Improving Clinical Trial Patient Retention Using Cognizant’s HealthActivate Patient Engagement Solution

| HealthActivate

2 KEEP CHALLENGING September 2014

Life Sciences companies are under increasing pressure to reduce clinical trial costs, even as less than 50 percent of trials complete on time or on budget. Patients drop out, or fail to follow trial instruc-tions, such as when to take medication, how to document what they’re eating and what kinds of activity they’re doing. And patients often report they feel forgotten once trials commence, with little communication with the investigator or the staff.

Understanding why patients participate in trials, and providing the ongoing communications with them are crucial to patient engagement and, by extension, successful trials.

Cognizant: Helping Your Organization Increase Patient Engagement and Reduce Trial CostsLife Sciences firms are under increasing internal and external pressures to improve research and development efficiency – especially around clinical trials. The growing use of specialty drugs and ‘personalized medicine’ has made completing trials more difficult due to smaller patient populations.

Patient retention is one of the largest determinants of whether a trial is completed on time or on budget. In addition to smaller trial sample sizes, trial subjects are often confused by complex protocols and can develop ‘trial fatigue’, especially in long, complex trials. Patients often complain of feeling out of touch with their investigators once the trial begins.

At Cognizant, we enable your organization to engage clinical trial patients with powerful, proven capa-bilities that understand patient trial motivations, personalize communications with them for richer understanding, and provide ongoing communications tools, including mobile, web and sensor-based technologies to keep patients motivated and on track.

Empower Clinical Trial Patients with Cognizant’s Powerful HealthActivate Patient Engagement PlatformPatient engagement is ultimately about understanding and influencing patient motivations and behaviors so they adhere to trial protocols. The Cognizant HealthActivate Patient Engagement Product that brings together three critical concepts for successful patient engagement:

1. Bring Your Own Healthcare Device (BYOhD). The BYOhD lets investigators, sponsors and patients decide which devices and sensors they’ll use to collect and integrate trial data from multiple sources. These sources can include a wide variety of healthcare consumer and patient self-monitor-ing devices, from wireless glucometers, BP monitors, and spirometers to wearable fitness trackers.

Our BYOhD capability then creates an integrated, longitudinal patient record that is analyzed and turned into actionable insights that can further stimulate engagement.

2. Behavior modification techniques. The point of patient engagement in trials is to encourage adherence with trial regimens and reduce (or eliminate) patient drop-outs. Cognizant’s HealthActi-vate platform? provides personalized, targeted patient education and services that:

a. Encourage and support the right trial-related behaviors regarding medication, activity and nutri-tion regimens

b. Assist the patient in understanding the trial, their condition, their medications and their trial obligations such as responding to surveys and reporting Adverse Events

c. Send reminders and notifications regarding medication dosing and appointments

d. Use gamification techniques to make trial participation fun and encourage positive behaviors – e.g., dosing on time, reading educational materials, keeping appointments

COGNIZANT’S HEALTHACTIVATE PATIENT ENGAGEMENT SOLUTION 3

3. Personalized health coaching. Cognizant HealthActivate provides patients with real-time virtual coaching through their mobile devices or laptops. It notifies them about new educational material, reminds them of appointments, and periodically surveys patients to encourage them towards the right trial behaviors. We couple this with optional, live health care coaches who can offer effective and timely support with appropriately tailored interventions.

As we know, “one size doesn’t fit all” patients, so Cognizant HealthActivate dynamically adjusts your messaging and engagement mechanisms as circumstances and data warrant. Underpinning all of these capabilities are powerful analytics capabilities that are collecting and evaluating patient data and then using those descriptive and predictive evaluations to select the right engagement mechanisms for the patient as the trial progresses.

Cognizant HealthActivate: A Modular Approach to Match Your Needs Cognizant HealthActivate is comprised of plug-and-play modules that help you customize a clinical trial patient engagement program that best matches your business objectives and strategy. Cloud-based delivery options ensure fast and economical implementation.

1.0 Personal Instrumentation

(BYOhD)

2.0 Behavior Changing Techniques

Social collaboration/usingGame Design/analytics

to target the right intervention

3.0 Virtual & Real health coaches

Improved health outcomes,

lower cost, better experience

SS gg

Figure 1: Cognizant’s Patient Engagement Platform is based on interweaving three critical components, each of which is necessary to create and sustain effective engagement with clinical trial patients

Figure 2: Cognizant’s Patient Engagement Platform Plug & Play modules

4 KEEP CHALLENGING October 2014

Our Patient Engagement Platform modules include:

Patient EducationOvercome the barrier that only 12% of patients are health literate by delivering the consumable

information in the right medium at the right time and provide incentives to motivate users

Consumable Right Medium Right Time Intrinsic Incentives

• 2 minute videos• Mobile articles• Quizzes• Tips & Challenges

Leverage patient archetypes to deliver information via the right channel• Smartphone• Web Portal• SMS• Email• Phone

Customer-centric access and ability to pause, rewind or repeat on your terms• 24/7 portal access• Evening and weekend

clinical support

• Intrinsic incentives• Points, badges and

levels for actions• Leader board• Team challenges• Recognitions• Extrinsic Incentives• Team lunch• Starbucks® card• Free Fitbit® or scale

Medication Adherence

Increase medication adherence rates with alerts, recognitions, passive collection and reporting

Alerts Recognitions Passive Collection Reporting

• Rule based triggers and events

• Push education on impact of non-adher-ence

• Call pharmacist• Notify health coach

• Acknowledge adherence and allow users to notify peers

• Badges• Adherence

challenges• Share badges with

friends

• Collect injections via Bluetooth or proxy biometric data

• Auto-injector• Blood glucometer• BP monitor• Pulse Oximeter

• • Send actionable informa-tion to:

• Nurse• Health coach• Care giver

Virtual CoachIncrease self-awareness by providing immediate feedback for alerts, acknowledging the accom-

plishments of milestones and provide educational topics most relevant to your health status.

Alerts Milestones Educational Topics

• Biometric data is outside the normal range

• Medication non-adherence will trigger requests to call a pharmacist or advice nurse

• Congratulations for earning badges, passing quizzes and completing challenges

• Group recognitions about the leaders for team based challenges

• Recognitions when new levels are reached

• • Challenge the user daily to take tips, quizzes or watch videos

• Share educational tips to increase awareness about symptoms or risks based on user profile

Social & Gamification

Engage users with their peers by voting on videos and content, providing team and individual based challenges, and sharing milestones and results with their friends

Team/Individual Challenges Voting or “like” Content Sharing Milestones

• Teams compete based on department, location or position. Teammates can motivate others towards a common goal.

• Individuals can invite others to join challenges

• Users can rate videos and other educational content

• Surveys used to assess effectiveness and understand motivations by archetype

• When milestones are reached, users can share them with their friends, care givers or community

• Health coaches also view milestones and can add personalized, motiva-tional messages

COGNIZANT’S HEALTHACTIVATE PATIENT ENGAGEMENT SOLUTION 5

Sponsor and Investigator SupportCognizant HealthActivate includes sponsor and investigator portals that give you a deeper under-standing of individual patient progress, including dosing compliance, educational materials access, visit scheduling and compliance and patient survey results across different trials and in different geog-raphies.

Learn MoreCognizant can help you engage with the patients you recruit for your trials to reduce your trial costs and get to real-world outcomes faster. For more information contact inquiry@Cognizant.com, HealthActivate@cognizant.com or visit www.cognizant.com.

Reporting & Analytics

Member feedback lets users view results and track progress over time. Health coach reporting will target at risk patients and Administrative reporting shows program progress

and activity over time.

Member Feedback Health Coach Reporting Administrative Reporting

• View trending on my biometric and medication adherence data

• Share quiz results in real time• Use points, rankings badges

and levels to compare progress to peers

• Real-time feedback on at-risk and compliant patients

• Trending to track patient progress over time

• Group comparisons to show progress vs other health coaches

• Assess utilization and activity reporting

• View outcomes and correlate results with activity

• Assess resource utilization to increase the efficiency of your local nurses/health coaches

Bring Your Own health Device

(BYOhD)

Cognizant HealthActivate strongly supports trials in which patients are required to use one or more medical devices, wireless ‘wearable’ devices and in-home monitoring devices.

This BYOhD capability gives the trial sponsor and investigator additional flexibility and encourages patient trial participation.

Device connects Device integration Other Features

• Wireless and USB• Glucometers• BP monitors• Spirometers• Weight scales• Pulse Oximeters• Commercial ‘Fitness’ and

‘Wellness’ devices from multiple manufacturers

• Intelligent integration hub for 40+ devices; 100+ by EOY 2014

• Device and OS agnostic• 3rd party applications and data

streams• Multiple ‘fitness’ and ‘wellness’

portals – e.g., exercise and nutrition

• Integrated longitudinal patient record from all data sources

• Fully HIPAA and PHI compliant• Supports de-identified data and ‘Safe

Harbor’ standards• Metered open API• Out of box user app & portal with

social features

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inquiry@cognizant.com

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About CognizantCognizant (NASDAQ: CTSH) is a leading provider of informa-tion technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jer-sey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embod-ies the future of work. With over 75 development and delivery centers worldwide and approximately 187,400 employees as of June 30, 2014, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant.