Contributed Commentary by Sam Whitaker and Jason Dong, Mural Health  

January 20, 2023 | Patient-centricity has become a buzzword in clinical trials, but many practical barriers still limit diversity and reduce participant satisfaction. As an industry, our true north should be making it easier to participate in clinical trials for a meaningful impact on patients and significant added value for sponsors.  

A key challenge leaving patients feeling marginalized, decreasing diversity in recruitment and retention, and ultimately impacting the quality of data is a lack of solutions to adequately overcome financial barriers. For example, a Journal of Clinical Oncology study found financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials (DOI: 10.1200/JCO.2015.63.2463). Similarly, a Journal of the American Medical Association Oncology study found patients with an annual household income below $50,000 had 32% lower odds of trial participation than higher-income patients, and trial participation decreased as the yearly household income decreased (DOI: 10.1001/jamaoncol.2015.3924).  

Despite such findings, the payment product sector offers a lack of digital payment options, payment delays, and even obscene monthly fees for patients who do not use their reimbursement fast enough. To make trials patient-centric, we must revolutionize product platforms, so they genuinely serve patients and caregivers.  

Payments That Work for the Patient 

The Council for International Organizations of Medical Sciences states: “participants should not have to pay for making a contribution to the social good of research.” Yet many debit-card payment products currently on the market charge fees to participants. Arguably the most predatory of these are so-called “inactivity” fees which penalize patients for not using their reimbursement fast enough.  

Patients also incur fees for accessing their funds, receiving an account statement, replacing a physical card, removing all the funds from their account, and converting funds to local currency. Therefore, eliminating this fee structure within clinical trials must be one of the first steps to overcoming financial barriers to trial participation.  

We must also make it easier for participants to choose how they are paid, with options reflecting the methods patients use in their everyday lives. Participants should be able to select from digital options like Venmo, PayPal, and direct deposit. We must also include slow adopters of technology. For example, participants should be paid via check if that works best.  

Moving away from reloadable debit cards towards digital options also provides operational efficiency to multiple study stakeholders. For example, eliminating a physical card inventory decreases fraud risk, speeds study startups, and reduces expenses.  

Driving Robust Engagement and Actionable Insights 

While updating payment products is crucial, there must be effective interfaces between the product and the patient to create a patient-centric experience. Mobile applications allow us to transform a payment product into something more compelling and strategic.  

Mobile apps can provide insights to sites and sponsors by collecting satisfaction data from participants using the payment product. Technology can identify participants with negative experiences and empower proactive intervention by the site, hopefully retaining those who would otherwise drop out. Data also allow study teams to identify high-performing sites, those that may need support to increase patient satisfaction, and weak spots in protocols that drive attrition. In the future, this functionality could include predictive analytics to identify participants at risk of drop-out before they are in a critical state.  

Transportation to and from clinical trial sites presents not just a financial barrier but also a logistical challenge for many participants. In a 2017 survey of US clinical trial sites, 95% reported that transportation infrastructure would improve recruitment efforts, and 63% felt it would ensure all studies were recruited on time. Eighty-four percent noted that taxi or ride sharing would be the preferred transportation method. By integrating with services like Uber Health, patients can call rides from their mobile app and would not have to front the payment because it is integrated.  

Integrated mobile apps also offer the opportunity to expand communication with patients beyond one-way email and SMS notifications. This includes not just app-based push notifications but secure two-way centralized messaging between the site and the participant, allowing participants to connect with site personnel directly. In the future, this could include sentiment analysis to get better insights about patients.  

Now Is the Time for Change 

We are faced with an exciting opportunity to expand the scope of payment products in a way that will broadly impact trial participants, sponsors, research sites, and the broader global patient population. This opportunity exists because companies operating inside the participant-payment category have failed to innovate. Still, we can modernize the participant experience and execute a bigger vision that leverages participant payment strategically.‍  

Sam Whitaker is the co-CEO and co-founder of Mural Health, a company that represents a natural evolution from Sam’s past work. The Mural Link product leverages a next-generation participant payment technology to drive deeper benefits to the participants and more meaningful value to both sites and sponsors executing the study. Before co-founding Mural Health, Whitaker founded Greenphire in 2008, where he was responsible for inventing the first payment technologies vertically integrated into the clinical trials industry. Whitaker is from suburban Philadelphia, Delco, and is a graduate of the University of Pennsylvania. He can be reached at sam@muralhealth.com. 

Jason Dong is the co-CEO of Mural Health. He co-founded the company, intending to use technology to elevate the patient experience in clinical trials. When Dong was an investor in pharma technology businesses at Advent International, he had an off-the-cuff conversation with co-founder Sam Whitaker about what it would look like to modernize the patient experience. That conversation snowballed, and over the next year, Mural Health was founded. Dong is excited to bring his expertise and insights into building a world-class organization at Mural Health. Dong grew up in New Zealand and came to the US to attend Harvard. Previously, he was a management consultant at McKinsey & Co. He can be reached at  jason@muralhealth.com.