If you’ve been reading our past blog entries (see here, here, and here), you know pharmas are scrambling to woo insurers and pharmacy benefits managers to get access to real world evidence that supports the value –and hence utilization—of their drugs.
But as the race to lock-up access to valuable outcomes-based data continues, there are other data troves that, thus far, remain untapped–at least by industry players.
These include the data warehoused in so-called integrated delivery systems (IDS) as well as the various health information exchanges (HIEs) designed to enable the safe, secure transfer and retrieval of data housed by disparate provider groups in a given geography.
After all, IDSs like Geisinger Health System and Kaiser Permanente care for individuals on an in-patient and out-patient basis, tracking patients via electronic medical records. Meantime, by collating disparate data points into a continuity of care document, HIEs — both privately-run as well as state-based groups—also begin to integrate information about drug dosages, co-morbidities and outcomes to create a more complete clinical picture. Regardless of the data source, this indepth view has far more utility in building a case for a product’s market access than the claims data pharmas have traditionally relied upon.
So if these data are so valuable why aren’t pharmas doing more to access it?
It’s well known that pharmas have met with mixed success when using de-identified prescription data to bolster healthcare economic arguments about their medicines. Payers typically haven’t trusted the data, in part because their own databases allow for a deeper, more comprehensive analysis than what’s typically been available to pharma via third-party vendors.
That’s resulted in pharmas partnering directly with payers –think Pfizer/Humana or AstraZeneca/WellPoint. But even as pharma-payer deals are becoming more common, experts say there are still significant technical and cultural issues stymieing pharma-provider alliances.
For starters, even with the most robust HIEs, it’s not necessarily the case that data moves seamlessly from provider A to provider B. “We talk a lot about technology that can populate an electronic health record automatically,” says John Kravitz, an associate vice president of IT for Geisinger, which has one of the most advanced IT initiatives going in healthcare. “It still takes a lot of massaging to make it work.”
That’s because in a given HIE, physician groups use not only different computer systems, but also claims and care-management systems, none of which are automatically designed to talk to each other – what in IT lingo is called “interoperability.”
Another complexity: the legal rules underpinning how and when patient data can be shared. Fact is, each state HIE has different rules for how patient data can be shared and with whom.
Such technical challenges can be overcome. What may be more difficult is surmounting the knee-jerk “ick” factor of being too closely tied to industry. And having been burned by restrictions on what counts as marketing to physicians, “most in industry are scared to death” about potential relationships with providers,” says health information exchange consultant and founder of Mosaica Partners, Laura Kolkman. “Until [pharmas] know how not to misstep they will stay on the sidelines,” she predicts.
Still, payers have clearly figured out a way to overcome the stigma of working with pharma, so it’s a fair bet provider groups will too. One reason: there’s a powerful financial incentive to do so. Many hospitals and large physician groups are cash-strapped because of falling Medicare reimbursement and higher costs associated with implementing new, more efficient care delivery models. Collaborations with pharma for access to de-identified data would provide some much needed cash to fund the required upgrades. (Even the technology upgrades for EMRs don’t come cheap as this WSJ article shows.)
And it’s not as if those alliances couldn’t be centered around topics where there is clearly mutual interest: think medication adherence or clinical trial recruitment. If a doctor can help a patient improve his adherence to a diabetes medicine, the patient’s outcomes should get better and the physician’s quality ranking escalates; so too does the pharma’s sales revenue since the patient is actually taking –and renewing—his script. In other words, if a pharma and a provider were to work together to improve patient adherence, there’s no conflict: it’s a win for the healthcare system overall.
Will pharma-provider alliances happen? Steven LoSardo, a director at PricewaterhouseCoopers, which recently assembled a new report on the importance of clinical informatics in driving down healthcare costs, believes it’s a question of “when” not “if”. “We hear through our clients that different HIEs and integrated health systems are very interested in this,” he says.
Image courtesy of flickrer Evil Cheese Scientist via creative commons.