Keisha Maughn, Principal, Vice President, Real-World Evidence (RWE) at STATinMED Research shares her perspective about claims data, patient insights, coverage plans and navigating the data lake.

Not all claims datasets are appropriate for every research question. With claims data, it’s important to consider the source, whether it’s commercial plans from large employers or the single payer view (national payers). Due to their size, these companies have the negotiating power to give patients with a greater variety of options including providers and therapeutics at more favorable prices. 

Patient Insights and Value Communications

When investigating claims regarding patients with chronic diseases such as schizophrenia or multiple sclerosis, data from large commercial and national payers may, in fact, reveal insights that underrepresent the more clinically severe patients who are unable to work due to their illness.  Many of these patients covered by Medicare and Medicaid often face barriers to care related to cost (for those with Medicare) and coverage limitations.  They are also more likely to have higher burden of illness. Excluding these patient populations from a study looking at burden of illness may significantly underreport disease burden and negatively impact any resulting economic models and downstream value communication. 

Plans, Providers and Patient Costs

Patients with high deductibles and those with small commercial plans also face barriers to care related to cost, and limited availability of in-network providers. Smaller commercial plans tend to have less negotiating power than their larger counterparts, which results in higher barriers to care. 

When it comes to specialty products, patients may be faced with extremely limited options with only a single drug in a particular class covered by the plan. Even with limited options, the utilization management policies can be highly restrictive, requiring patients to pay high coinsurance amounts. This cost sharing for healthcare services can negatively impact patients’ decisions to seek care and treatment.  In fact, studies have shown an inverse relationship between out-of-pocket cost and medication adherence.  

Data Lake Navigation

The STATinMED real-world data lake provides keen insight into the vast ecosystem, from large accounts to the smaller accounts where patients may have a different experience. Leveraging the data lake in evidence generation provides more representative insights into the true burden of disease, results of which may greatly improve success in value communication.

We understand real-world evidence and solve problems with confidence. Contact the STATinMED Business Development team to learn more!