Since time immemorial, sponsor firms have chosen software. Then it gets introduced, so to speak, to the throats of research sites. Sometimes principal investigators and clinical research associates (CRAs) like the technologies they are obliged to use. Sometimes they just use them.

So it is remarkable that Greenphire has industry-savvy research sites knocking on its door with no mandate or funding from sponsors.

Ten major academic medical centers (AMC) and a hundred independent clinical sites have called Greenphire and said, more or less, "we'd like to pay for your services with our own money." In a context of industry-sponsored trials, that's unheard of. Even small, independent Phase I units have taken the initiative to seek out Greenphire's solution and buy it on their own.

Unified Approach

ClinPage wrote about Greenphire more than two years ago, but the company's services and operations have since expanded. It launched a full-featured system to handle all payments to sites, not just debit cards for patients. The Philadelphia firm is now running 156 projects, with 31 more in the planning stage, on behalf of 200 sponsors. It's also integrating its technology to work with that of other eclinical firms like Almac.

The scale is impressive. "We are currently executing about 25,000 patient payments per month and that number has been growing at 20 percent month over month for approximately the past 24 months," says Greenphire cofounder and CEO Sam Whitaker: "We are supporting a little over 600 sites." Among other honors, Greenphire participated in a radical Pfizer project with Mytrus that used no traditional sites.

In brief, Greenphire manages and transmits electronic clinical trial payments to approved companies and individuals. Launched in 2007, the company offers comprehensive, web-based tools to control both the messaging around approved payments ("we just sent you $20") and the actual funds.

Because of deep expertise in financial transactions, Greenphire was able to tackle a fatal weakness in many clinical trial management systems (CTMS). Such CTMS typically require hundreds of hours of labor to prepare money to be processed by other people. A second or third system is typically needed to cut the check or transfer the funds. This industry-wide problem is so messy that one prominent contract research organization (CRO) with a North Carolina headquarters runs the management of clinical site payments as a separate division.

Greenphire's system does everything the sponsor or CRO needs. It can be linked to electronic data capture (EDC) or randomization and drug supply systems that determine who should be paid. Greenphire helps sponsors and CROs issue rechargeable debit cards with trial-specific branding; it zaps electronic deposits directly into recipients' bank accounts; or, if required, it prints Elizabethan curiosities called "checks" on fragile sheets of dried tree cellulose.

Multiple Currencies

Greenphire's services are not limited to the U.S. and Europe. Megabank relationships allow it to process payments in 210 different currencies around the world. Should the Euro implode under the weight of its rhetoric—should the world of clinical trials need to resume using German marks or Italian lira—that will not pose a challenge for Greenphire and its clients.

Greenphire's Whitaker is not a unicorn-chasing, kumbaya-singing hippie. He's an entrepreneur. But he does say that demonstrating appreciation has always been at the heart of what the company was trying to do. The firm recognized that money in clinical trials was part of a complex web of gratitude—not just compensation. "It was a communication of thanks," he says. "We wanted to thank the patient and let them know the money was available."

Even after years of discussion on the topic, there is simmering resentment about late payments from industry. Those familiar, standard, industry-wide 120- or 180-day payment delays are part of the reason for sites' poor cash flow and high debt. The time lags are all the more ironic given such profitable sponsor firms.

Payments In Seconds

As some high-performing research sites are operated more like any other business, the delays in sponsor payments will become more glaring, more untenable. In that environment, sponsors that get payments right will presumably forge happier, healthier relationships with the most productive sites.

Having said that, the chronic delays in payments are no evidence of conspiracy. As Whitaker goes on to say, there is a manual, paper-dependent process that takes months to run its course in traditional payment processing. Monitoring visits to sites must be scheduled; the ensuing reports must be written; and at each step, various layers of managers scrutinize everything.

Greenphire says it can cut the administrative aspects of such work flows by 60 to 90 percent. Once a payment is approved, it takes seconds—not days, weeks, months or years—to make it. "What we try to do is manage it from soup to nuts, from end to end," Whitaker says.

Cost Savings

In one recent Greenphire contract win, it was competing against two CROs. Both CROs quoted a price of roughly $180,000 to handle the payment aspects of a large, two-year clinical trial. Each CRO would have handled the payments owed to research sites on a quarterly basis, or four times a year.

Whitaker, in contrast, proposed to run the payments once per month, or three times more frequently, and to handle the whole job for $120,000. Greenphire got the contract. Whitaker immediately phoned the losing bidders on the project to offer to collaborate in the future. "Our system is applicable for the CRO, maybe even more so than for the sponsor," he notes, given that top CROs are cultivating long-term relationships with key sites. "There is a really strong economic value proposition," Whitaker adds.

Greenphire is also taking on technology firms. Whitaker just saw a well-established competitor demonstrate its newly acquired CTMS. He had trepidation prior to the demonstration. The vendor in question was a large, respected firm; its CTMS is promoted as one that can handle payments.

One Solution

As it turns out, however, Whitaker was not overwhelmed by the capabilities of the competitor's system. At the end of the day, like many other CTMS, the rival system can only generate a simple list of payments and payees. To actually make payments, sponsors using the rival system would need to sign an additional contract with a CRO or embark on a custom-built IT project that could take as long as sequencing the genome of a new species.

Greenphire recently raised additional funds from private investors. Whitaker says the money will be used both to enhance its existing level of service and quality—and to augment its sales effort with high-level, experienced business development individuals. Some of those people are on board now; others are in the process of joining the firm.

Helping Hands

To help chart its strategy, Whitaker has enlisted a few new advisory board members who have the expertise to sell the entire company at some future date. Fortunately, he says, there are no concerns on the performance of the firm's services after an internal Greenphire customer survey produced warm reviews.d9A2t49mkex

As with other paper-encrusted processes in clinical development, Whitaker says, there is not yet wide appreciation for the real cost of issuing a paper check, any more than there was broad agreement on the cost of a paper case report form in the years before EDC.

The all-in cost to generate one paper payment in a clinical trial probably exceeds $100, once all the attendant human labor is computed. A more honest, accurate accounting of the full cost of inefficient clinical trial payments is long overdue.

Greenphire charges on a usage-based model, and estimates that its payments to sites cost 30 to 50 percent less than when managed by a CRO. Its payments to patients offer even greater savings of 50 to 80 percent. As knowledge of the fully loaded cost of paper payment percolates through the industry, and not just through the spreadsheets of financial analysts, it should propel even stronger growth for Greenphire.