Clinical trials must recruit and retain patients to succeed. But it’s easier said than done –and as a result many trials are delayed, scaled back or even scrapped completely especially when they involve international travel. Today’s guest, Scott Gray founded Clinicierge to reduce logistical and financial challenges for patient to enhance enrollment and reduce attrition.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
Clinical trials must recruit and retain patients to succeed. But it’s easier said than done –and as a result many trials are delayed, scaled back or even scrapped completely especially when they involve international travel. Today’s guest, Scott Gray founded Clinicierge to reduce logistical and financial challenges for patient to enhance enrollment and reduce attrition.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
0:00:10 - David Williams
Clinical trials must recruit and retain patients to succeed, but it's easier said than done and, as a result, many trials are delayed, scaled back or even scrapped completely, especially when they involve significant travel. Today's guest, scott Gray, founded Clincierge to reduce logistical and financial challenges for patients, to enhance enrollment and reduce dropouts. Hi everyone, I'm David Williams, president of Strategy Consulting from Health Business Group and host of the Health Biz Podcast, a weekly show where I interview top health care leaders about their lives and careers. If you like this show, please subscribe and leave a review. Scott, welcome to the Health Biz Podcast.
0:00:50 - Scott Gray
David, thank you very much. Happy to be with you.
0:00:52 - David Williams
Outstanding. We're going to talk all about patient recruitment and retention. I want to talk a little bit, if you don't mind, about your childhood and your background and want to know what was your childhood like and any childhood influences that have stuck with you throughout your career.
0:01:06 - Scott Gray
Wow. Okay, so I was one of five children, twin brothers, who were older, sister, oldest and then a younger sister, so I'm sort of fourthish and I was always like the curious one, the reader. I should have been the nerdy-ish one, like to do mechanical things and build things and figure out puzzles and all of that. So it kind of does influence what I still do today in figuring out puzzles of how to get people where they need to be to participate in clinical trials.
0:01:51 - David Williams
And Scott, what did you do for your education after high school?
0:01:54 - Scott Gray
So well. In high school I went through all of the AP courses advanced biology, german four, and I asked to take an extra major Spanish one. So, and then I had medical terms in Latin, because I thought I was going to be a doctor?
Yeah, sounds like it. My parents, though, were divorced and things were financially not well, and I decided, coming out of high school, that I wanted a job so I could buy a car, so worked in a factory for three years. Well, after two years, I looked around the manufacturing floor and realized I did not want to be that person in 30 years, so went back to my desk at home and looked through all of the college brochures, selected a travel training school, and that's what I did. I went through a travel training curriculum and then started in the industry hospitality industry.
0:02:50 - David Williams
Sounds good and I saw a few things along the way.
0:02:53 - Scott Gray
Rosenbluth, yes yeah, they were my first employer right out of travel school and there I got more experience learning the computerized reservation system so what everyone now uses online to book travel and then was recruited by a manager who was opening another branch office for that company and they were serving a large pharma company in their corporate meetings and events management. So that's where I learned corporate meetings and events management and began traveling a lot of the us and some outside of the us and in experiencing the world very nice I think I remember rose and blue from back when I was working for boston consulting group.
0:03:38 - David Williams
When we're doing the post merger integration of two very big pharma companies, that makes us with two very different cultures in one, the travel department reported into like the executive, you know services, and another one reported into procurement, and so the two used to come and we were I won't say the city, but you know one group used to stay in the four seasons and the other stayed in the wind them and then one would fly first class and the other one wouldn't, and so we had all these very big departments to put together, but the travel was the one that was, like, the most difficult and got, you know, got special attention.
0:04:11 - Scott Gray
so it's a lot of interesting is that a company that now goes by three letters? Yeah, it is so. I worked on their account and they became a customer of my company I'm great consulting, which we founded in 1994 to do corporate meetings events. They became one of our first customers back in 1994, nice, and remained as a customer until we went through strategic planning, exited corporate meetings in 2017 and we terminated our agreements in the corporate meeting space very interesting great well, and then I saw in between rose and blue and maybe it's me get again.
0:04:52 - David Williams
is that what you're talking about?
0:04:54 - Scott Gray
They were, they were another corporate meeting planning company and you know how and more skills there, had an opportunity to manage A department and other the other booking agents who are working in the air department. And then I moved over again to the corporate meetings and events management planning side and again had some more great travel opportunities around the globe and and meeting other farm execs. Their business was was also heavily Saturated in the farm sector, so I got to know a lot of the other farm companies and and the executives at their company got it, got it.
0:05:35 - David Williams
So now, and great consulting you started and you continue to have that. How does, how does that fit into the overall picture?
0:05:43 - Scott Gray
So, I'm after. After the get again, I took a director of operations position at a small meeting planning company in the philly suburbs there was. I was there for about 8 months and the guy that owned it didn't have any more business for us to manage the rest of the years so he Terminated all the staff. Midyear got so I got fired June 3094 best birthday present ever nice Bounded, great consulting that in August. And then we rapidly grew.
And then back 10 years ago now it is a little over 10 years ago a customer for whom we were doing investigator meetings asked if we could figure out A way to providing logistical support to patients in a rare disease clinical trial that they were launching in 18 countries. Ex-us got it. The sites were remote from where the patients lived and we need to figure out how to get them. So we used our hospitality experience, our experience providing the logistics for physicians or farmer reps or sales reps when they would go to big global meetings and we apply those sensibilities, including the hospitality aspect, to the way we built the Clincierge Business and now what we do in clinical trials got it all right.
0:07:06 - David Williams
So you're used to sort of the high end, high touch, all the little details that people need to do their job. I mean, I was, I was not joking about with the. With this merger there's a big philosophical difference. Right one was the, yeah I experienced it as well.
0:07:21 - Scott Gray
Yeah, yeah, the way they operated in the south was way different than the operated in the north. Yeah, so you know.
0:07:29 - David Williams
so what happened is you have one philosophy says you know, that's expensive, that's difficult, someone doesn't need that. Another one says I'm working on important and expensive things and if I've got my maximum productivity, calmness and rest, it's going to be worth it. That's right.
And so I concede now already how we're talking about you know we'll get into. I'm sort of leading the witness here, but you know what are the challenges in clinical development, what are some of the big issues that you deal with, why, you know, why does it matter that you have the Clincierge approach, even?
0:08:04 - Scott Gray
Well, so a really good question, david. The thing that you know, I didn't believe that this wasn't already a business when this particular client asked us to create this. We just had a good work in relationships, so thank you for that opportunity is really all I was viewing it as. But then, after doing a market assessment of what's already out there, similar to what we were doing, we discovered that there wasn't much and the types of patients that could benefit from having support services as we were creating, you know, prepaying for travel so that it wouldn't be a financial burden to a family, and even having the knowledge of how to put those logistics together where a family may not have ever traveled and didn't know the first thing about how to get their child from Philadelphia to Chicago so that they could be in a rare disease or in a pediatric clinical trial. So the surprising thing was there wasn't something out there that the it was. You know it was the same the measure of insanity keep doing the same thing over and over and expecting something different.
So dropout rates in clinical trials continue to be hovering between 35 and 40%, which means if you have 50 patients in a trial that lasts a year and 10 patients decide to drop out mid-year, you have to re-enroll those 10 and you now have.
They have to be in for a full year. So you've extended your time investing in the operation of that clinical trial and that's funded by the R&D budgets and pharma and biotech. They're now extending the cost to conduct the trial. They're extending the timeline in which they would like to get their outcomes data so that they can submit to the FDA and whichever governing body around the globe where they want approval, and that they can come to market and begin recovering their R&D investment. With the availability of Clincierge services, we they discovered that the companies were discovering and now we are able to do this for many more that they were able to recruit faster because we were going to support the patients. They were more willing to enroll in the trial and retain at a higher level, get outcomes data faster, come to market faster, got it. So it's a win-win for everyone.
0:10:32 - David Williams
So the the recruitment issue is one that is widely discussed and known and there's different reasons for the challenges of recruitment. Retentions also mentioned, although I'll say you give a higher emphasis to it. So I want to talk about retention in a minute. But on the recruitment side, how much of a factor is it in recruitment, the sort of the Clincierge type of services that you can provide? Is that a factor people realize upfront? Or is it more that once they are involved and they're like wait a minute, I understood that my travel is paid for, but if I'm out of pocket for you know however much and I have to wait for reimbursement, you know that's hard. Do people realize upfront that, gee, this is going to be logistically challenging for me and therefore you can benefit there? Is it only once they're enrolled?
0:11:18 - Scott Gray
Actually, the availability of our, of the Clincierge services is used as a recruitment enhancer for those companies that are doing patient recruitment. And I'll use actually the very first customer, the one who asked the question and caused me to create this service. They they had a competitor in this rare disease space who had already launched their trial. Again, rare disease trial. There's a limited number of patients who have been identified, who are even qualified for the trial, so it's immediately competitive at the recruitment phase. We created the Clincierge services. Our customer was now able to speak to the type of support that the patients would have access to. They recruited faster than their competitor who started earlier, retained at a higher percentage, concluded their trial earlier than the competitor who started earlier, got the outcomes data sooner and became the very first RNAI therapy ever approved by the FDA. So that's the demonstration on the ROI of this type of service Got it.
0:12:34 - David Williams
Now I can see that obviously, as you had described before, the ability to recruit quickly and then not just to recruit quickly but also to maintain those patients throughout the course of the trial, means that you can have, you know you can. You can do your data lock sooner and everything moves along faster, which is worth a lot. And then also just there's the cost reduction as well. What do you do along the way, you know, with the Clincierge service, to enhance retention, and is it just a matter of it's just easier and more convenient for the patient, or are there things that you do along the way to understand, like the personalized need, and even identify people at risk that maybe they're going to be dropouts? How does the whole process work?
0:13:16 - Scott Gray
Well, the way we provide our service is by having a Clincierge coordinator who works directly with the patient or the family unit in organizing each of their visits and what our coordinator does. Once the site has gotten us all the documents that the patients have consented for us to communicate with them, then our coordinators talk with the patients and the and or their caregivers to understand what their specific needs are. Are there special mobility or cognitive issues that we need to be aware of so that we can properly organize the logistics? Is their wheelchair access required for vehicles, for hotel rooms, for the airline? Do they need to sit in a specific seat in the airplane? Does there need to be an oxygen tank that goes on board? So we focus on all of that, removing that the obligation or the complexity and the obstacle of the patient having to do that themselves. Plus, we get funded to buy all of those services, so there's minimal impact for the patient to be out of pocket and then, if there is anything, they submit the receipts to us and we're able to rapidly reimburse them.
0:14:43 - David Williams
Now you're describing sort of the the challenges that somebody that has is traveling. Either they're not used to travel or they're, almost by definition, medically compromised if they're going to be in in a trial so they may have special needs. How is this all compounded by, or what happened during the pandemic?
0:15:01 - Scott Gray
Good question, okay, so there were some things that we innovated at that point because there were many patients who they wanted to continue through their trial regimen and if the site was still operating, if they were not Shut down, with health care workers Is redeployed to COVID treatments.
The site was still operating and the patients wanted to still proceed. We figured out methods of getting the patients safely to their sites when, when Europe air travel was shut down, it may have been that we organized a car and a driver who would take them on the on the long drive Across country where an overnight stay was required in each direction. There were other instances where we got approval for private jet transport for an immunocompromised Patient who only had one more visit To finish out their trial regimen and for hat to have all of their their data being included in what was being, what was being collected for outcomes. Another would be, instead of patients going to sites, we organized some instances where site personnel went to the patient's home or sample collection. Instead of the patient dropping it at the site, we sent Hired car service or shared car service to go pick up that sample and take it back to the site. Got it.
0:16:39 - David Williams
Help me understand if you have a role in terms of increasing equity and inclusion in clinical trials. I think about this has obviously been a topic that has gotten a lot of attention Over the past few years, but there's still a lot of challenges with it. I'm relating to what you said before about a patient who's you know, who's never traveled out of pocket is an issue, whereas I travel all the time I can handle out of pocket, etc. So I think about it'd be easier for me to be in a trial for those reasons plus others, and I wonder whether some of your Services also are either indirectly or directly in support of those equity and inclusion goals.
0:17:17 - Scott Gray
Yeah, our services definitely are and we have. We have mandates coming out from Even the FDA. Now there were, there are governing bodies around the globe that were, that are ahead of what the FDA has now put forth in the expectation that companies are now in Expanding the diversity in their clinical trials so that they can. There's better understanding of the science, the effect on different, different genetics, and you can't test it in different genetics unless you have a diverse population in the clinical trial. It can't just be tested on Wealthy 50 year old white guys who can afford to go to the site, you know, or fly somewhere. Because Of the way we deliver our services and provide our services and that they're prepaid by the sponsor, we're able to level the socioeconomic Barriers so that anyone can participate, got it.
0:18:21 - David Williams
So when do you take the business from here? I mean now, because of post pandemic, there's a lot of emphasis going on still with with clinical trials, a lot of expensive trials, a lot of complicated ones, including things like gene therapy, where you know it's a more more complicated than just you know showing up at a site. How do you factor those things into your business? Or do you in fact go the other way and say these more mass market products where you would think there's less of a need for the real high end Clincierge services but you can still get that recruitment and retention benefit from what you do? I wonder how you think about that.
0:18:56 - Scott Gray
Yeah, so, in addition to continuing to expand on our concierge level services that we already provide, one of the things that we've done over the past several years is to I mean, we came out of corporate meetings.
This was a whole new space for us and the workflow is very different.
So we took time to understand the workflow of the now more than 300 trials that we've supported, understand the variations and the consistencies in the workflows, and we've invested in workflow technology that is just in its launch stages. One of the outcomes that we realized is we are now finally able to respond to many customer inquiries where they've enjoyed the benefit of the services that we've done on the concierge side. But can we also support what we're calling noncon the patients who don't need concierge level support? For example, a user interface on a cell phone where you log in and just order a shared ride service to go across town to your trial visit and we pay for it, so you don't have the burden of trying to submit receipts etc. So we're looking at the ability to scale significantly in again the nonconcierge side of the business and be able to support all types of patients and all kinds of disease states, and all along while continuing to maintain our focus of ensuring the best experience possible for the patient, outside of what they need to endure in the medical aspect.
0:20:38 - David Williams
Got it. Scott. I noticed on your profile a couple of looks like longstanding volunteer commitments and I wanted to ask you a little bit about a couple of those that I saw. I saw the smart ride and also Valley Youth House. What are those and what's been your involvement?
0:20:55 - Scott Gray
So Valley Youth House I've been involved with for about eight or nine years and that is in Pennsylvania. We do servicing for homeless youth, especially LGBTQ youth who have been discarded by their families. We provide counseling services, educational services to help them become independent individuals, such as how to open a checking account, how to interview for a job. There's a network of employers that we work with to try to get people into internships and they can become independent individuals on their own. So Valley Youth House we're in about 13 counties in Pennsylvania.
The Smart Ride a friend of mine, a colleague, founded it 20 years ago. Smart Ride happens this weekend, actually here in South Florida and it's a 165 mile bicycle ride from Miami to Key West. We ride out at sunrise from University of Miami and up midday in Key West on Saturday and the intent the Smart SMART stands for Southern Most AIDS Ride Together and there are benefiting agencies who serve people who are infected with or affected by HIV or AIDS, Such as I know a program in the past was the Hugs Program in Orlando where infants who were born HIV positive have access, so their families have access to support and healthcare treatments.
0:22:41 - David Williams
Thanks for clarifying the acronym. I would have guessed that after you said the length of the ride, it was because your muscles are smarting from all of the exertion parts, and I'm actually a big confession.
0:22:52 - Scott Gray
I've been the Iceman for 16 years. That's my job again this year on the crew. I've never ridden the ride. The riders keep telling me my job is harder.
0:23:01 - David Williams
Yeah, well, good, let them think that I would be with you on the ice truck, but that also sounds great. Last question is if you've had a chance to read any good books lately, if there's anything you'd recommend for our audience.
0:23:14 - Scott Gray
Oh, that's a really good question, one that I just downloaded last week. The author is Don and Don if you're listening, I hope I say your last name correctly Shmink S-C-H-M-I-N-C-K-E. And the book that I downloaded is called Winners and Losers, and what caught my eye it's one of the taglines is about how to lose powerfully, and I'm kind of reading it to see how it applies to the risk and the willingness to lose that I've taken over the last 29 years of business.
0:24:00 - David Williams
Great Well. Scott Gray, founder of Clint Sears, thank you so much for joining me today on the Health Biz podcast.
0:24:07 - Scott Gray
A pleasure. David, Thank you so much for having me here.
0:24:11 - David Williams
You've been listening to the Health Biz podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.