Model Overview
Our Patient Journey Stage Model is designed to help you better understand where patients are in their treatment journey—whether they are on treatment, finished with treatment, had a treatment disruption, or are restarting treatment. Knowing where your patients are in their journey empowers your team to recognize treatment disruptions and prioritize opportunities for intervention.
You have the ability to filter in both Conversations and Signals by journey stage, allowing you to identify patients experiencing barriers to care or tracking progress through treatment over time.
Patient Journey Stage Filter in Conversations
Patient Journey Stage Filter in Signals
What are the Patient Journey stages?
The available journey stages include:
Before Treatment
On Treatment
After Treatment
Treatment Disruption
Restarting Treatment
No Clear Journey Stage
You can refer to the rubric below for detailed guidance on what signals indicate each stage.
How We Determine Journey Stage
As a part of evaluating a conversation, we determine the patient’s current stage in their treatment journey, whether the patient is actively participating in the conversation or being referenced by a provider, pharmacist, or other healthcare professional. Each patient is typically assigned to just one journey stage, but if there are signs of more than one stage, the model looks closely at the conversation to identify which stage is most clearly represented.
If more than one patient is discussed in a single interaction, we assess each patient’s journey stage individually.
Signals That Influence Journey Stage
Signals are pieces of information in the conversation that help pinpoint the patient’s journey stage. When multiple stages seem possible, the one with the strongest evidence in the conversation should be selected.
For example, a customer indicates that they stopped Drug A, and they are going to start Drug B. If there are signals in the transcription that the call is being made about Drug A, the journey stage would be: After Treatment. However, if the call is being made about Drug B, the journey stage would be Before Treatment.
Access Patient Journey Reports
You will also see journey stage reports in Signals, as well as reports layered with the Eddy Effect for richer context.
To access these reports, select + New Dashboard, or click into an existing custom dashboard under My Dashboards.
Select Add Card
Select the Patient Journey Stages from the checklist and click Add Card(s) to Dashboard.
You will then be able to see the Patient Journey Stage Report and Patient Journey Stage and Eddy Effect Report.
If you have questions as you explore your patient journey insights, KBo is ready to assist with real-time guidance.
Patient Journey Stage Rubric
No Clear Journey Stage
No Clear Journey Stage
Definition
Customer journey stage could not be determined with the information provided in the interaction. This could range from an HCP seeking general information about the medication, programs or services offered by the client, and/or exploring treatment options, or otherwise lack of context in the call.
Examples
If a customer is calling in regards to a generic or competitor medication and has never been on the client’s treatment, this would be considered “No Clear Journey Stage”
Healthcare Provider (HCP) offices could be calling to inquire about the medication or financial assistance programs or other program processes in general.
Individuals who heard about the medication through advertisement may be calling to inquire about the medication or financial assistance options offered by the company for themselves or someone else generally.
An individual is interested in starting or restarting treatment; however, they do not current have a prescribing physician.
A customer calls regarding a copay card or claims issue, but there is not enough information shared to determine if the patient is currently on treatment.
Healthcare Provider (HCP) or patient indicates that they are not going to move forward with treatment and there is no signal in the transcript that the patient started treatment.
A customer who was intending to begin the medication but is unable to do so due to death or other reason.
There was not enough information shared during the call to determine where the customer was in the journey.
What does this sound like?
“I am calling on behalf of [healthcare provider entity] and wanted to know about your financial assistance program”
“I saw a commercial about this drug and wanted to ask some questions”
“Do you offer any samples to [healthcare provider entity] offices?”
“What side effects are common with this drug?”
“I’m a new provider and need access to the portal.”
“I’m calling to check the status of a claim from February 2024.”
“I’m canceling the patient’s prescription.” (no indication that the patient has been on treatment).
“I’ve decided not to move forward with treatment”
What does this not sound like?
This tag is not intended to be used when we are able to distinguish a journey stage.
This tag is not intended to be used as a catch-all for benefit verification/prior authorization/appeals calls. If there is a benefit provider or prior authorization/appeals call where there is no indication that the patient is already on drug, the appropriate label is “Before Treatment.”
Keywords
Question about program
General question
How to acquire medication
Portal access
Portal login
Password reset
No longer moving forward
Product question
Side effect question
Before Treatment
Before Treatment
Definition
The customer is seeking enrollment, is newly enrolled, has not yet started treatment but is planning to obtain treatment for a patient
Examples
If the call relates to a benefit verification, prior authorization, or appeal and there is no signal in the transcript that patient is already on treatment, the patient would be in the Before Treatment journey stage.
If the customer calls to enroll in copay assistance or check if a patient is enrolled in copay assistance and there is no signal in the transcript that patient is already on treatment, the patient would be in the Before Treatment journey stage.
A patient or family member may be calling to check the status of a new enrollment form, prescription, prior authorization, first delivery details, etc.
An agent makes an outbound call to check in on a patient who reports they have not yet started treatment.
HCP office is calling to inquire about next steps or confirm receipt of enrollment form.
An agent calls the patient to offer a welcome to the program and explain what the patient should expect when they start treatment.
Agent speaks with a benefit provider to discuss initial prior authorization/benefits verification.
Patient has treatment on hand and would like to talk with someone prior to taking first dose.
What does this sound like?
“My Healthcare Provider (HCP) said I should reach out to ask about your copay assistance program”
“Do you know the status of my prior authorization (PA)?”
“I have some questions about how to use my copay card at the pharmacy as this is the first time I will be using it”
“I’m going to start treatment as soon as I receive the medication delivery.”
“I have my first treatment scheduled with my HCP next week.”
“I’m calling to complete a welcome call and discuss our program.”
“I feel like it is taking forever to get started on this treatment.”
“I’m calling to schedule my first shipment.”
“I am receiving injection training before administering my first dose.”
What does this not sound like?
This tag is not intended to be used for a re-authorization or reenrollment call for a patient who is already on treatment.
This tag is not intended to be used for patients who have already started taking the treatment; this can include patients who are receiving treatment through free drug programs, quick start programs, treatment trial, etc., even if they are still in the initial (prior authorization) PA process.
Keywords
Supposed to start
Help you get started
Not started yet
New patient
First treatment
First shipment
New enrollment
Get patient enrolled
Prior authorization/appeal status
Verify benefits and eligibility
Check coverage
Welcome call
New referral
Check enrollment status
On Treatment
On Treatment
Definition
The patient is currently on treatment
Examples
An agent may be calling to provide an outbound check-in on a patient to see how they are doing with their treatment.
A patient or personal representative may be calling to place a medication order, a change in treatment dosage or frequency, a change in insurance or personal information, re-enrollment, report side effects, etc.
An agent may speak with a benefit provider regarding an annual re-authorization/reverification of benefits.
An agent may speak with a patient about their upcoming re-enrollment process for the financial assistance program.
A customer calls regarding a copay card or claims issue for a patient who is currently on treatment.
If a customer is calling about billing or payment information for the medication, without a signal that indicates any other journey stage, we will consider this to be “On Treatment.”
If a customer is reporting an Adverse Event and there is no signal or indication that the patient has stopped taking the treatment (or any other journey stage), this would be considered “on treatment.”
If there is a call regarding “scheduling medication delivery” and there is no signal or indication that the patient has not yet started the treatment (or any other journey stage) this would be considered “on treatment.”
The patient has entered hospice care and there is an indication in the transcript that the patient remains on treatment.
What does this sound like?
“I received a message from the pharmacy that my medication delivery is ready to be scheduled.”
“I’m on the free drug program and need to order my medication.”
“I started the medication a couple of days ago”
“I am noticing an improvement in my symptoms already”
“I’ve been on this medication for years!”
“This drug has been such a life-changer for me”
“Once we got the insurance sorted out, everything has been smooth sailing with the program.”
“My insurance changed, and I want to know what I need to do so I can continue receiving my medication.”
“I just received a bill for my medication, and I was under the impression that I didn’t have to pay with the copay program, can you help?”
“I will be switching to a different treatment next month.”
“I take the medication two times per week.”
“I will follow up with your infusion site before your next treatment is due.”
“I’m calling to check the status of my medication shipment, it was supposed to be here yesterday, but it didn’t arrive yet.”
What does this not sound like?
This tag is not intended to be used for a patient who is waiting for their initial prior authorization before they have started the treatment.
This tag is not intended to be used for patients who are experiencing a current disruption in treatment.
Keywords
Next treatment
Received treatment
Started treatment
Experienced an adverse event
Renewal
Re-enrollment
Refill
Schedule delivery
Check status of shipment
Re-authorization status
After Treatment
After Treatment
Definition
The patient has discontinued treatment.
Examples
An agent could be placing an outbound check-in call and discover that the patient is no longer on treatment.
The patient experiences a treatment disruption, and the transcript indicates that there is no plan to resume treatment.
A patient or personal representative may call to report that they are no longer using the medication or have switched to a different treatment.
A patient or personal representative could be calling to inquire about appropriate disposal of medication after treatment is complete.
The patient has entered hospice care and there is a clear indication in the transcript that the patient is discontinuing treatment.
What does this sound like?
"I finally got off the transplant list, so I will no longer be taking the medication.”
“My doctor actually took me off that medication.”
“I switched to another medication.”
“I am in remission so am no longer taking the medication”
“What am I supposed to do with the extra medication left since my doctor took me off of it?”
“I am going to go ahead and close your case, then.”
What does this not sound like?
This tag is not intended to be used for a patient whose treatment has been temporarily disrupted due to reasons ranging from lapse in insurance to supply issues, side effects.
Keywords
Patient is deceased
Patient passed away
Switched treatment
Started different treatment
Stopped treatment
Discontinued/ended treatment
Completed treatment
No longer taking
Quit taking
Treatment not working
Took me off
Not restarting/resuming
Close case
Treatment Disruption
Treatment Disruption
Definition
The patient has been taking medication, and, for whatever reason, there is a disruption in the treatment whether that is due to a voluntary or involuntary reason.
Examples
The patient’s treatment is temporarily disrupted due to lapse of insurance, delayed re-authorization/benefit verification process, supply issues, side effects, voluntary decision to pause treatment, or other reason that may or may not be specified on the call.
The patient’s treatment is temporarily disrupted, and while the transcript suggests the patient may resume treatment, there is no timeline for when that will happen.
The patient has entered hospice care and there is indication in the transcript that the patient has missed doses.
What does this sound like?
“I am still waiting for my insurance to approve the medication again. I have not had the medication for about 3 weeks now.”
“I am wondering when I can expect the prescription to be available at my local pharmacy, I have been out of my medication for a while now.”
“My doctor wants me to hold off taking the medication until they can run some further tests.”
“My injection pen misfired, and I don’t have any doses left on hand, so I missed a dose.”
“I heard there was a recall on my treatment, and I don’t want to take any until I know my lot was not impacted.”
“I am pregnant, so I stopped treatment for now. I don’t know if my HCP will put me back on treatment.”
What does this not sound like?
This tag is not intended to be used for a patient who has discontinued use of treatment and does not intend to continue treatment.
This tag is not intended to be used when a patient’s is undergoing a PA renewal, but they still have medication on hand to use.
This tag is not intended to be used when a definitive plan to restart the medication is discussed, including when the medication will be resumed.
Keywords
Missed dose
Postponed
Temporarily stop
Stop for a while
Treatment on hold
On hold for now
Pause treatment
Cancelled
Rescheduled
Overdue/late for treatment
Treatment lapse
Restarting Treatment
Restarting Treatment
Definition
The patient is resuming or working to resume treatment after stopping or disruption of treatment.
Examples
The patient’s treatment was disrupted, and the transcript provides a timeline for when the patient will restart treatment. This may include a planned restart date or the agent or customer calling to schedule a medication delivery so the patient can restart treatment.
The patient or caregiver is calling to inquire about reenrolling in the program as they wish to restart treatment.
The patient could be calling to report that they would like to resume treatment after having tried a competitor drug that was not as effective.
The agent may call the patient who has been waiting to restart a medication due to documentation delays (order forms, backordered medications, expired prescriptions, denied prior authorizations, etc) to notify the patient that the issue causing a disruption has been resolved and patient is able to schedule shipment.
What does this sound like?
“We received a referral from your HCP so you can restart the medication.”
“I tried [competitor medication], but I was not having the same success. I am working with my insurance to get approved to get back on this medication.”
“I told my spouse we had to figure out a way for me to get back on this medication.”
“I started having symptoms again about a month after being off the medication, so I need to get back on.”
“Gosh, I used to take this medicine back in 2004 and now I’d like to restart it.”
“We will need an enrollment form in order to restart the patient on treatment.”
“My HCP had me stop taking the medication last week and am going to start again on Tuesday.”
What does this not sound like?
This tag is not intended to be used for a patient who missed one dose and already resumed treatment.
This tag is not intended to be used for a patient who has already restarted treatment; the patient would be considered on treatment.
Keywords
Restarting
Starting again
Resume
Get back on
Taken before/Taking it before
Re-train