In addition to learning about the process of finding and securing a trial award, AICs considering getting into clinical research should also take a look at the reality of patient recruitment for clinical trials. Recruitment is a challenging and unique aspect of trial conduct, but rhymes with many activities that are more familiar to AICs. In some ways, independent for-profit healthcare providers have a few acuminous advantages for the process that research institutions might lack.

As we have mentioned a few times in this guide, trial recruitment is a hard, unsolved problem. Estimates vary by geography and treatment area, but the vast majority of drug studies either struggle to enroll their target number of patients point-blank or at minimum face significant (costly) delays as they attempt to do so. The associated costs and pain are big drivers of sponsor interest in finding research partners who work across a more widely distributed set of patient groups, and as we saw in chapter three, AICs can use this interest to their advantage—provided they know how to talk about the problem knowledgeably.

To secure patient participation, sites and researchers typically lean on two main channels: referral and advertising. Referrals come largely from patients’ existing care teams, and patients report preferring to hear about clinical research opportunities through their doctors, but the same survey efforts show that patients actually hear about studies from ads and advocacy groups much more often. There’s a second-order hurdle for researchers here, which is that patients in underrepresented groups also tend to be less likely to have a regular doctor or established primary care provider—therefore also being less likely to be referred.

AICs’ existing patient populations are de facto in some form of regular contact with physicians, since their infusion treatments were prescribed to them, but the providers who referred those patients to AICs also see many other patients that they do not refer. These nodes in the AIC’s network are an important first connection between the AIC’s directly-accessible patients and their broader addressable market. AICs can plan to spend some time making their referring providers aware of studies ahead of time so that they can start thinking about patients who might be a good fit and interested in participating.

Another valuable partner in referring patients who might be qualified is a relevant patient advocacy group. Due to the larger scale and distributed nature of the phases of trials AICs are likely to be participating in at first, it’s likely that the sponsor will already be in contact with the major advocacy groups that work on the condition the drug is intended to treat, but if AICs know of others (especially local groups or chapters) it’s likely worth either flagging them to the sponsor during study start-up or reaching out to them directly.

The other major channel for patient recruitment is advertising. Historically, the expense of reaching large enough numbers of people to get lucky by landing in front of the rare patient with a relevant condition has made trial recruitment a capital-inefficient application of ad budgets, but contemporary ad tech allows for much more targeted tactics. Because every message related to trial recruitment is part of the informed consent process and must secure IRB approval, it’s important for AICs to think through their recommendations in the study start-up phase (or risk causing delays to get IRB approval for adjustments after the trial begins).

It’s important to understand that trial recruitment requires sites and researchers to adhere to some ethical constraints—for example, a trial can’t be represented as making a safe or effective treatment available, emphasis on compensation should be minimal, and the compensation or reimbursement itself cannot be coercively high. However, even within these messaging frameworks (and with the caveat that both patient compensation and study protocol are ultimately decisions set at the sponsor/study level, not on a per-site basis) AICs can still lean on their ability to market patient-forward care as they promote trial participation to their target audiences.

Marketing tactics that can work well for clinical research will be familiar to basically any person who’s marketed to consumers—paid social targeted by geography, demographic, and relevant interests, remarketing, geotargeted paid search, local public transit ads and radio spots (especially for older audiences and broader populations), and flyers at local points of interest for the target audience (like referring providers’ offices or in places patients access care-related services, like patient advocacy or care coordination).

A helpful advantage AICs have in recruiting is experience offering a patient-forward version of scheduling. Recruitment doesn’t just stop at lead generation. Taking a patient from the initial outreach through a successful screening and to enrollment is a game of patience and follow-up, and to speak to patient populations who have attempted to volunteer for trial participation is to hear story after story of black boxes and ghosting. While many patients will not be a fit due to inclusion/exclusion criteria, lack of motivation, or inability to commit to required travel, research sites also leave large numbers of eligible patients in the dark after they fill out the info request form or simply fail to keep in contact long enough to complete screening.

Ultimately, all the traits that make an AIC successful in marketing through its normal course of business—patient experience obsession, diligence, and a focus on efficiency—lend themselves well to trial recruitment efforts.