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Advancing Data & Analytics Collaboration Between Provider and Life Sciences Organizations
Robert Musslewhite, CEO, Optum Analytics
Spotlight: provider viewpoint on life sciences
Implications for data and analytics
Trends in the provider landscape
©2018 Optum, Inc. All rights reserved. 2
Provider landscape going through a series of changes
Push towards Value Based Care
New provider payment models focused on
quality and cost outcomes.
Need commitment to quality and efficiency
goals along with investment in infrastructure to
facilitate performance improvement.
Price and cost pressures
squeezing margins
Long-anticipated challenges to revenue and
cost driving declining margins.
Need to contain it, realize full value of IT
investments and harness innovation to fuel
future growth.
Rise of “Consumerism”
Increasing patient awareness, financial
accountability and active engagement in their
health demands improved choice,
engagement and experience.
Need to rethink approach to growth strategy.
Ongoing political and legislative
uncertainty
Healthcare players, including lawmakers,
industry groups and patient advocates, will
continue to clash; likely result in additional
policy changes.
Need to build enterprise resilience on a
baseline of continued uncertainty.
©2018 Optum, Inc. All rights reserved. 3
Key themes as providers adapt to this transitioning phase
Growth of population
health management
Leveraging data to deliver more efficient, higher quality care
Creation of mega-systems Vertical integration
76% organizations employed
population health programs1
115 provider-provider transactions
announced in 2017 in their quest
for scale, improving bargaining
power and efficient care delivery
through facility specialization
Expanding beyond automation to digitization, analytics allows health systems to improve the
consistent, high quality delivery of care, avoid unwarranted utilization of services, and better
support their patients and care delivery processes
Large players cross historical
industry lines to combine
assets, reduce spending
+ +
1.http://www.himssanalytics.org/sites/himssanalytics/files/HIMS
S17%20Population%20Health%20Final%20Presentation.pdf
2.https://www.kaufmanhall.com/sites/default/files/2017-in-
Review_The-Year-that-Shook-Healthcare.pdf
©2018 Optum, Inc. All rights reserved. 4
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trademarks, product names, service names, trade names, and logos or images of the same does not necessarily constitute (a) an endorsement by such company or
Optum or Advisory Board and its products and services, or (b) an endorsement of the company or its products or services by Optum or Advisory Board.
Spotlight: provider viewpoint on life sciences
Implications for data and analytics
Trends in the provider landscape
©2018 Optum, Inc. All rights reserved. 5
Data analytics gaining significant momentum driven by external and internal forces
Digital health funding continues at a record pace1 ($, Bn)
153
2314
2013 2020
Massive growth in patient health data volume2 (in Exabytes – 1 Exabyte = 1 million Tb)
External Internal
>95% Hospitals adopted EMR3
82% Hiring the right IT talent4
Dr. Michael Blum, Director, Center
for Digital Health Innovation, UCSF
Providers have overcome historical barriers
Analytics is a top of mind issue, with high potential
>90% Provider IT executives view analytics
as big source of tech investments5
We have the data in usable, annotated forms, and the
ability to validate apps that [has a promise to] make a
difference in the system.”
$47-60B Healthcare analytics and solutions
market size in 20176
1. http://www.startuphealth.com/marketing/insights/51630
2. https://www.healthdataarchiver.com/health-data-volumes-skyrocket-legacy-data-archives-rise-hie/
3. https://www.advisory.com/daily-briefing/2016/06/02/ehr-adoption-rates-rising-barriers-to-interoperability
4. https://www.ca.com/content/dam/rewrite/files/White-Papers/healthcare-reaping-the-benefits-of-digital-transformation.pdf
5. https://www.healthcatalyst.com/the-changing-role-of-healthcare-data-analysts/
6. Optum research
$2.9
$11.5
2013 2014 2015 2016 2017
©2018 Optum, Inc. All rights reserved. 6
Predictive modelling for
staffing optimization
Significant opportunity for providers to tackle new areas with data and analytics
Procedural profitability
analysis
Episodic cross-continuum
care management
Clinical decision support
Remote patient monitoring
Personalized care delivery
Post-acute network
management
Targeted service-line
marketing
Population health risk
management
Tracking physician referral
patterns
Post-acute discharge
disposition
Surgery room efficiency
improvement
Outcomes-based contracting
Medication management Improved patient recruitment
for clinical trials
Product evaluation,
purchasing and contracting
EHR enabled care pathways In-house comparative
effectiveness studies
Product utilization and
compliance
Capacity management and
operational benchmarking
©2018 Optum, Inc. All rights reserved. 7
Major roadblocks limiting realization of true value of analytics
Status
Quo
Digital
Enterprise
DATA
Fragmented system leading to
limited view of patient information
IT INFRASTRUCTURE
Processes don’t bridge system
boundaries, leading to inconsistent
execution
LEADERSHIP FOCUS
Multiple stakeholders with varying
priorities, lacking common vision
IT GOVERNANCE
Disconnect between IT governance and
corporate planning; success measured only
by “on-time”, “on-budget”, not by outcomes
Providers struggling to address key roadblocks
Of the data needed for
precision medicine and
population health resides in
today’s EMRs
<8%
“We’ve done the same test three times,
because there was no easy way of
knowing if it had already been done.”
CIO, large health system
If the CEO doesn’t own digitization, it will
die—it’s not even a fair fight.”
Aaron Martin, Chief Digital Officer,
Providence St. Joseph Health
Challenge for CIOs focused on
business intelligence
implementations #1
©2018 Optum, Inc. All rights reserved. 8
Spotlight: provider viewpoint on life sciences
Implications for data and analytics
Trends in the provider landscape
©2018 Optum, Inc. All rights reserved. 9
Highlighting takeaways from Optum & Advisory Board provider market research
WHO did we speak with?
• Chief Pharmacy Officers, VPs of Supply
Chain, Chief Medical Officers, VPs of
Quality, VPs of Population, Service Line
Leaders (Oncology, Cardio) etc.
• Product evaluation
• Purchasing and contracting
• Appropriate use
WHAT did we discuss?
Insights derived from 200+ providers through interviews, surveys, and polls across the past 3 years
Common Provider Themes
Focus on a pop.
health, holistic view
to capture total cost
of care
1 2 3
Increase in number
of stakeholders
interested in and
accountable to data
4
Appetite to continue
experimentation with
different-in-kind life
sciences partnerships
Emphasis to expand
beyond traditional
clinical trials data for
decision-making
©2018 Optum, Inc. All rights reserved. 10
Highlighting takeaways from Optum & Advisory Board provider market research
Common Provider Themes
Focus on a pop.
health, holistic view
to capture total cost
of care
1 2 3
Increase in number
of stakeholders
interested in and
accountable to data
4
Appetite to continue
experimentation with
different-in-kind life
sciences partnerships
Emphasis to expand
beyond traditional
clinical trials data for
decision-making
©2018 Optum, Inc. All rights reserved. 11
Pharmacy execs note growing need to include multiple metrics for drug evaluations
Focus on a population health, holistic view to capture total cost of care 1
Today’s focus on readmission rate is not enough in the population health focused world
• >84% of pharmacy executives are
accountable for managing the budget in a
value-based world across the continuum
• They want to know how does your drug:
Reduce utilization of emergency
department services
Minimize adverse events that require
intervention
Reduce adherence challenges
Help reduce per member per month
spend (PMPM)
Improve disease-specific metrics
Chief Pharmacy Officer, health system in the southwest
“It’s ironic that manufacturers come to the ACO
totally focused on readmission data. They don’t
realize that only a small percentage of patients will
be hospitalized and an even smaller percentage will
be readmitted. The larger portion of the
population is the PMPM group. That’s where I’m
focused on: ‘How much am I spending to keep
everybody well?’ and ‘if I use drug X how does
that impact my PMPM spend?’”
Example: Providers with Capitated Contracts
Patients
hospitalized
Patients
readmitted
Total Patients Under Capitated Contract
©2018 Optum, Inc. All rights reserved. 12
Some health systems already using additional metrics to drive selection Case: Pine Health
Focus on a population health, holistic view to capture total cost of care 1
Pine Health’s1 Process For Letting “Patient Adherence Profiles” Guide Drug Selection
High compliance Generics; even those that
need to be taken multiple
times per day
Moderate compliance
Low compliance
Branded agents that offer
sustained or extended
release
Branded long-acting agents
that reduce number of doses
and administrations
Patient Adherence
Profile:
First-Line Medications to
Consider:
Before PCP visit, ACO-dedicated
pharmacist calls patient to complete
assessment
• Are you taking medications currently or have
you taken medications in the past?
• Have you ever missed a dose?
• How many doses have you missed in the
last six months?
• Have you had any troubling side effects?
• Have you ever reached out to a doctor with
concerns about your medications?
• Do you have a regular primary care
physician?
• Have you ever participated in a medication
compliance program?
? Hypothetical Adherence Assessment
1. Pseudonym.
©2018 Optum, Inc. All rights reserved. 13
Implications for life sciences: success hinges on presentation of product milestones
Focus on a population health, holistic view to capture total cost of care 1
Requirement to think about medications through a new lens
Provider questions yesterday
• Is this drug clinically effective?
• Is this medication safe for my patient?
• Has this drug worked well for my patients in the past?
• Do I have reason to use one of the newer drugs in class?
• Is this drug covered by the patient’s insurance?
ADDITIONAL provider questions today
• Are the patient’s out-of-pocket costs likely to inhibit
adherence?
• Is this drug easy for my patient to take properly?
• Do the common side effects cause many patients to
stop taking the drug?
• Are there less expensive, similarly effective options?
• Is there evidence this drug can help reduce
downstream utilization better than other options?
• Is there a care pathway I need to follow?
• Should I contact other members of my care team to
review my Rx selection (e.g., pharmacist, nurse)?
Broadening product criteria from…
Cost Safety Efficacy
…to include
Access Appropriate
Use Adherence +
©2018 Optum, Inc. All rights reserved. 14
Highlighting takeaways from Optum & Advisory Board provider market research
Common Provider Themes
Focus on a pop.
health, holistic view
to capture total cost
of care
1 2 3
Increase in number
of stakeholders
interested in and
accountable to data
4
Appetite to continue
experimentation with
different-in-kind life
sciences partnerships
Emphasis to expand
beyond traditional
clinical trials data for
decision-making
©2018 Optum, Inc. All rights reserved. 15
A Working Definition
Providers relying less on clinical trials data as source of truth for appropriate use Although providers largely fall in level 3, appetite is high to move towards level 1
Emphasis to expand beyond traditional clinical trials data for decision-making 2
Appropriate Use is a broad term that refers to using and prescribing
medications in a manner consistent with a care standard.
Levels of Appropriate Use
Utilization based on
evaluation of population-
specific real world data
Utilization matches care
standard based on empirical
or consensus-based practice
(e.g., non-randomized trials,
case studies, usual practice)
Utilization matches
restrictions based on
clinically proven evidence
(e.g., randomized controlled
trials)
Level 2 Level 1
(Aspirational)
Level 3
(Most Prevalent)
©2018 Optum, Inc. All rights reserved. 16
Implications for life sciences: deeper collaboration and data sharing will be required
Adherence data –
that show patients’
likelihood to
comply with
regimens in
different scenarios
Results on
multiple
population health
metrics– that
prove a
treatment’s overall
impact
More effective
cost savings
analyses – that
incorporate
provider
reimbursement
realities
Clinical trials
data – providing
initial safety and
efficacy data
Head-to-head
product
comparisons –
against current
standards of care
Real-world data –
for a specific
organization’s
patient population
Emphasis to expand beyond traditional clinical trials data for decision-making 2
Level 3
Level 2
Level 1
Standard data today
Not standard data today
Source: Advisory Board research and analysis.
“Data pharmaceutical firms are bringing
to us is just basically whatever external
consultants have told them they need to
do. They haven’t spent enough time
really listening to customers to
understand the data we truly need.”
VP of Pharmacy, health
system in the Midwest
“Where manufacturers could be
helpful is supporting the appropriate
use of these drugs. We’re still shot-
gunning in that world as opposed to
figuring out which specific drug to use.”
Director of Ambulatory Pharmacy,
health system in the Southwest
“If pharma continues to have the old
paradigm of just prescribe the drug and
see that as their value, that doesn’t
resonate with the care team. Focus is
not on getting the physician to order a
medication but instead on getting the
patient to take that medication.”
VP of Pop Health, health
system in the South
Health impact
analyses– for a
specific
organization’s
patient population
©2018 Optum, Inc. All rights reserved. 17
Highlighting takeaways from Optum & Advisory Board provider market research
Common Provider Themes
Focus on a pop.
health, holistic view
to capture total cost
of care
1 2 3
Increase in number
of stakeholders
interested in and
accountable to data
4
Appetite to continue
experimentation with
different-in-kind life
sciences partnerships
Emphasis to expand
beyond traditional
clinical trials data for
decision-making
©2018 Optum, Inc. All rights reserved. 18
New individuals are influencing treatment and prescribing decisions
CMOs playing a unique behind the scenes role
Increase in number of stakeholders interested in and accountable to data 3
n=138 Pharmacy leaders
93%
78%
28% 32%
16%
10% 10% 9% 8%
Traditional Influencers Emerging Influencers
Pharmacists Physician
peers
Service line
leaders
CMO Quality
dept. staff
Care
managers
Patients IT dept.
staff
CMIO
©2018 Optum, Inc. All rights reserved. 19
CMOs taking new lead as the adherence enforcer
Increase in number of stakeholders interested in and accountable to data 3
• Drive system-wide clinical
standardization
• Promote system-wide
physician engagement
• Integrate costs into clinical
decisions
• Increase adherence to
care standards
• Ability to secure broad
medical staff buy-in
• Improve performance on
value-based payment
programs
Snapshot of the CMO Role
Responsibilities Metrics
The CMO’s Day-to-Day Impact on Pharmacy
• Analyze clinical practice variation
data (including drug use)
• Conduct one-on-one discussions
with outlier physicians to increase
adherence to care standards
• Attend P&T1 committee meetings
Manage Outliers
Clinical and cost
effectiveness data to support
a change in care standard to
physicians
Outcomes data that drugs
improve performance on
readmissions, adverse events,
adherence
Validation and attribution
studies to defend data and
convince resisting
physicians
What Do CMOs Care About – It’s All About The Data
1. Pharmacy & therapeutics committees
©2018 Optum, Inc. All rights reserved. 20
Pharmacy executives gaining more influence on drug selection, use, and evaluation
Increase in number of stakeholders interested in and accountable to data 3
1. Pharmacy & therapeutics committees
Select Measures of Success
The Pharmacy Executive
Select Responsibilities
• Manage pharmacy budget/staff
• Oversee drug ordering/dispensing
• Serve on P&T1 committees
• Perform outcomes research
• Coordinate care across sites, care settings
• Perform direct patient care activities
• Monitor physician prescribing variation
• Manage overall pharmacy costs
• Lower drug cost by category
• Improve formulary adherence
• Minimize adverse drug events
• Reduce drug-related readmissions
• Improve medication adherence
What Pharmacy Leaders Care About
Costs Outcomes data Appropriate use; minimizing
prescribing variation
Clinical efficacy and
safety
©2018 Optum, Inc. All rights reserved. 21
Implications for life sciences: deploy a targeted approach to identify provider leads
Increase in number of stakeholders interested in and accountable to data 3
Proliferating Potential Points of Engagement Onus on Pharma to Identify Provider Contacts
Who Own Pop. Health-Based Pharmacy Strategy
Chief
Executive
Officer of
Pharmacy
Ambulatory
Pharmacy
Director
Chief
Transformation
Officer
Chief
Pharmacy
Officer
VP of
Population
Health
Chief
Medical
Officer of
the ACO
VP of
Clinical
Innovation
and Quality
How integrated is your ambulatory setting
(including the ACO, PCMH1) with the
health system’s pharmacy department?
Which members of your team “own”
pharmacy strategy for your ACO or
population health efforts?
Which members of your leadership team
are addressing pharmacy costs and spend
in the ambulatory arena?
Which team members are directly held
financially accountable for lowering the
cost of care?
1
2
3
4
? Questions to Identify the Right Call Points
1. Patient-centered medical home.
©2018 Optum, Inc. All rights reserved. 22
Highlighting takeaways from Optum & Advisory Board provider market research
Common Provider Themes
Focus on a pop.
health, holistic view
to capture total cost
of care
1 2 3
Increase in number
of stakeholders
interested in and
accountable to data
4
Appetite to continue
experimentation with
different-in-kind life
sciences partnerships
Emphasis to expand
beyond traditional
clinical trials data for
decision-making
©2018 Optum, Inc. All rights reserved. 23
In early stages Met with limited success Met with limited success
Providers interested in exploring partnerships despite mixed results in past efforts
• Contracts where portion of
manufacturer payment is tied to
measurable outcomes
Outcomes-Based Contracting
Appetite to continue experimentation with different-in-kind life sciences partnerships 4
• Engagements to study questions of
mutual interest in a product-
agnostic fashion
• Questions may target medications,
investments, or services
Research Collaborations
Research collaborations in
the past 5 years 10+ 30+ Performance-based risk
sharing agreements in the
past 5 years
• Patient education resources
• Medication adherence solutions
Beyond The Pill Solutions
Solutions created as
supplementary product
offerings 50+
Used for strategic positioning in TAs1 Used for market access and adoption
1. Therapeutic Areas
©2018 Optum, Inc. All rights reserved. 24
Appetite to continue experimentation with different-in-kind life sciences partnerships 4
Challenges in the past have inhibited the widespread success of OBCs1
Identifying And Maintaining
Partnership
1
• Accessing information and
targeting appropriate fit
Disconnect between health
system strategic focus and
manufacturer product suite
• Overcoming administrative
burden
Time and resource intensive
negotiation and contracting
process
Measuring Outcomes
2
• Determining outcome metrics
Challenge in selecting clinically
appropriate and measurable
metrics
• Tracking and analyzing
outcomes
Copious amounts of information to
collect and review
Aligning Stakeholders
3
• Dealing with mistrust
Involved parties often perceive
competing objectives in partnership
• Promoting buy-in and proving
program efficacy
Lack of publically reported
schemes question feasibility
Ch
allen
ges
1. Outcomes-based contracting
©2018 Optum, Inc. All rights reserved. 25
However, market advancements indicate promise for future partnerships
Appetite to continue experimentation with different-in-kind life sciences partnerships 4
Identifying And Maintaining
Partnership
1
• Accessing information and
targeting appropriate fit
• Overcoming administrative
burden
Measuring Outcomes
2
• Determining outcome metrics
• Tracking and analyzing
outcomes
Aligning Stakeholders
3
• Dealing with mistrust
• Promoting buy-in and proving
program efficacy
Ch
allen
ges
• Emergence of 3rd party non-
biased ‘matchmakers’
• Rise of dedicated provider
roles focused on contracting
to handle tactical
administrative functions
• Meaningful and ongoing
advancements in provider
IT to handle data
electronically and track
patients across multiple
settings
• Enhanced patient
segmentation
• Progressing towards
unsustainable spend rates
(for both stakeholders)
• Providers continuing to
migrate to payment risk,
even if at slower pace
©2018 Optum, Inc. All rights reserved. 26
Implications for life sciences: explore opportunities without ‘one size fits all’ mentality
Appetite to continue experimentation with different-in-kind life sciences partnerships 4
Value-driven Contracting May Be In It’s
Preliminary Stages But It’s Not Going Away
We’re in the very early days, so for anyone
to say the approach won’t work, when the
entire medical community is moving in the
value-based direction, is premature.
-Pharmaceutical Reimbursement Expert
Value-based deals are a component and
not the silver bullet. On its own, it’s not
really enough to address the pricing issue.
But I don’t see it fading away, either,
because the pressure to demonstrate value
for a medicine is too great.
-Pharmaceutical Reimbursement Partner
‘Win Themes’ And Considerations For Crafting
Successful Partnerships With Providers
1. Target health systems with baseline level of
readiness – Not everyone is ready
• Large-risk bearing organizations
• Sophisticated IT infrastructure
• Org structure reflects investments in robust
procurement/supply chain team
2. Understand what agreements are best
suited for YOUR product – Not every
product is a good candidate
• Traditional outcomes-based contracts:
medical devices, high-cost rare disease
treatments, etc.
• Beyond the pill solutions: treatments for
chronic conditions, co-morbid conditions,
etc.
©2018 Optum, Inc. All rights reserved. 27
Learn more about how Optum Analytics can drive collaboration
Brandi Greenberg
Expert on Market
Dynamics Affecting
Patient Care
CEO/COO
Relationships 8,800+
Years of researching
provider issues 35+ National provider
meetings hosted annually 90+
Life Sciences companies
engaged on a range of
issues 200+
Generator of Broad,
Deep & Enriched
Patient Data
Claims lives 188M+
Clinical lives 100M+
Data and analytics
professionals 26,000+
Convener of
Healthcare
Delivery Issues
We are well-positioned to drive collaboration
©2018 Optum, Inc. All rights reserved. 28
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