Biopharma and life science leaders are calling this patient-first approach "optionality": some participants prefer traveling to a trial site, while others can't due to cost or time constraints, and a rigid single-site model doesn't accommodate either group well. 20/20 Onsite partnered with Block Clinical to build a "Modified Decentralized Visit" model that blends travel, comfort, and choice, using 20/20 Onsite's Mobile Vision Clinics (MVCs) to meet participants at a convenient location instead of requiring a trip to a fixed site.
The model grew out of a real constraint: in one rare disease trial, participants had no site available in their home country, so international travel was unavoidable. Block Clinical built a seamless travel experience for participants making the trip to the U.S., and 20/20 Onsite deployed an MVC that already supports the protocol to meet them at a desirable location rather than at a traditional clinic. To date, that approach has supported nine international participants traveling from neighboring countries and from European countries, including Canada and Germany.
To explain how the partnership works in practice, we spoke with Eric Nier, Senior Director of Business and Account Development at Block Clinical, about how the two organizations work together to reduce the burden of participation.
An Interview With Eric Nier, Block Clinical
Tell us about Block Clinical and your responsibilities there.
"We started Block Clinical to be like the Expedia of clinical trials, where all patient logistics were booked and prepaid via a system that captured all transactions in real time. Typically, patient support models are very manual, time-consuming, and costly. We believed that every patient and every trial deserved to have the proactive management and approach that we provide, regardless of the study type and site location. We built the Block Clinical platform so we could keep the process automated and affordable in order to help companies make it easier to offer that kind of proactive support.
My role within the company is to work with clients and potential clients to bring the idea of a Strategic Patient Logistics Program to the table, as a manner of corporate infrastructure, much like a corporate travel program; think Concur. As Director of Business Development for Block Clinical, I have always been going out and telling that story. We were fortunate to have early adopters and a good client base that see this vision. Our key to success has always been new offerings and new technology that meet the niche needs of our clients. My job is to connect with industry leaders and look for new ideas or ways that we can continue to expand these strategic partnerships that benefit not only the patients but the organizations that employ them as well."
Can you tell us about your background in hospitality and how that translates well into your current position in the clinical research space?
"I worked for the Ritz Carlton hotel company early in my career, and the motto for the Ritz Carlton is 'the genuine care and comfort of our guests is our highest mission.' For Block Clinical, it's the same thing, but for the patients.
When I left the hotel industry, I went to work for a corporate meeting and event management company with a client base primarily in pharmaceuticals. A while back, a client approached us asking if we could provide the same logistics and hospitality that we did for their corporate meeting but for their patients. This is where hospitality impacted clinical trials to improve the patient experience and trial results. We realized just how much of an influence this model has on clinical trials in driving patient recruitment and retention."
How does Block Clinical partner with 20/20 Onsite to enhance the patient experience?
"Anytime you can alleviate the burdens of participation, especially financial burdens, it's going to make the patient experience much better. Partnering with 20/20 Onsite takes it to the next level because we're able to choose locations where we can easily bring patients to the mobile unit. We can find a central location that's easy for all the patients to travel to, so it's not an overburden to get them to the site. For example, for a patient traveling cross-country or internationally to a site, we can now find a neutral mobile location to conduct visits and ease the visit experience.
The 20/20 Onsite Mobile Vision Clinic makes the process very versatile for us and the project teams. It gives us much more flexibility and options to deliver a customized experience for the patients, again, to drive retention and ease of participation. It also makes it easier for the study teams. One of the industry leaders commented that we offer the 'platform of choice.'
The way I see this working in the future is that patients will have a patient coordinator reach out to them and ask, 'What kind of visit do you want? Do you want to go to the site? Do you want someone to come to your house? Do you want to do it virtually? The MVC is going to be in Durham and you're in Raleigh. We'll get you to the MVC because it's passing through.'"
What can a patient expect from start to finish when travel to a trial site is required?
"The accommodations are customized based on the patient's needs. Our patient coordinators communicate directly with the patients or caregivers to ensure that the needs of the patient are addressed for each on-site visit, and support is there before, during, and after their travel.
For example, if a patient is immunocompromised, many times we will send them through airlines with what we call a 'Covid kit,' including masks, hand sanitizer, gloves, and whatever else they need to protect themselves during travel. It's all very customized to each patient's individual needs."
How do international patients decide which city they're traveling to, and what role does Block Clinical play?
"We look at our patients' locations across the country and find a central location for them to meet. We look for flights and airports that are accessible, with easy transportation, and avoid layovers when possible.
The 20/20 MVC will arrange to be there at the central location where we bring the patients, which is a unique approach. In general, there are lots of moving parts and operations coordination happening behind the scenes. The most important part of all this is that the patient doesn't feel that. They don't know that we're routing a vehicle, finding flights, arranging ground transportation, and all the rest. Once arrangements are made, they are all smoothly delivered to the mobile location to complete screening, with easy return trips.
Overall, it's a very smooth process, and patient satisfaction is very high. The feedback we've received from patients on our partnership with 20/20 Onsite has been excellent."
Is there a particular patient story that stands out to you?
"There was a very important trial with sick, immunocompromised patients. Once patients passed pre-screening, we only had a couple of days' notice to get them to the site for screening. They didn't want the patients flying commercial, so we spent a considerable amount of time and resources chartering private aircraft to get these patients and families where they needed to be.
Another example was having to fly a patient and family back home internationally before their visa ran out. We had a very short window to turn that around and had to do so with an accompanying physician flying with the patient. You have to imagine airline ticketing with medical equipment onto an international flight in a short amount of time would be a logistical challenge. Thankfully, we completed it in time. The family was very appreciative, which always makes all those challenges well worth it."
How do you see the patient experience in clinical research evolving over the next few years?
"It's a couple of things, with optionality for the patient at the center. It's going to be having a coordinator reach out to the patient to provide a schedule in line with the protocol, proactively managing the visits for our patients, while providing visit options where applicable. Do you want a nurse to come to your house, or would you prefer a virtual visit? If that's not feasible for you, we'll present you with an option. As we look toward a decentralized or hybrid model, the patient is more in control of their options."
How can partners like Block Clinical and 20/20 Onsite continue supporting clinical research, and why should sponsors and CROs invest in this model?
"Having the Mobile Vision Clinic can be a huge cost-saver for sponsors, because they can reduce the number of regional pop-up sites they'd otherwise need. Then you look at it from the patient's perspective, and there's a lot of convenience in that model, rather than flying long distances. It gives us a lot more flexibility and cost savings by partnering in this way.
By picking a hub city to station the MVC in and flying patients to meet it, you get an efficient model: a modified decentralized visit, if you will."
Bring Optionality to Your Next Clinical Trial
If your study is trying to offer a better participant experience while reducing the risk of dropout, a Modified Decentralized Visit model built around point-of-need ophthalmic execution is worth exploring early in protocol design. Request a patient experience consultation to see how 20/20 Onsite and Block Clinical can get creative with your specific logistics constraints.
Frequently Asked Questions
What is a Modified Decentralized Visit? A Modified Decentralized Visit is a hybrid model where a participant travels partway, often to a central hub city, and a Mobile Vision Clinic meets them there rather than requiring travel all the way to a fixed trial site. It blends the flexibility of decentralized trial design with the equipment and staffing consistency of an in-person assessment.
What does "optionality" mean in clinical trial patient experience? Optionality means giving participants a choice in how they complete a visit, whether that's traveling to a site, having a clinician come to them, or completing part of a visit virtually, rather than requiring every participant to follow the same fixed model regardless of their personal constraints.
How does 20/20 Onsite support international clinical trial participants? 20/20 Onsite has supported nine international participants traveling from countries including Canada and Germany, using Mobile Vision Clinics stationed at a central hub location instead of requiring participants to travel to a fixed U.S. site for every visit.
Can a Mobile Vision Clinic reduce the number of regional trial sites a sponsor needs? Yes. Stationing an MVC in a hub city and coordinating participant travel to meet it can reduce the number of regional pop-up sites a sponsor would otherwise need to stand up, while still giving participants a convenient, centralized location for assessments.
What kind of travel support do immunocompromised participants receive? Support is customized to the participant's medical needs, which can include supplies like masks, hand sanitizer, and gloves for travel, and in some cases has included chartering private aircraft or arranging an accompanying physician when commercial travel wasn't appropriate.
How does the Block Clinical and 20/20 Onsite partnership reduce dropout risk? By removing the largest logistical and financial burdens of participation, coordinating flights, ground transportation, and mobile clinic scheduling behind the scenes so the participant experience stays simple, and giving participants a say in how each visit happens.