Client Profile

A top 10 Pharmaceutical company

Client Need

The Client was seeking insights on patients healthcare costs and outcomes utilizing their branded product, to make informed decisions. EXL with its advanced analytics capabilities analyzed the cost of care and utilization of services for the client’s product versus competitive products, across multiple indications.

Challenges

The client did not have access to the cost of care data via adjudicated patient claims. Even being a data centric organization, it was difficult for them to have insights to cost of care associated with patients on their treatment as well as competitor treatments.

Orchestration

EXL Health:

  • Defined the patient universe for each product indication, based on ICD-10 diagnosis codes
  • Segmented the universe into 5 main cohorts based on the defined business rules and further segmented cohorts into treatment periods, existing patients and new patients
  • For each Cohort:
    • Defined various dimensions, e.g., channel and age, gender, location, timeframe, etc., and Calculated several measurements, including Total Cost of Care, Utilization of Services, Prospective Risk and Comorbid conditions

KEY OUTCOMES

  • EXL Health’s analysis segmented the patient populations based on client‘s drug multiple indications and delivered insights on
    • Costs: Determined Rx amount and comparison between the cohorts for both new & existing patients and for Commercial and Medicare population
    • Utilization: Evaluated drug usage and preference of existing/new members towards combination of biologic and non- biologic drugs
    • Comorbidities: Identified cohorts and preference of members having multiple chronic conditions
    • Compliance: Drug adherence insights
  • Provided leverage to client in payer discussion regarding value based outcome discussions

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