Using real world data to experience real world success

Understanding the patient journey to ensure that a diabetes drug continues to lead the market

Assessing drug performance on health outcomes, utilization and total costs of care associated with the drug is critical not only for pharmaceutical companies but also payers to ensure value-based outcomes. Data-driven insights become especially important as life sciences companies enter value-based contracts with payers. Performing such analysis needs a strong foundation of data assets, clinical and analytics expertise to truly perform healthcare economics outcomes research validation. With this intelligence, pharmaceutical companies can place less financial burden on patients, while entering more favorable contracts with payers.

EXL’s solution

EXL’s Health Economics and Outcomes Research (HEOR) solution can help meet the challenges associated with proving optimal health outcomes as well as financial success. EXL’s HEOR solution not only brings this valuable real-world data to the table, but it also empowers payers to help life sciences companies effectively leverage this information to improve outcomes and reduce costs by offering.

Perhaps most importantly, EXL works closely with life sciences companies to implement a standardized, proven approach that is highly likely to improve outcomes and costs.

Case study:

Understanding the patient journey to ensure that a diabetes drug continues to lead the market

Assessing the challenges

This leading diabetes drug company needed to come to a better understanding of total costs of care as well as the overall patient journey. More specifically, the company was looking to compare the cost of care over time for its therapy to other similar drugs. This is especially challenging because the diabetes field is a crowded space with literally dozens of therapeutics available on the market. An understanding of the longitudinal patient journey, however, could help the company better understand the relationship between outcomes and costs – and then enter into conversations with payers regarding value-based contracts.

Leveraging the HEOR solution

With the HEOR solution, EXL was able to help the life sciences company analyze all of the major diabetes drugs classes, starting with generics and working all the way up the chain to insulin therapies. The company was able to come to this understanding as HEOR leverages internal patient level claims data to produce a set of cost of care, utilization of services, prospective risk and impactability insights based upon de-identified type 2 diabetes patients with diagnosis, procedures and associated drug codes.

In addition to performing these cost comparisons, the company gained a better understanding of the overall patient journey. In essence, company leaders leveraged the EXL’s HEOR solution to understand how patients started their treatment journey when they were first diagnosed with diabetes and the various actions and treatment regimens that they took as the disease continued to progress. With EXL’s HEOR, a very complex algorithm was created to determine which patients started at a low level with generic therapy then switched to a more sophisticated treatment – and to measure incremental costs as they moved from one drug to another. The analysis specifically evaluated how patients traversed through four lines of therapy of diabetes treatment. More specifically, the analysis showed that more than 50% of patients would move up levels of treatment. The company also was able to emphasize to patients, providers and payers the objectivity of the data analysis, as it was preformed by a third-party.

EXL’s HEOR solution allows the drug company to evaluate the performance of the drug continually with interactive dashboards to gain insight into performance on ongoing basis. Thus empowering the organization to evaluate trends over time and adjust strategies accordingly.

Embracing valuable insights

The life sciences company leveraged HEOR to produce the following insights:

Market access

  • Identified potential utilization of medications by members with varying risk
  • Evaluated additional members that could benefit from the drug based on their risk for similar drug class and dosing
  • Identified prescribing patterns by physician type
    • Assessed primary care physician efficiency ratings based on cost and quality
    • Evaluated specialist efficiency based on cost and quality
  • Demonstrated variation by geographic area
    • Disease prevalence
    • Risk prevalence
  • Showed the impact of the total cost of care by prescribing pattern and patient risk
  • Impact on patients with prescription of the drug
    • Compliant
    • Non-compliant
  • Variations in cost by ZIP Code
  • Disease prevalence by ZIP Code
  • Frameworks for outcomes-based contracting
    • Adjusted for current PMPM and adverse events
    • New members growth by zip code or MSA
    • By line of business variation i.e., Commercial vs Medicare Advantage
      • Risk
      • Disease prevalence
      • Risk

Patient journey

  • Medicare population had more lines as well as longer line durations compared with Commercial populations
  • The majority of diabetes patients started with a particular therapy and then moved up to Insulin
  • Insulin patients had the highest total cost of care

Taking action

These insights helped the company develop effective messaging with regulatory approval that can be disseminated to healthcare providers as part of an educational program. In addition, the intelligence empowered leaders to tap into additional market potential by identifying new patients based on lab values.

The analysis also helped determine what drugs patients start on, when they switch and what they change over to. This helped the company determine how and when patients are moving away from their therapies – and, conversely, how and when patients are moving toward their drugs.

The information helps to fuel conversations around value-based care with payers and show the better outcomes as well as lower costs achieved with its drugs. In conclusion, the sophisticated data analysis provides ammunition for the in-depth negotiations that the life sciences company has with the payers’ market access teams.