We see health care differently - Optum · 2020. 5. 31. · Only person-linked, integrated dataset...

We see health care

differently …

Comprehensive data

Novel insights

Transformative actions

Lasting value

Largest eligibility-

controlled claims dataset

160 million lives

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24 Hours of Optum data: Creating a more complete health picture

We capture:

Only person-linked,

integrated dataset

30 million EHR

linked Rx claims

Largest EHR dataset

90 million lives

More than

150,000 providers

2,000 hospitals

7,000 clinics

8.3M Signs,

diseases, symptoms (provider

notes)

4.0M Procedures

2.8M

Measurements (provider

notes)

4.9M Vital signs

and observations

3.2M Lab

results 1.9M

Medications prescribed,

administered and filled

4.8M Diagnoses

$749M Health care

costs

How did we get here?

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Optum solved one of the biggest problems in health care:

Multiple EMR systems that do not communicate with one another

Longitudinal comprehensive clinical dataset

Medical groups

Integrated delivery

networks

Staging area

Hospitals

Multi-specialty practices

EMR1

Small group practices

EMR2

Physician offices EMR 3

Rx platform

Billing system

Rx platform

Billing system

Rx platform

Billing system

Rx platform

Billing system

EMR1

EMR2

EMR3

• Demographics • Lab results • Provider notes

(NLP) • Procedures

• Diagnosis • Medications • Outpatient visits • Vital signs

• Hospitalizations • Observations

Data and analytics for life

sciences

Analytics for providers

Processing: Validation, normalization, standardization, mapping

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Comprehensive data leads to novel insights for brand marketing, value-based

contracting, comparative effectives and evidence generation

Linked

EHR/

claims:

15M+

Claims

120M+

EHR

80M+

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Lab values More than 260 different labs (e.g., A1C, eGFR, FEV, values)

Patient and provider details Physician speciality, age, gender, smoking status, race geography

Vital signs BMI, blood pressure, pain scores

Medical procedures and conditions

Indications, treatments and comorbidities

Cost Disease burden for

pharmacy, provider, and facility spend

Medications Therapeutic-area-specific

market baskets

Provider notes Treatment rationale, lifestyle observations, signs and symptoms, biomarkers

Claims + EHR data expanS ion

Adding Rx claims for:

1. Individuals with EHR capture

and Optum insurance claims

2. Individuals with EHR

capture alone

More than 1 billion prescriptions per year

from 76 million patients per year:

• 25‒30% is eligibility controlled

(30 million lives)

• Includes data from 90%+ of HCPs

• 90%+ of pharmacies

• All payers, including cash

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One of the largest and most

complete claims data assets

in the United States

One of the largest and

broadest EHR data assets

in the United States

Optum EHR

Optum insurance

claims

Linked EHR/ claims

All-payer Rx claims

Adding one of the largest aggregators of pharmacy claims

The funnel challenge: What business questions do you need to answer?

Quality data manufacturing leads to more useable, research-ready patients

Competitor data

Usable patients

Optum data

Usable patients

Data usability is a

function of patients

meeting research

requirements such as

clinical markers of

interest and tenure

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What our journey has yielded

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Dyslipidemia Case Study

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

Quantifying Statin Intolerance

• A common reason for statin-related sides effects is Statin Associated Muscle Symptoms (SAMS). In our study, these qualitative symptoms were limited to: muscle aches, muscle weakness, muscle stiffness, muscle cramps, myalgias, and myositis. Approximately 90% of all statin-related side effects occur within the 1st 6 months after initiation of therapy. We define statin intolerance as a patient reporting these symptoms within 1 year after initiation of a statin therapy.

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Description Patients

# Patients Taking a Statin 6,929,680

# Patients Experiencing SAMS 1,951,936

% Patients Experiencing SAMS 28.2%

# Patients Experiencing SAMS with No

Preexisting History 924,519

Estimated % With Statin Intolerance 13.3%

Patients Receive PCSK9 2,111

Patients Receiving PCSK9 After Statin

Intolerance 900

• American Heart Association’s

Estimate = 10-15%

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11

Statin Intolerance Symptoms by Number of Statins

• For patients who did not have symptoms within 1 year before starting a statin, the graph below shows the

number of patients with statin intolerance symptoms looking 1 year after being prescribed/administered the

medication

• ~1/5 of patients already complain of symptoms despite being on only 1 statin, and these symptoms increase

as the patient is prescribed different statins

– By the time patients try 3 or more statins, almost 40% of the patients show statin intolerance symptoms within 1 year

1M 2M 3M 4M 5M

1 Statin

2 Statins

3+ Statins

Patients with Statin Intolerance Symptoms from Physician Notes

Patients without Symptom Mentions Patients with Statin Intolerance Symptom Mentions

Only a small proportion (<1%)

of patients with symptoms are

then prescribed a PCSK9

850 (0.1%)

705 (0.2%)

555 (0.5%)

Optum’s Cohort Builder quickly defines and profiles study populations,

simplifying and speeding time to analysis, insight and evidence generation

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The Cost of Hypoglycemia

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Understanding Impact of Hypoglycemia

COST

Pharmacy (AWP)

$27.77 PMPM

Medical (Std. Cost)

$1,019.62 PMPM

COST

Pharmacy (AWP)

$9.17 PMPM

Medical (Std. Cost)

$4,158.73 PMPM

WITHOUT Hypoglycemic

Events

WITH Hypoglycemic

Events


Each node is a the next sequential place of service for the patients journey

- Custom journey design possible

- Treatment Flow available

Event of Interest: Diabetes diagnosis

Event of Interest:

Hypoglycemic event

DIABETES WITHOUT

HYPOGLYCEMIC EVENT

DIABETES WITH

HYPOGLYCEMIC EVENT

Primary Adherence

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Breast Cancer Oral Medication Overview

• Between 2015 – 2016, the overall patients represented in the EHR linked all payor data who

have a prescription for one of the medications of interest is ~33K

– Just over 1K patients have a prescription for Ibrance

19,441

4,006

11,848

1,163

0

5,000

10,000

15,000

20,000

25,000

Arimidex Aromasin Femara Ibrance

Patient Count by Medication (2015-2016)

n = 33,120 patients


Primary Adherence by Brand

• Looking at primary adherence differences between the 4 brands shows that Ibrance only has

half the fill rate compared to Aromatase Inhibitors

– Majority of Ibrance prescriptions are not filled, whereas <40% of Aromatase Inhibitors are not filled

68.0%

0.0% 0.0%

31.9%

60.4%

0.1% 0.1%

39.4%

65.1%

0.0% 0.1%

34.8% 33.6%

0.3% 0.0%

66.0%

Filled as Written Filled Another Brand(Different Class)

Filled Another Brand(Same Class)

No Fills

% o

f W

ritt

en

Pre

scrip

tio

ns

Primary Adherence

Primary Adherence by Brand

Arimidex

Aromasin

Femara

Ibrance

Legend


Payment Type by Brand

• For medications that were filled as written, the addition of the all payor data shows variation in

the type of payment

– Patients adhering to Ibrance are more likely to use commercial insurance and cash compared to the

other payment methods for the Aromatase Inhibitors

1.3%

40.8%

0.0% 2.8%

37.7%

0.9%

41.5%

0.0%

6.0%

36.4%

2.4%

44.9%

0.1% 2.8%

27.0%

16.0%

46.9%

0.0% 2.8%

22.1%

Cash Commercial Manufacturerprogram

Medicaid Medicare

% o

f R

x C

laim

s

Payment Type for Pharmacy Claim

Payment Type by Product

Arimidex

Aromasin

Femara

Ibrance

Legend


Biomarker Status and Primary Adherence

• Out of patients with medications of interest and eligible for primary adherence:

• For patients with an indicated biomarker status of HR+/HER2-, the filled as written rate is

increased for Ibrance, but slightly decreased for aromatase inhibitors

10,388

7,840

7,407

HR Positive

HER2 Negative

HR+/HER2-

Prescriptions for Patients with Biomarker Status

66.0% 55.5%

62.7%

36.1% 34.0% 44.5%

37.1%

63.5%

Arimidex Aromasin Femara Ibrance

% o

f W

ritt

en

P

rescrip

tio

ns

Filled as Written vs. No Fill Rate for HR+/HER2- Patients

Filled as Written Filled as Written Filled as Written Filled as Written No Fills No Fills No Fills No Fills

n = 7,407

Expanded Offerings for Enterprise-Wide Enablement 2017-2018

NEAR

>

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A New World of Use Cases

• “Moment-of-Truth” based

• Weekly updates

• Most recent information:

– Written → Filled prescription tracking

– Most recent lab value

– Dx indication for prescription

– Admissions & Re-admissions

• Patient-Centric

• Quarterly updates

• Full history of information:

– Visits

– Labs

– Meds

– Dx’s

Fast, Representative and Actionable Robust and Precise

• Panther

• Smart Files

• CDMs

• Clinformatics

• Provider RWE

• Patient Journey

• Cohort Builder

• Comparative Analytics

• Integrated All-Payer Panther (with weekly updates)

• North Star

• Commercial Analytics

Commercial and Sales Audiences Medical & Scientific Audiences

Evidence Generation Data Insight Expansion Data

P r o d u c t s

F e a t u r e s

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SEB DATA

CLINICAL DATA

$ CLAIMS DATA

Electronic Health Records

Electronic Medical Records

Clinical Notes

Genomic Data

Registry Data

Care Management Program Data

Healthcare Delivery Data

Medical & Pharmacy Insurance Claims

Eligibility & Enrollment Data

All-Payer Pharmacy Claims

Point of Sale Data

Payment & Access Data

Socio-Demographic

Health Risk Assessment

Media & Digital Exposure

Wearable / Device Data

Patient Engagement Data

Promotional Exposure

Purchasing Patterns

Loyalty / Membership

Survey Responses

Reported Outcomes

Social, Environmental & Behavioral Data

Orange: In production: The largest deterministically linked Claims – Electronic Health Record data asset on the market; additional data assets listed are part of Optum’s expanding data eco-system

Optum integrates data from across the health care ecosystem, enlarging and enriching our view of the patient, provider and payer

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Near Term Focus 2017-2018

C o n t i n u e t o b u i l d E H R - b a s e d p o p u l a t i o n

E x p a n d a l l - p a y e r m e d i c a l a n d p h a r m a c y p o p u l a t i o n s

D e e p e n g e n o m i c i n s i g h t s : •B i o m a r k e r s •T u m o r t y p i n g

I n c o r p o r a t e n o v e l d a t a :

•C o n s u m e r D a t a •W e a r a b l e D a t a •P a t i e n t R e p o r t e d O u t c o m e s ( P R O )

$

Boost denominator and scope of insights

• Organic growth of EHR patients

• Multi-sourced EMR patients

• Integrated (claims + EHR) patients

• Increased speed at the time of prescriptions (Dx, Labs, NLP-

derived)

Diversify payer representation

• Boost integrated patient counts

• Improve cost / utilization perspective for research

• Provide broad market representation of brand share / formulary

choice for commercial audiences

Demonstrate pharmaco-genomic interactions

• Oncology

• Auto-immune disorders

• Rare diseases

Incorporate patient’s perspective and behavior outside of the

health system

• Front Store Pharmacy

• PRO’s

• Media

Steve Davis

SVP, Data and Advanced Analytic Tools

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We see health care differently - Optum · 2020. 5. 31. · Only person-linked, integrated dataset...

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