COVID-19 RWD Waterfall Strategy

How real-world data (RWD) from open and closed claims and beyond can be layered to better explore the variant-driven surge in COVID-19 

Just as the world was experiencing a semblance of normalcy amid the COVID-19 pandemic, the far more contagious Delta variant, with over 1000x the viral load, has quickly become the dominant strain in the US among the newly infected. Domestic COVID-19 cases are rising in 41 states, and pharma manufacturers are urgently conducting critical research and development (R&D) to stunt the impact of breakthrough cases among the vaccinated, as well as provide some form of futureproofing for new, more dangerous variants.

To better inform critical R&D efforts, pharma and government agencies are reliant upon real-world data (RWD) to study detailed COVID-19 patient journeys, honing in on questions such as: What is the extent and impact of breakthrough infection among the fully vaccinated? Will patients need a booster shot and when? How easily are vaccinated patients transmitting the virus? What pre-existing conditions in a vaccinated patient’s medical history lead to a higher risk of hospitalization and mortality from COVID-19? 

Pandemics create a level of urgency to achieve a global strategy, but researchers are traditionally stifled by the lack of accurate, un-siloed data that is crucial to uncovering real-world evidence (RWE). One approach that has emerged to overcome these data hurdles is to link and synthesize datasets that encompass both open and closed claims, each of which have unique benefits that each describe aspects of the longitudinal patient journey. This waterfall strategy, achieved by leveraging a combination of the near real-time yet long tailed nature of open claims data with the richness of slightly lagged closed claims data can be a potent tool in the fight for effective care strategies.

What are the differences between open and closed claims?

Open claims are generated from a broader set of data sources, including medical claims clearinghouses, pharmacy systems, labs, hospital chargemaster and EMR software vendors, whereas closed claims are generally derived from health insurers (payer) and pharmacy benefits managers (PBMs). Open claims provide insight into the patient journey on a near real-time basis, often from yesterday, and generally over a longer period of time but only for the transactions in the available data ecosystem. Alternatively, closed claims offer a near complete view of medical and pharmacy activity but only during a patients’ period of enrollment with health insurance providers available in the data ecosystem. When blended in for the near term, open claims offer a far greater breadth of data types while closed claims can fill gaps in care. Over the long term, closed claims offer a comprehensive view of the patient, although often lagged by 90 days, while open claims can fill gaps in care during periods when payer data is unavailable or a patient has moved between commercial, Medicare or Medicaid coverage.

What are the key benefits of RWD open vs closed claims for COVID-19?

Open claims:

• Vaccine administration can be linked to later diagnoses of COVID-19 breakthrough cases 
• Accurately linked open claims data lends a broader, long-term view of the patient, including which pre-existing conditions could have impacted hospitalization, long-haul symptoms and mortality rates among COVID-19 patients
• Open claims COVID-19 data is more readily available in the near real-time than closed claims data, due to data lag, making it an advantageous source for urgency-minded R&D teams
• COVID-19 lab sequencing data that is otherwise unavailable to physicians and patients can be linked to explore the impact of variants

Closed claims:

• Closed claims data captures all medical inpatient, outpatient and pharmacy transactions while the patient is insured with a provider, with the exception of cash transactions. Therefore, closed claims data is instrumental in studying the inner workings of the patient journey
• Closed claims data often captures which specialists have been treating patients and the associated conditions that may have contributed to COVID-19 symptoms in infected COVID-19 patients or “long haulers”
• Closed claims allow for evaluation of the total cost of COVID-treatment care 
• Closed claims sources can be linked to follow patients across a combination of Commercial, Medicare and Medicaid carriers 

What is the importance of linking open and closed claims related to COVID-19?

By linking and synthesizing open and closed claims related to COVID-19, researchers can better study the longitudinal patient journey over a longer time horizon. This longitudinality is crucial in analyzing the virus, even as new variants emerge and breakthrough cases and re-infections occur. 

Partnering with HealthVerity

HealthVerity Marketplace manages the largest US healthcare data ecosystem, including closed claims for more than 150 health insurers and nearly 100 million COVID-19 tested, diagnosed, vaccinated or sequenced patients. If you are a pharma organization or government agency and would like to learn how interoperable RWD managed within the HealthVerity data ecosystem and beyond can contribute to crucial R&D in the battle against COVID-19, fill out the form below, email us at marketing@healthverity.com or contact us!