WHY IT MATTERS
The inability to obtain these insights makes it impossible to capture a therapy's comprehensive impact, affecting payer formulary/market access decisions.
CHALLENGE #10
HCRU & Cost Analyses
>50% of teams report it is a "significant to very significant challenge" to obtain:
-
Payer cost data
-
Hospitals' itemized charge data
-
Longitudinal enrollment coverage at the patient level
-
HCRU by setting of care
-
Patient insurance assignment/status
What’s behind the challenge?
-
No access to a comprehensive data source that tracks the patient journey — across HCPs, HCOs, care settings, and payers — capturing switches in patient insurance
-
Lack of access to coverage/cost data for treatments, procedures, products, and services
-
Using data that doesn’t include all payers or includes payers but not health plan type (e.g., PPO vs. high deductible or Medicare FFS vs. Medicare Advantage)
-
No access to patient enrollment data to confirm the payer coverage listed on claims