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Linked Patient Learning
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The short version: Renewal season evaluates each vendor on its own metrics — and by those metrics, almost every vendor looks good. But patients aren't lost inside any one vendor's piece of the journey; they're lost in the handoffs between them, the seams no contract covers and no dashboard shows. These twelve questions test whether you can actually see the journey across your vendors — because if you can't, you're not deciding which vendors to renew. You're guessing.
Every renewal deck tells the same story. The hub reports strong enrollment completion. The pharmacy reports fast turnaround. The engagement platform reports healthy open rates. Each vendor arrives with a dashboard that proves its piece is working — and each dashboard is probably accurate.
Here's what none of them shows: the patient who completed a flawless enrollment, got a fast benefit verification, received three well-timed messages — and still came off therapy in month seven, in a gap between two vendors that neither one's report was designed to see. Each vendor was selected to optimize its own piece. No one was selected to optimize patient continuity across the pieces.
So the renewal question isn't really "is this vendor performing?" Each one is, by its own definition. The question is whether anyone — any vendor, any dashboard, any function — can see the whole journey. These twelve questions find out.
Score each one honestly: can answer with evidence, can answer partially, or can't answer. Keep count of the last column. It matters more than the other two.
1. Can the vendor show one patient's complete journey on a single timeline — enrollment, fills, financial assistance, field interactions — or only its own touchpoints? This is the foundational test. A vendor that can only show its own touches isn't lying to you; it's showing you its scope. But if no vendor can show the whole timeline, nobody in your program can see where patients are actually lost.
2. When a patient discontinues, can the vendor tell you where in the journey it happened and what preceded it — or only that the patient stopped appearing in its system? "Stopped appearing in our system" is not a discontinuation analysis. It's the moment the patient crossed out of this vendor's visibility — which is usually several steps before anyone noticed they were gone.
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3. Can anyone show you, today, which handoffs out of this vendor are currently sitting open and unresolved? Every vendor hands patients to someone — specialty pharmacy, financial assistance, the field. An open handoff is a patient suspended between two functions. If no report shows open handoffs, patients are waiting in the seams right now and no one knows how many.
4. Which of the vendor's reported metrics measure duration — persistence, time on therapy — and which measure volume: enrollments, calls, touches? Sort the renewal deck into those two columns. Most decks are all volume. Volume tells you the vendor was busy. Duration tells you whether patients stayed. Only one of those is why you fund patient support.
5. If this vendor's program quietly stopped working tomorrow, how long would it take you to notice — and would its own dashboard be what told you? A vendor whose failure would be invisible on its own dashboard is being measured on the wrong things. If the honest answer is "we'd see it in persistence numbers two quarters later," the measurement gap is yours to close, renewal or not.
6. Can the vendor connect its activity to a persistence outcome for an actual cohort — or does the ROI case rest on activity counts and assumptions? "We made 4,000 adherence calls" is a cost. "Patients we reached stayed on therapy longer than patients we didn't" is an outcome. Ask which one the renewal case is built on.
7. For every handoff into and out of this vendor, is there a named owner on the other side — a function contractually required to catch what this vendor throws? Most handoffs are owned on the throwing side and unowned on the catching side. That asymmetry is where patients disappear while both vendors' metrics stay green.
8. When the vendor encounters a barrier it can see but can't fix — a coverage change, a lapsed assistance renewal — what is it required to do, and who is required to respond? If the answer is "they flag it in a monthly report," the patient waits a month. Escalation paths that exist in goodwill rather than in the contract stop working exactly when volume gets hard.
9. Which moments in the patient journey does no vendor you're renewing own at all — and who inside your organization owns those? List your vendors against the journey and the uncovered stretches appear fast: month-seven reauthorization, the gap after case closure, the coverage change in year two. No renewal decision fixes an unowned moment. Only naming an owner does.
10. Is the renewal priced on activity volumes, or is any part of it tied to an outcome you actually want? You don't need a full value-based contract to start. One outcome-linked element changes what the vendor pays attention to — and what they'll proactively bring you.
11. What evidence — not vendor-reported — tells you this vendor's piece of the journey is where next year's dollars matter most, versus a gap two functions over? This is the uncomfortable one. A renewal can be the right vendor doing good work in the wrong place: funding more capacity for a function that already works while the actual leak sits in a seam nobody is pricing.
12. If you were designing support around keeping patients on therapy — rather than getting them started — would you buy this same set of vendors again? Not "are they performing." Would you re-choose them, as a system, for the 90% of the journey where persistence is decided? If the honest answer is "we'd build something different," the renewal calendar is making a design decision that deserves to be made deliberately.
Don't total points. Count the "can't answer" column — and notice where those answers cluster.
If they cluster in Sections 2 and 4, you have a measurement problem: the program may be fine, but nobody can prove it, and that's fixable inside the renewals.
If they cluster in Sections 1 and 3, you have a structural problem — and it isn't any vendor's fault. "Can't answer" there means no one can see across the handoffs, and the gaps live between your vendors, where no renewal, replacement, or added vendor will reach. Renewing well requires exactly the view no single vendor can give you: the whole journey, across every function, with the leaks located and ranked by what they cost. Producing that view is what our patent-pending diagnostic, the Gap Finder, was built to do — so that renewal decisions, and the budget behind them, are aimed at where patients are actually being lost.
The point of the twelve questions isn't to fail your vendors. Most will turn out to be doing the job they were scoped to do. The point is to find out whether anyone is doing the job between the jobs — because that's the work no renewal covers, and it's where the patients are going.
Linked Patient Learning helps pharma teams see where patient persistence leaks across functions and vendors — so renewal and investment decisions are driven by evidence, not dashboards. If renewal season is coming and the twelve questions are hard to answer, let's talk.