Direct by Design: How Pharma Can Lead the Future of Patient Experience and Interoperability

Authored by: Colleen Ferlotti and Rupa Mehta

The healthcare landscape is shifting toward direct relationships between pharmaceutical companies and patients, an evolution driven by rising consumer expectations, affordability pressures, and an urgent need to modernize the patient experience. Traditional channels – payers, providers, and pharmacies – remain essential, but they are often fragmented and operationally strained. Increasingly, pharma leaders see an opportunity to step in, not by bypassing those stakeholders, but by building connected, patient-first pathways that simplify access, elevate support, and create new standards for engagement.

This perspective builds on the conversation from the recent Trending Health episode, Direct by Design: Pharma’s Next Channel is the Patient¹. It explores two critical opportunities for pharmaceutical leaders designing these next-generation Direct-to-Patient (DTP) platforms:

First, how pharma can close long-standing patient experience gaps that providers have struggled to address; and second, why achieving true scale requires participation in the same interoperability standards that underpin safe, coordinated care across the broader healthcare ecosystem.

Pharma is Addressing the Patient Experience Gap, Because it Can

“Direct by design” isn’t merely DTC media, it’s designing upstream, end-to-end journeys (diagnosis → initiation → adherence) with digital entry points, service layers, and logistics that meet consumer expectations.

That vision demands capabilities (e.g., access navigation, benefits verification, refill orchestration, proactive adherence support) that many providers, constrained by margin pressures, struggle to keep up.

Why Pharma is Positioned to Succeed

While the concept of digitally-enabled care pathways is not new, healthcare has continually struggled to deliver an experience that patients find satisfying when compared to other industries. Pharma, newer to this space, is showing signs that it may finally deliver what others have not. A few reasons we believe this is the case include:

• Provider margins are thin and volatile. Even as performance stabilized from 2023-2024, recent reports maintain that hospitals are operating close to the line, with median operating margins hovering near low single digits and significant spread between winners and laggards. That limits discretionary investment in non-revenue clinical services like navigation and longitudinal engagement.²
• Pharma’s structural profitability is higher. Industry margin datasets consistently place branded pharmaceuticals well above traditional care delivery providers on net income margins. Advocacy and analyst snapshots over the last two years echo a similar directional conclusion: manufacturers’ net margins materially exceed other supply-chain sectors, creating more room to fund patient services that reduce friction to appropriate therapy.³
• Investment is already flowing into patient services. We see growth in tech-enabled patient support (enrollment, affordability, onboarding, and adherence), and the expansion of digital health tools embedded in care journeys. These capabilities are precisely what close experience gaps-if designed with evidence, outcomes, and equity in mind.⁶

So what? For pharmaceutical brands, “patient channel” is not a media plan; it’s an operating model choice. Pharma is in a better position to invest in experience than providers in a way that may bring healthcare closer to other consumer products industries for the first time. But with this, there must be an accountability to measure clinical, access, and experience outcomes, not only conversion.

Signals your organization is ready: clear ownership of patient services, integrated access/ affordability workflows, service-level agreements with partners (HUB, specialty, RMOs), and outcomes dashboards that tie services to initiation, persistence, and total cost of care.

The Hidden Risk: Cross-industry Technology Gaps Can Break DTP Models

Direct-to-patient models add new systems, apps, vendors, and services into already complex data flows. Without interoperability, each new touchpoint risks becoming another silo. That’s not only inefficient, but it can introduce risk to patients.

Why it matters now

As pharma steps closer to the point of care, it also steps into an information ecosystem that has been decades in the making. Understanding how healthcare data has evolved helps explain why interoperability is not a technical detail, it is a safety and trust issue.

• From paper to digital. Health information was once trapped in paper charts and isolated systems. The HITECH Act and other policies moved this data into digital form, making it easier to share and exchange securely.⁴
• From one-to-one sharing to connected networks. Instead of each hospital or clinic sharing information directly with another, the U.S. is now operationalizing national exchange through Qualified Health Information Networks. This enables information to move more freely and securely across the whole country.
• From messy data to common standards. The healthcare world is learning to “speak the same language” with data. Shared rules and standards make it easier for everyone – doctors, hospitals, researchers, and companies – to connect systems and use information safely and effectively.⁵

Why the Life Sciences Industry Must Take This Seriously When Playing in Care Delivery

The promise of DTP will only hold if pharma’s patient-facing tools and services integrate with the broader care ecosystem. Without that alignment, what begins as innovation can quickly erode safety, experience, and trust – three dimensions of performance that every life sciences organization must manage intentionally as it moves closer to care delivery.

• Patient safety and quality. Peer-reviewed evidence links poor usability and missing interoperability to medication safety risks. If a brand-run service can’t reliably read and write key clinical data (e.g., problems, meds, labs), you invite duplicate therapy, missed contraindications, or delayed interventions.

• Experience fragmentation. Patients shouldn’t juggle a provider portal, a pharmacy app, and a brand app that don’t talk to each other. Interoperable APIs, consented data use, and participation in data exchanges prevent “yet another login” from becoming “yet another gap.”
• Regulatory and reputational exposure. Information blocking rules, evolving policies, and payer interoperability expectations raise the bar on how data must flow. DTP initiatives that hoard or strand data will face scrutiny and lose provider trust.
• Increased design complexity. Entering into the care delivery ecosystem means new levels of internal cross-collaboration and significant implementation investment, as well as new external connections and requirements.

How to succeed: Pharma should define the types of patient experiences they want to provide, hire the right employees who can deliver them, define clear ownership and organizational structure to support them, and be prepared for agility as regulations change frequently and significantly in this space.

What Good Looks Like: A “Direct by Design” Blueprint that Closes Both Gaps

To bring the vision of a truly connected patient channel to life, pharma must design for both experience and interoperability, ensuring that patient experiences are seamless for users and integrated across the broader ecosystem. The following principles offer a practical blueprint for doing both.

• Build services that providers want to plug into.

A Direct-to-Patient model only works when providers see value in connecting to it. Earning that trust starts with building systems that fit naturally within existing clinical workflows rather than sitting alongside them.

• Use shared rules and tools. Set up systems that follow common data standards, give clear instructions for how to use them, and make it easy for apps or services to work right inside electronic health record (EHR) systems.
• Connect through trusted networks. Join a national health information network so you can share important updates, like care plans or test results, without making doctors or nurses log in to separate websites.
• Invest in experience and measure it like a clinical asset. Tie investments to access, initiation, and persistence metrics (e.g., time-to-start, abandonment) and, where feasible, clinical outcomes.
• Treat data governance as a launch-critical workstream. Map standard data elements for each service moment: define provenance, consent, and retention policies that satisfy regulatory obligations and partner requirements.
• Reduce clinical risk through interoperability-aware design. Implement closed-loop medication workflows (e.g., eRx status, dispense, adherence signals) back to clinicians.
• Partner where it counts. Where provider capacity is constrained, coordinate with health-system pharmacies and care management teams; and align SLAs to prevent handoff gaps.

Bottom Line

Pharma’s patient channel can and should close real experience gaps that providers can’t sustainably fund today. But without interoperability, DTP becomes another silo. The winners will invest in integrated services that clinicians trust, patients prefer, and regulators applaud, because they are direct by design and connected by default.

References

1. Vynamic LLC. (2025, October 30). Trending Health podcast: Direct by Design: Pharma’s next channel is the patient. https://vynamic.com/trending-health-podcast/ Vynamic LLC
2. Kaufman Hall. (n.d.). National Hospital Flash Report: Hospital margin context; Axios coverage of margin dispersion. https://www.kaufmanhall.com/insights-reports/national-hospital-flash-report kaufmanhall.com+2kaufmanhall.com+2
3. Damodaran, A. (n.d.). Margins by sector (US). NYU Stern School of Business. https://pages.stern.nyu.edu/~adamodar/New_Home_Page/datafile/margin.html Stern School of Business+1
4. Office of the National Coordinator for Health Information Technology. (2020). Cures Act Final Rule. https://www.federalregister.gov/documents/2020xxxx/health-data-technology-and-interoperability‑certification‑program (Note: specific citation for TEFCA final rule, designated QHINs, and FHIR pilot roadmap found at https://www.federalregister.gov/documents/2024/12/16/2024-29163/health-data-technology-and-interoperability-trusted‑exchange‑framework‑and‑common‑agreement‑tefca) Federal Register+2ASTP TEFCA RCE+2
5. Health IT Answers. (2024, January 22). FHIR Roadmap for TEFCA Exchange V.2: FHIR APIs are on their way into TEFCA Exchange. https://www.healthitanswers.net/fhir‑roadmap-for-tefca-exchange‑v‑2‑fhir‑apis‑are‑on‑their‑way‑into‑tefca‑exchange/ healthitanswers.net
6. IQVIA. (2024). Digital health trends 2024. https://www.iqvia.com/ (McKinsey & Company. (2024). The next wave of value for pharma: Digital patient services. https://www.mckinsey.com/)