The AbbVie Hepatitis C Community Educator (HCCE) program aimed to engage and activate patients previously diagnosed with HCV to discuss treatment options with a healthcare provider. The program enrolled over 7,000 patients from 2014-2015 through various channels. Community educators provided personalized support to enrolled patients to help overcome barriers to care. While one-third of enrolled patients were ultimately activated, educators faced challenges with patients facing multiple constraints and difficulties reaching patients consistently by phone. Access issues related to insurance policies and prior authorization also presented barriers to activating some patients.

1. AbbVie Hepatitis C Community Educator
(HCCE)
Program Analytics
November 13, 2015

2. Program Overview
•AbbVie’s HCCE program was launched August 2014.
•Program goals were to engage with patients who had been previously
diagnosed with HCV and activate them to discuss their HCV treatment
options with a healthcare professional who treats HCV.
•Enrollments were driven by television advertisements, online activities
(Facebook page, ads), and Community Educator (CE) efforts in their
territories (community events, outreach to local healthcare
organizations, etc).
•Enrollments were processed in one of 3 ways:
–Call Center
–Online Registration
–Business Reply Card
•Enrolled patients were assigned a dedicated CE based on factors
including location, language, how they heard about the program, and CE
caseload.

3. HCCE Patient Care Model
•CEs leveraged Legacy’s JOURNEY Learning™ training to connect with
their patients, build meaningful relationships, and activate them to take
the next step in their HCV journey.
•CEs leveraged the HCCE Patient Assessment Technology (PAT™)
platform, built by Legacy for the HCCE program, to deliver tailored
interactions to patients, based on personalized needs assessments.
•Two assessments were administered by CEs in initial conversations with
patients to identify key patient challenges (i.e. clinical, social,
behavioral), attitudes, and barriers to discussing treatment options.
•CEs conducted on-going live (telephonic, face-to-face) interactions,
applying JOURNEY Learning skills to engage and activate patients to talk
to a healthcare provider about their HCV treatment options.
–Details of each interaction, including patient attitude, topics
discussed, and patient concerns were logged in the PAT platform.

4. HCCE Program: Activation Funnel (All Time)
Total Enrolled (All Time):
100% / 7071 pts
Reached:
1 completed interaction
72% / 5066 pts
Engaged:
2+ interactions
56% / 4001 pts
**Activated to Care:**
33% / 2344 pts
58% of Engaged Patients
The HCCE program was
highly effective in
activating patients.
One-third of all enrolled
patients, and over half of
all engaged patients, were
ultimately activated to care
by their CE.

5. Activating Patients: Key Take-Aways
•Activating patients takes time
–Patients generally required 1-2 months from the time of enrollment
to the date they were able to have a discussion about HCV treatment
options with a healthcare professional who treats HCV.
•On average, 4 interactions were required before a patient was activated.
•A majority of patients preferred biweekly interactions.
•Patients who go on to become activated are more likely to
–Be seeing a specialist vs a GP/PCP
–See their doctor about their HCV frequently (at least once/year)
–Be interested in understanding how to talk to their doctor about their
treatment options
–Have been previously treated for HCV (slightly higher likelihood vs non-
activated patients)

6. Patient Enrollment

7. • 58% of all patients enrolled in 2015.
• The percentage of enrollments via call
center decreased substantially in 2015, as
TV ads were discontinued.
Enrollment Source

8. • Engaged patients (Active,
Paused, Activated to Care)
enrolled via call center
slightly less often than other
patient groups.
• These data are consistent
with more engaged patients
actively seeking information
and responding to
community outreach efforts
by CEs.
Enrollment Source by Status

9. • Consistent with previous slides, these data
indicate that CE outreach efforts were
responsible for the majority of patient
enrollments in 2015, while TV ads brought
in the majority of enrollments in 2014.
Enrollment by Channel

10. • Consistent with previous slides, there was a
shift in how patients heard about the
program in 2015 vs. 2014.
• Note: Community organizations, healthcare
workers, and local health events were
attributed to CE efforts.
How Patients Heard about Program

11. • The biggest influx of patients correlated with airing of TV ads.
• CE efforts were responsible for a steady baseline of patient enrollment
of ~300 patients per month, on average.
Enrollment Trend

12. Top 10 States:
Patient Enrollment
State Enrolled
MI 582
FL 503
CA 502
TX 411
NY 319
OH 312
NC 283
PA 281
TN 260*
MA 259*
• Geographic distribution of patients enrolled in the HCCE program is generally
consistent with state populations.
• *States with higher enrollments than might be expected, based on population.
Enrollment by State

13. Patient Characteristics

14. Patients by Gender
• More males than females enrolled in the HCCE program; however, the percentage
of females was higher than might be expected from national averages (62% male /
37% female) (CDC Enhanced Viral Hepatitis Surveillance 2013).

15. Patients by Language
• Almost all patients who enrolled in the HCCE program identified as English-speaking.

16. • Most patients were diagnosed in the past 10 years, although some patients had
been living with a HCV diagnosis for decades prior to enrolling in the HCCE
program.
Year of HCV Diagnosis

17. Prior Treatment
• Most patients enrolled in the HCCE program were HCV treatment-naïve.
• Patients who went on to be activated were slightly more likely to have received
prior treatment for HCV.

18. Prior Treatment Outcomes
• Among previously-treated patients, the majority completed treatment but
were not cured of their HCV.

19. • The majority of patients who enrolled in the HCCE program segmented as Motivated.
Just over 25% segmented as Contemplative
• Note: Patients who were not yet segmented by the program end date were excluded
from this analysis
Patients by Segment

20. • Over half of patients who interacted with their CE preferred to be contacted every 2
weeks; about 1/3 preferred weekly interactions with their CE.
• These data are consistent with the nature of the HCCE program, which focused on
activating patients to see a healthcare provider to discuss HCV treatment options.
Medication adherence-based programs tend to be more heavily weighted towards weekly
interactions.
Communication Frequency Preferences

21. • Administering either of the two
assessments took CEs 16
minutes, on average.
Administering both
assessments at the same time
took ~5 minutes longer than
administering one assessment.
• When no assessment was
administered, CEs spend ~14
minutes interacting with the
patient.
• Given the preferred patient
frequency, these data suggest
that a CE dedicated full-time to
patient interactions could
manage a caseload of at least
150 patients.
Length of Interactions

22. • Patients were most concerned with the effects HCV could have on their
overall health and on the cost of treatment.
• A significant number of patients were also concerned about additional,
non-HCV-related health issues.
Patient Concerns

23. Effects of a HCV Diagnosis
• Concerns about their future health and about infecting others were the
most frequently cited effects of being diagnosed with HCV.

24. Patient Program Goals
• Patients who enrolled in the HCCE program were interested in learning more about
HCV and how to find appropriate care.
• Patients who went on to be activated were more interested in learning how to talk to
their doctor about HCV than patients who were not activated, suggesting that they
may have come into the program more ready to take action.
Activated

25. Treatment Interests & Concerns
• Most patients were curious about new HCV treatments and eager to be cured.
• Patients who were never activated were slightly more likely to indicate that treating
HCV wasn’t their highest priority.
Activated

26. Frequency of Doctor Visits
8%
3%
1%
81%
7%
20%
5% 7%
56%
12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
A few times a
year
Every
couple/few
years
Every month I'm not
currently
seeing a doctor
about it
Once or twice a
year
Patient Response: How often do you see a
doctor about hep C?
No
Yes
• Patients who went on to be activated were much more likely to be regularly seeing a
doctor about their HCV than patients who were never activated.
• These data may indicate that CE interactions helped patients engage in their own
healthcare and be more proactive about discussing treatment options with their doctors.
Activated

27. Doctor Type
• Patients who went on to be activated were much more likely to be seeing specialist
about their HCV, while patients who were never activated were much more likely to be
seeing a GP.
Activated

28. Patient Activations

29. • For patients activated to care in 2015 (regardless of enrollment date), the median time
from enrollment to activation was 38 days. Average was 52 days.
• These data indicate that, even for motivated patients, navigating the healthcare system
and getting in to see an appropriate treatment provider takes time.
Time to Activation

30. Cumulative Activation Rate: 2015
• The cumulative activation rate increases over time, as more patients hit their 60 day
mark in the program.
• Note: A patient is counted as "eligible" in the month, and subsequent months, that he or she has
been in the program 60 days.

31. Interactions to Activation
• For patients who enrolled and activated in 2015, CEs interacted an average of 4 times
prior to the patient being activated.

32. Patient Attitudes
Activated
• Activated patients were slightly more likely to exhibit more positive and fewer
negative/mixed attitudes in interactions with their CE.

33. • Patients who were
activated to care had a
similar distribution of
how they heard about
the program, compared
to all patients.
How Heard: Activated Patients
Activated to Care

34. • As with the overall enrolled patient population, there was a shift over time in how
patients who were activated in 2015 heard about the program, with an increasing
percentage enrolled as a result of CE efforts in later months of the year.
How Heard Trend: Activated Patients

35. • Most patients who engaged with a CE segmented as Motivated. (Patients who opted out
were not included in this analysis.)
• Segmentation distributions were not significantly different in patients who were ultimately
activated to care.
• These data suggest that patients who enrolled in the HCCE program were already somewhat
engaged in their healthcare; they needed help from CEs to understand and take the next
steps, and to maintain motivation as they navigated the healthcare system.
Segmentation: Activated Patients

36. Top 10 States:
Patient Activations
State Activations
CA 210
FL 184
NY 173
MI 148
TX 104
OH 93
MA 93
NJ* 83
IL* 69
TN 64
• Geographic distribution of activated patients program is generally consistent with
enrollment/state population.
• *States with higher activations than might be expected, based on enrollment.
Activated Patients by State

37. Activated as Percentage of State Population
Top 10 States:
Activations per
Population
State Percentage
RI* 0.0050%
MI 0.0015%
PR 0.0015%
MA 0.0014%
CT 0.0013%
WV 0.0012%
NV 0.0011%
SC 0.0011%
LA 0.0010%
TN 0.0010%
• Geographic distribution of activated patients program is generally consistent with
enrollment/state population.
• *States with higher activations than might be expected, based on population.
Activations per Capita

38. Activations vs. Caseload
• Very high caseloads
may negatively affect
activation rate, e.g., if
CE is unable to
appropriately engage
his/her patients

39. Challenges
Educators Spend Time on Patients Who Can’t Be A2C
Patients Are Facing Multiple Resource Constraints
It Is Difficult to Reach Patients
CEs and their District Managers were surveyed to better
understand their perceived challenges in activating patients.
Top-cited issues:

40. Challenges: Reaching Patients
• In general, 1 out of 3 interactions was successful (CE was able to speak with patient)
• CEs spent a substantial amount of time “chasing” patients

41. Challenges: CE Perspectives
• “[The biggest challenges that get in the way of patients being
activated are] resources............ The PCP not referring, insurances
saying no, patients getting discouraged.”
• “Patients might be very motivated but lack of insurance is a major
concern for them and for our program”
• “With some insurance policies, patients are required to consult with a
PCP prior to be referred to a HCV specialist. Unfortunately, the
activation breakdown is at the PCP office. PCP downplays the
importance of HCV treatment…”
Challenges: Insurance/Healthcare System