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Linked Patient Learning
Loading Experience
A patient services VP showed me her dashboard recently.
Enrollment completion: 95%.
Benefit verification: 48 hours.
First fill rate: 87%.
Then she showed me her persistence data. Down 18% year-over-year.
"I can't explain it," she said. "Every metric we measure says we're doing things right."
That's the gap I keep seeing. Strong metrics. Declining outcomes. No clear connection between the two.
I call it the 90/10 Framework.
What the 10% Is
The 10% is what your patient engagement infrastructure was built to measure.
Enrollment. Benefit verification. First fill. Hub calls. Foundation applications.
These are activation moments. Discrete. Trackable. Reportable. They give you clean dashboards and quarterly metrics.
Most pharma teams optimize the 10% relentlessly because they can. The vendors are built for it. The systems track it.
Pharma actually does the 10% pretty well.
That's not the problem.
What the 90% Is
The 90% is everything else.
It's the patient deciding at week 6 whether to refill the prescription that gave her a headache.
It's the spouse navigating a Medicaid redetermination that nobody flagged.
It's the foundation approval taking 21 days when the patient needed medication in 7.
It's the side effects appearing at 11pm on a Sunday when the hub isn't open.
It's the copay card converting to foundation support — a coverage stress signal nobody recognized.
It's the 14-day window between hub enrollment and specialty pharmacy first fill, where 23% of patients quietly disappear because no single vendor owned that handoff.
The 90% is where persistence is won or lost.
It's also where most pharma infrastructure has no visibility.
Why the 90% Is So Hard to See
It happens between vendor touchpoints. Hubs see enrollment. Pharmacies see fills. Foundations see approvals. None of them report on the space between.
It happens in patient lives, not pharma data. Coverage transitions, family conversations, work conflicts, transportation challenges — these don't show up in your dashboard because they don't happen in your systems.
It happens slowly. By the time you can prove persistence is dropping, the damage is already in the numbers.
Why the 90/10 Framework Matters
It names a problem most cross-functional teams are feeling but can't articulate.
Medical Affairs sees outcomes that don't match Commercial's activation metrics.
Commercial sees declining persistence despite strong enrollment performance.
Patient Services sees vendor scorecards looking fine while patients fall through.
Brand sees real-world evidence that undermines the value story.
They're all looking at the same problem from different vantage points.
The 90/10 Framework gives them shared language.
It says: the activation work you're doing isn't wrong. The infrastructure to sustain it doesn't exist yet.
The Questions Worth Asking
Take a step back and ask:
If you can't answer these clearly — that's the 90% problem.
What We Built
After dozens of conversations with senior pharma leaders about exactly these questions, we built something specific.
A structured tool that helps cross-functional teams map the invisible gaps in their patient engagement infrastructure. Purpose-built for the 90% problem. Customizable for therapeutic area and company size. Security-built for pharma environments. Designed for Medical Affairs, Commercial, and Patient Services to use together.
If your answers to those questions reveal gaps you can't define — that's exactly what this is for.
Send me a message. Let's talk.
— Liza, Linked Patient Learning
Written by
Liza Prettypaul-Lodhia
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