An integrated approach for deeper insight with both open and closed claims data

Pharma teams are under sharper financial scrutiny and policy pressure than they've been in years, and the decisions being asked of them (pricing, access, launch strategy, lifecycle planning) all hinge on a comprehensive patient journey.

Open claims alone leave gaps in cost and outcomes. Closed claims alone leave gaps in reach and recency. Neither is enough on its own to answer the questions leadership is now asking, which is why the foundational dataset you choose directly shapes what you can defend, forecast and act on.

Open and closed datasets refer to how the data is collected and to what extent, you have visibility into the patient journey. In a previous blog, HealthVerity discussed choosing between standalone open claims and closed claims as the foundation for analytic needs and various use cases, each offering unique benefits and applications. Here we’ll explore integrating both open and closed claims in a singular dataset.

Integrating open and closed claims for comprehensive real-world datasets

An integrated open and closed approach involves using both open and closed claims datasets for their respective strengths, using them separately and sequentially, and taking insights from one dataset type as the starting point for new questions explored in the other. This approach enables users to leverage the same integrated version of diverse data sources for more nuanced analyses, such as the need for precision around outcomes or utilisation seen in closed claims, along with the payer impact, longitudinality and in-depth patient exploration seen in open claims.

An integrated open and closed data solution serves multiple purposes across commercial analytics and reporting, Health Economics and Outcomes Research (HEOR), Medical Affairs, Real-World Evidence (RWE), pipeline management and business development teams, allowing for more seamless collaboration and reduction in resources through the usage of a singular dataset.

Benefits of an integrated open and closed claims foundation:

• Full product visibility and share tracking: Open claims often exclude blocked products, distorting writer and market share views. Integrating closed claims restores that visibility, so manufacturers can track product share by provider, account and payment type across the full market.
• Reduced data bias: Standalone open or closed claims tend to have unequal coverage across payment types, which can introduce regional and socioeconomic bias into a cohort. An integrated foundation smooths that out, giving results that are representative of the U.S. population.
• Complete treatment pathways: Patients don't always share the same medical and pharmacy plan, so a single closed source may capture one benefit but miss the other. Open claims can also have gaps in diagnoses or treatments. Combining the two closes those gaps and reveals the full therapy progression.
• Stronger longitudinal analysis: Closed claims only cover the window a patient is enrolled in a health plan, which limits long-range studies. Open claims fill in the periods before and after, extending patient follow-up and supporting analysis of complex, chronic conditions.
• Demand forecasting and lifecycle planning: Open claims show real-time market demand while closed claims add historical context. Together they sharpen forecasting and inform inventory, production and product lifecycle decisions.

Tradeoffs of an integrated open and closed claims foundation:

While an integrated foundation inherits benefits from each parent dataset, it comes with its own tradeoffs that should be weighed when selecting a foundational dataset.

• Payer and provider confidentiality restrictions: Payers contributing closed data must keep their financial relationships with providers confidential, so payer names are excluded from the closed foundation and, by extension, the integrated one. NPI is treated similarly. Some suppliers strip it out entirely, while others include it with strict use restrictions that prohibit inferring payer-provider financial ties. Both limits complicate payer analyses and often call for a separate payer data asset. Confirm how the integrated foundation you're evaluating handles each.
• Timeline discrepancies: Open claims are captured in near real time, while closed claims typically lag 60 to 90 days behind the healthcare event. An integrated dataset therefore mixes recent events with ones that closed months earlier, and trend analyses need to account for that offset.
• Analytical readiness: The dataset should arrive ready for analysis. If the supplier hasn't handled cleansing, deduplication and standardization upfront, the burden shifts to the user and consumes significant time and resources.
• Key variables and formats: Open claims use the NCPDP D.0, 837 and 835 formats, while closed claims are encounter-based with less field richness, which limits the common variables available across the integrated dataset. Assess which fields each business case requires and confirm availability in the foundation you're considering.

Building on your data foundation

Even with a solid data foundation of open, closed, or an integrated solution depending on your specific need, the fact remains that no one dataset will address everything. Further integrating your foundation with additional data assets promotes even more precise analytics and actionable insights to inform strategic decisions, clinical protocols, physician targeting and recruitment efforts, and commercial or epidemiology and outcomes-based reporting.

For example, when integrating your foundation with Social Determinants of Health (SDoH) and lab data, users can better target patients for more accurate cohort selections, which supports more personalized treatment strategies. In addition, the ability to track long-term health outcomes and treatment effectiveness, particularly in pharmaceutical research and clinical trials, supports comprehensive outcomes research.

Access integrated open and closed claims through HealthVerity Marketplace

Symphony Health, a HealthVerity company, brings decades of longitudinal open claims expertise to the industry's largest real-world data ecosystem. Through HealthVerity Marketplace, you can now discover and license Symphony Health's open claims alongside closed claims covering the full continuum of care during a patient's enrollment, delivered in a single, integrated foundation.

The result is a more complete view of the patient journey for sharper decisions, more efficient operations and better outcomes, all through a self-service experience built for the way modern data teams work.

To see how HealthVerity Marketplace can address your data needs, connect with us today.