An optometrist giving an exam to a patient

CASE STUDY

F500 biotech manufacturer streamlines processes, scales up, and saves costs with Infinitus

Seasonal staffing, outsourcing, and electronic solutions weren’t getting the job done – but Infinitus could.

Challenge

The ophthalmology wing of a South San Francisco-headquartered Fortune 500 biotechnology manufacturer had a big problem: Patient benefit verifications for their medications were complex and time-consuming, and because of treatment schedules, cases skyrocketed in number every January during the annual insurance reverification period. The manufacturer’s patient access team needed a way to keep up with benefit verification needs that spiked by a factor of 10 or more to ensure eligible patients received financial assistance. Seasonal staffing, outsourcing, and relying on electronic benefit verification (eBV) systems weren’t getting the job done. In fact, in 2021, a large percentage of an outsourced vendor’s team got hit by COVID-19, delaying therapies for patients.

Solution

The biotechnology manufacturer onboarded the Infinitus AI digital assistant to streamline the benefit verification process for its top ophthalmology medications, enabling staff to seamlessly handle even the most extreme fluctuations in call volume. The Infinitus solution was able to collect data from commercial payors when eBV couldn’t, creating a more complete picture of patient benefits that their team could act upon. This enabled the patient access team to get patients more efficient access to the medication while also saving their company costs.

Outcome

>200%

More benefit investigations completed in January 2023 compared to January 2022, with no additional staffing or technology solutions necessary

>95%

Call automation success rate

6X increase

in medications now supported by the Infinitus digital assistant, across therapeutic areas including ophthalmology, rheumatology, and neurology, because of partnership expansion

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“Within our commercial organization, Infinitus and AI are synonymous. When anyone here says AI, they’re thinking Infinitus.”

An image representing a healthcare leader who provided an anonymized quote

Patient Access Executive

Here’s why it worked

After attempting to solve the benefit verification challenge by hiring and training seasonal staff, outsourcing to care management firms, and trying various electronic options, the biotechnology manufacturer’s patient access team knew they needed to look elsewhere. Other solutions they tried that promised to leverage AI were coming up short.

The complex nature of the ophthalmology medication’s benefit investigations meant it took up to two months to recruit and at least three months to adequately train seasonal staff to handle reverification demands. This put the company into an unsustainable constant cycle of hiring and training every fall to receive five weeks of productive work at the start of each year. And that hiring cycle came at a cost – paying for the necessary training time and recruiting was financially inefficient.

At the same time, electronic solutions weren’t able to collect the necessary data at scale. While eBV systems helped with patients on government plans like Medicare, they fell short in cases where patients had commercial plans (e.g., United Healthcare, Blue Cross Blue Shield).

So when company executives were introduced to Infinitus, they recognized the potential for a breakthrough solution. “We thought, this sounds like it could solve the gap we were looking at,” said one patient access executive.

Infinitus automates calls to commercial and government payors, as well as pharmacy benefit managers, on behalf of patient support programs like the manufacturer’s patient access team, and others including Fortrea Patient Access and Cencora. In this instance, the AI component of Infinitus’ solution was informed by a combination of the biotechnology’s institutional knowledge as well as Infinitus’ payor intelligence and expertise gained from making millions of calls. The result enabled the manufacturer to offload thousands of benefit verification calls for ophthalmology medications per day, with no additional hiring or technology needs necessary each January.

For a program already looking to make a push into AI, the patient access team was pleased with the results.

“Within our commercial organization, Infinitus and AI are synonymous,” said the patient access executive. “When anyone here says AI, they’re thinking Infinitus.”

From simple to complex

While the first of the biotechnology manufacturer’s medications that the Infinitus digital assistant supported was an injection administered in a provider’s office, the complexity of benefit verifications performed increased dramatically as the footprint of drugs supported by Infinitus increased. As the digital assistant started performing benefit verifications for infusion-based therapies, getting proper coverage for multiple sites of care and coordinating benefits across multiple payors became the new standard.

“The product is now more robust, it’s more flexible, it’s more scalable,” said the patient access executive. “There’s even better quality. The Infinitus team’s knowledge of reimbursement has gone through the roof.”

Today, Infinitus supports over 1,000 therapies and procedures across dozens of therapeutic areas, which means customers like the manufacturer can launch new programs in a matter of weeks – not months.

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The product is now more robust, it’s more flexible, it’s more scalable. There’s even better quality. The Infinitus team’s knowledge of reimbursement has gone through the roof.”

An extension of their team

As with all of Infinitus’ clients, the manufacturer has a dedicated team at Infinitus, with whom they worked closely during implementation of their first program. With all partnerships, Infinitus ensures all parties are comfortable and informed, instead of handing over keys to the digital assistant and calling it a day, leading to “a much more seamless implementation process when compared to a lot of our other vendors,” said the patient access executive.

For those reasons, the manufacturer considers Infinitus an extension of their own team. In fact, their positive experience and strong results led the manufacturer’s patient access team to integrate the Infinitus digital assistant to support a number of additional medications across multiple therapeutic areas, including neurology, which has benefit verification processes even more complicated than the original ophthalmology treatments Infinitus was supporting. This is saving more staff time they would otherwise spend on the phone with payor representatives, and helping ensure patients receive timely access to treatment. The manufacturer continues to be pleased with the partnership to this day.

“We work with a lot of different vendors,” said the patient access executive. “And I can say Infinitus is the easiest to work with. We’re aligned with the same goals, it’s easy to get things done, there’s great communication.”

Can Infinitus work for you?

Infinitus is a strategic resource for healthcare organizations like Fortrea Patient Access looking to scale their resources with AI. The Infinitus digital assistant can complete tasks including benefit verification and prior authorization follow-up accurately, consistently, and with a faster turnaround – and being powered by AI means Infinitus is constantly learning and improving.

Infinitus supports over a thousand therapies, procedures, medications, and tests. We can work with your team to ensure that one of our standardized offerings aligns with your operating procedures and needs.

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