceleration in demand for the specialist services UPS Healthcare offers in this area. UPS had already started improving, expanding and developing its DtP offering, which put them ahead of the game and allowed the firm to take advantage of having the supply chain and organisation in place to accelerate sales and volume through these channels.
Research shows that rehabilitation and recovery of patients at home is faster, with people responding better to being in their own environments. And it’s often also cheaper to discharge patients earlier and allow them to recover at home or even to treat them at home for some longer treatments, than in a hospital setting
Interest in DtP services increased by more than a third over the COVID-19 pandemic, with logistics firms playing a key role. Figures from GlobalData show that medical and pharmaceutical clients are increasingly interested in DtP services, and that this interest has continued to grow throughout the pandemic. The first quarter of 2021 saw the phrase mentioned 102 times across company filings, up from 75 at the same point in 2020.
Technology has also helped accelerate the shift, with the pandemic further forcing companies and patients to adopt new ways of doing things. UPS Healthcare has seen volumes increase and seen the importance of home treatments rise, which fits well with the firm’s core strategy of putting the convenience of patients at the centre of treatment.
A boom in home monitoring
Key drivers for this boom are patient convenience and lower costs, which points to DtP services increasing further in the coming years, particularly in the treatment of chronic conditions, where the persistent and ongoing need for treatment means that the advantages of home treatment are most noticeable.
One example can be seen in the treatment of diabetes. The prevalence of diabetes is rising in the U.S. and parts of Europe, and medical device firms are targeting people with pre-diabetes and those suffering from obesity. According to GlobalData’s research, the insulin pump and continuous glucose monitor (CGM) market is expected to continue to grow at a rapid pace throughout the rest of this decade, with many of these devices used by patients at home.
This fits with UPS Healthcare’s experience. Recent requests include one from an insulin pump manufacturer, who contacted the firm seeking a logistics partner for home deliveries. The firm delivers diabetes care and wanted to increase the volume of patients treated at home. For this to work they needed a sustainable delivery model, with sufficient track and trace control and convenience for the patients. Of course, this was a perfect fit for UPS Healthcare.
But the market is maturing from a technology perspective, too. The remote monitoring sensors and technology is developing quickly, allowing for better remote visibility for patients, via a smartphone app. It allows users to connect to a clinic if blood analysis suggests they need it. It’s a new dimension to the patient experience, as they don’t need to go to the hospital as often. It has improved the life of patients.
But it needs to be underpinned by a logistics solution that supports this patient journey. It may start with diagnosis and the search for treatment and appropriate medication, but it can only be successful if the final-mile delivery and experience is successful as well.
While simpler medical devices, such as insulin pumps (even connected ones) are likely to be delivered to patients who know how to use them, there are other situations that require technical healthcare support and resources.
Ester Van den Bossche is a senior manager for cold chain packaging and technology solutions at UPS Healthcare and she helps clients devise the right packaging and logistics solution, so their medical devices or treatments arrive in the ideal condition.
With increasingly sophisticated therapies being offered via DtP, it means more complex packaging challenges and even the provision of nurses at the point of delivery to help administer treatments. Even straightforward sample collection and delivery becomes more challenging in a hostile environment.
Van den Bossche explains that concepts such as last-mile delivery and DtP cover a wide range of real-world situations. “Sometimes, the solution is a single temperature-controlled box, but on other occasions it will be more complicated, including an entire temperature-controlled plane or delivery over long distances in countries with extreme weather conditions.”
Added to this, the increasing complexity of treatments means the value of shipments is going up. As Van den Bossche explains, “Some of these therapies are worth in excess of $500,000 each. And that kind of value adds complexity in itself, regardless of where it is coming from or going to.”
It’s again complexity that requires an experienced and trusted logistics partner able to cope with the technical shipping requirements. The shipments have to be kept in perfect condition, including time, temperature and humidity; but also with stringent security and insurance requirements.
One area in which there has been a clear acceleration of DtP services thanks to the pandemic is clinical trials. Dispersed or decentralised trials, with patients sent medications or medical devices at home, have become more prevalent over the last year. And this shifting focus from the investigator to the patient’s home looks set to stay.
Figures from GlobalData show a spike in the number of clinical trials using remote monitoring, remote drug delivery, or telemedicine doubled from 2019 to 2020. While this followed a slight dip between 2018 and 2019, the upward trend is clear.
UPS subsidiary Marken was quickly able to scale up and handle the clinical trial logistics for most of the COVID-19 vaccines, and was able to leverage its virtual clinical trial capabilities to move ongoing clinical trials, where appropriate, into the homes of patients.
For Van den Bossche, this is an area where UPS Healthcare’s network and the expertise in its specialist subsidiaries, such as Marken, pay off. “We handle a wide range of these requests and we make sure all the trial logistics are perfect. We handle the packaging and distribution of the drugs or devices, of course, but we also know how to deal with the complexity of things like making sure the right patients get the right dosage (either placebo or treatment) without knowing, or making sure the sponsor doesn’t see patient names, while we need to know who they are in order to deliver treatments or monitoring devices to them at home.”
But this kind of trial is booming across the industry. In a survey, some 73% of biopharma industry firms, and 78% of clinical trial service providers said that the pandemic had increased their use of decentralised clinical trials.
In the longer term, this is expected to continue, with more than nine out of 10 respondents expecting Covid-19 to increase the adoption of decentralised clinical trials in the long term.
Another key area that has seen expansion throughout the pandemic has been home diagnostics. Firms such as UPS play a vital role in the delivery and successful return logistics of collected specimens. These are not just from COVID-19 but also include cancer diagnostics, sexual health tests and other general wellness diagnostics.
But COVID-19 diagnostics have become an increasingly large part of the pharmaceutical supply chain during the pandemic, as countries have ramped up their testing programmes.
Putting the patient first
Some other changes in DtP logistics market are driven by patient expectations. A lot of the pressure comes from experiences in other areas of retail. While there are similarities, DtP logistics are a different from those involved in delivering a book. But while there are building blocks of the logistics chain that might be the same, it all happens in a different atmosphere, with a different urgency.
There is still a package that moves from a warehouse to a person at home. But it needs to be temperature-controlled and it needs to be delivered at the patient’s convenience. If you order a book and it arrives when you’re not in, the driver can leave it with neighbours or a safe place. But you might not want your neighbours to know you’ve got a certain disease or to accept medical supplies.
UPS Healthcare has built a full suite of services to support the ease and convenience of patients so they can take control of their delivery, while ensuring the shipment is maintained at a suitable temperature to ensure viability.
The crucial factors as predictability and certainty. In logistics industry parlance it means focusing on the delivery window. UPS has smart technologies that continuously redefine the delivery window. It sends an automated day-before-delivery alert via email or text message. Lots of its competitors send it on the morning of delivery. This doesn’t allow patients to plan their day in advance.
When it launched the service in 2020 UPS gave a four-hour window, but that’s continuously decreasing as it gets more accurate data about how long a delivery takes, and how accurate that matches with what was expected.
The UPS network recently completed a five year $2bn investment plan to increase capacity and the speed of deliveries across its network. This, says Van den Bossche is where UPS Healthcare is able to exceed not only patients’ and clients’ expectations, but also the capabilities of other providers.
It’s a combination of trusted final-mile delivery expertise and deep healthcare experience that’s hard to match. “Ultimately, it’s the end-to-end experience, that matters,” she says. “It’s not just the delivery, it’s from the moment of order right to the moment of delivery. There’s a complete chain. It’s the experience of the order taking, the information available after the order taking, it’s the warehouse work and the correct packaging options, it’s a handover to the courier and then it’s the actual delivery and all the communication around it. It’s connecting all those dots to meet and beat a patient’s expectations. That’s what provides a positive healthcare experience and outcome.”