differently Comprehensive data Novel insights Transformative - - PowerPoint PPT Presentation

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

• bservations

3.2M

Lab results

1.9M

Medications prescribed, administered and filled

4.8M

Diagnoses

$749M

Health care costs

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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How did we get here?

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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.

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.

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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%)

• f patients with symptoms are

then prescribed a PCSK9

850 (0.1%) 705 (0.2%) 555 (0.5%)

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

• It takes > 180 days for many patients to receive a PCSK9 after they are defined as statin intolerant.
• Using the integrated data, one could calculate the cardiovascular related costs for the long and short patients, and if the long patients

incur greater costs, an argument could be made that PCSK9s should be prescribed earlier in the treatment pathway.

50 100 150 200 250 300 350 400 450 500 Days Between Statin Intolerance and PCKS9 Prescription

Patients With a PSCK9 Prescription After Statin Intolerance

Days Between Statin Intolerance and Prescription for a PCSK9

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Late Patients Early Patients

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

• ffices

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

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

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

Event of Interest: Diabetes diagnosis Event of Interest: Hypoglycemic event

DIABETES WITHOUT HYPOGLYCEMIC EVENT DIABETES WITH HYPOGLYCEMIC EVENT

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

Holistic view, informed by data and illuminated by tools, guides actions and creates common understanding of value

Optimization of interventional, promotional, educational spends for patients, providers, payers Enables more precise understanding: who, what, when Not just what, but why: Detailed understanding of drivers of treatment choice at critical care-milestones

Who

Patient, provider, payer

What

Tailored interventions: messaging, support programs and tools

When

At critical junctures in the patient journey Optum Patient Journey application

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Holistic view of patient journey

Primary Adherence

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

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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

5,000 10,000 15,000 20,000 25,000

Arimidex Aromasin Femara Ibrance

Patient Count by Medication (2015-2016)

n = 33,120 patients

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

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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

% of Written Prescriptions Primary Adherence

Primary Adherence by Brand

Arimidex Aromasin Femara Ibrance

Legend

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

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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

• ther 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 Manufacturer program Medicaid Medicare

% of Rx Claims Payment Type for Pharmacy Claim

Payment Type by Product

Arimidex Aromasin Femara Ibrance

Legend

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

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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

% of Written Prescriptions

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

Claims + EHR data expanSion

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

• f pharmacy claims

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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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The Objective of Our Data and Tools – To Illuminate Three Pillars

PAYMENT & ACCESS $ $ $ $

$

HEALTHCARE DELIVERY SOCIAL, ENVIRONMENTAL AND BEHAVIORAL

There are three main pillars of insights needed to tell the full story of which care works best and why. We combine these three perspectives to provide the most complete view of patient perspective, cost and outcomes available in the market today. 1 2 3

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Healthcare Requires a Centralized View of the Patient, and Optum is Positioned to Construct that View

Rx fills Devices Written Rx Vitals Procedures Procedures Diagnoses Cost Eligibility Media exposure Financial strain Diagnoses Physician notes CPG Reported

• utcomes

Consumer behavior Payment and access Clinical severity User-generated information

PATIENT

Labs

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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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