As the industry develops increasingly complex treatments to address unmet clinical needs, it is imperative to ensure these life-saving therapies reach the patients who need them the most. Critical to that mission is demonstrating value, safety, efficacy, outcomes and cost effectiveness. As these high-value therapies face regulatory and payer headwinds, it is time to reconsider whether legacy clinical data solutions that were satisfactory for last-generation treatments are up to the task of what’s before us today. We recently hosted a webinar to reveal HealthVerity taXonomy, a world-class closed claims data product designed to power health economics, outcomes and real-world safety studies. We invite you to watch a replay of the webinar or enjoy the following recap:
Pharma evidence dilemma
After performing extensive market research with pharma companies, HealthVerity repeatedly heard about four key challenges that the industry is facing today when addressing outcomes, safety and effectiveness studies:
Payer concentration - Many legacy data solutions rely on a single source or limited number of payers for claims data. Is that sufficient to support more complex studies?
Payer type scarcity - Traditional data solutions focus only on self-insured or commercial claims. Will that suffice when half the country has some form of government health insurance?
Data discontinuity - The industry is increasingly experiencing data disruptions, with data owners becoming more restrictive of their data. Can you be sure that your current solution will continue to have the data that you need?
Incompatible data sources - For complex therapies, a combination of data types are ideal to answer for outcomes, safety and efficacy. Do you have seamless, interoperable, on-demand access to EMR, lab results and beyond?
HealthVerity taXonomy is the nation’s most comprehensive, consistent and curated clinical dataset, created to overcome these four challenges and to serve your needs today and as you go forward into the future.
Comprehensive: The broadest payer claims coverage ever assembled
HealthVerity taXonomy consists of over 245 million covered lives. This is the broadest coverage of any payer claims dataset ever assembled and includes patient data for up to nine years. Longitudinality is critical, particularly when working with rare diseases where you need to be able to discover a particular population with increasingly precise and narrow criteria. This vast closed claims dataset brings together all of the attributes you would expect, plus other elements, such as race and mortality, and represents all age groups, races and geographies.
Consistent: Manage data discontinuity
With over 225 payers represented in HealthVerity taXonomy, we see across a broad number of dimensions and ensure a diverse and representative sample that includes commercial, Medicare and Medicaid. Additionally, our data provider matrix maximizes stability in data supply, offering continuity in a market where some long-standing data sources are being retracted almost overnight. That’s because HealthVerity has created a bi-directional trust network between our data partners and end researchers with transparency and clarity into data provenance, data rights and use applications. This visibility allows data partners to be confident on where their data is being delivered and how it is being used. With our open architecture, this stable closed claims dataset provides a foundational view that also allows for new payers to consistently join the dataset.
Curated: Research ready from day one
With the feedback that we received from our top pharma clients, we decided to simplify, consolidate and curate our data model and HealthVerity taXonomy does exactly that. It’s highly curated and de-duplicated across sources, providing a visit-centric view that includes standardized costs and reference tables. This new approach pulls together a comprehensive view of patient journeys while still being within the privacy-compliant framework that allows for additional data to be synchronized from across HealthVerity Marketplace, such as EMR, lab results and open claims data, all within a single contract. This eliminates any concern about needing to perform an independent privacy review or taking months to assemble a multi-data-source cohort.
Streamlined and simplified data model
We spent extensive time synchronizing the data to inform a thoughtful and meaningful design with 11 pre-assembled, purpose-built and curated tables that allow you to focus on your research while avoiding the struggle and frustration of a traditional claims layout. This simplified data model provides everything you need across medical and pharmacy claims, enrollment, demographics, vital statuses, and reference tables from CMS and FDA. By de-duplicating records and prioritizing completeness of records, we are providing the most comprehensive view of patient visits and encounters. Diagnoses, procedures and prescriptions can easily be contextualized by the provided reference tables. Enrollment and remittance data are organized by payer type and Census region, allowing you to focus your cost analysis on specific groups of people and parts of the country. Instead of needing to contract and link with a number of different providers in a potentially weeks or months long process, we provide demographics and month of death as part of HealthVerity taXonomy, sharply reducing time to insights for overall survival outcomes research.
More value with standardized costs
By introducing remit data, we fill the gaps in legacy costs data, providing the result of real-world payer and provider negotiations, not the requested reimbursement amount normally found in open claims. By mapping the remit data to procedures, we are also able to calculate and understand median negotiated rates across hundreds of payers, instead of a single payer or small mix of payers where the costs are subject to their specific formularies and limited to the geographies and pay types they serve.
This approach to cost data will be stored in the procedure table, next to the payer submitted allotment amount, which gives you optionality and the ability to compare and diversify your sources for cost data. For example, in reviewing a single procedure code over the last three years, we see a 10% difference between actual cost and the calculated standard market cost. Providing both side by side, we offer options to take analyses to the next level. The standard market cost is not imputed, it’s the real cost in the real world. It’s a median across visit, year, pay type and Census region, thus making it more representative of the U.S. population receiving care and the most unbiased, real-market cost.
Beyond closed claims
HealthVerity taXonomy brings together an ecosystem of closed medical and pharmacy claims and enrollment data, but it can also be synchronized with other data types, such as EMR, open claims and lab results, without having to wait 90-180 days to negotiate contracts, receive the data and perform a privacy certification. Leveraging the universal HealthVerity ID (HVID) that is persistent for patients over time and across data sources, all of the data sources on HealthVerity Marketplace, the nation’s largest healthcare and consumer data ecosystem, are fully interoperable and HIPAA certified. In HealthVerity Marketplace, you can build cohorts and instantly see patient counts and data overlaps across sources and receive research-ready data in as little as two weeks.
Following are example use cases that demonstrate the value HealthVerity taXonomy brings on its own and the simplicity of the HealthVerity model that allows for the synchronization of other sources:
HEOR study of patients diagnosed with breast cancer
The breast cancer patient’s path to treatment can be costly and difficult. Additionally, it can be impacted by comorbidities, such as obesity, heart disease and psychiatric conditions. With HealthVerity taXonomy, we discovered nearly 1.6 million patients diagnosed with breast cancer between 2015 and 2023 and are able to see the following attributes over that eight year journey:
- Year of birth
- Region
- Race
- Mortality
- Treatment for chronic comorbid conditions
- Breast cancer treatment history
- Cost of care, including remittances, standard market costs and hospitalization costs
This data can be seamlessly synchronized with labs and EMR to contextualize the specific subtype of breast cancer, grade, stage and severity. With these insights, you can determine what targeted treatments are available to them and monitor adverse reactions via hospital admissions. Hospital chargemaster data can be integrated for a more comprehensive view of those costs, as well as additional lab results. All three of these sources can be seamlessly synchronized with no additional contract, making things simpler and far more efficient.
Outcomes in patients with type II diabetes and chronic kidney disease
Diabetes is a growing concern with 11% of the population suffering from the disease, 6% specifically with type II diabetes. Diabetes is also the leading cause of chronic kidney disease (CKD), accounting for 40% of new cases. Additionally, diabetes and CKD are more prevalent in non-Hispanic Black patients or Hispanic patients as compared to non-Hispanic White patients. Therefore, demographic insights are extremely important to better understand disparities in care. Diversity of pay type is crucial with CKD to understand the patient journey from diagnosis, where most patients have Medicaid or commercial insurance, through end stage renal disease when patients are automatically eligible for Medicare. With HealthVerity taXonomy, we discovered almost 20 million patients with type II diabetes, providing the following attributes:
- Year of birth
- Region
- Race
- Mortality
- Gender
- Treatment for chronic comorbid conditions, such as CKD (over 4 million patients), hypertension, heart disease and depression
- Disease progression, including the stage at diagnosis, interventions over time and dialysis preparation
More is needed than just medical claims, however, to accurately track disease progression. With eGFR testing in lab data, you can discover patients who were not diagnosed with CKD in medical claims, but their eGFR results qualify them for stage 1 or 2 categorization. Lab data is also paramount to monitoring disease progression over time, allowing you to see fluctuations in A1C levels based on interventions. EMR data further complements the diagnostics with regularly reported measures that are crucial to monitoring improvements and progression, such as BMI, height and weight, and even procedures prepping end stage patients for a dialysis port. Hospital chargemaster data and other sources can be integrated with HealthVerity taXonomy with no additional privacy certifications so you can get started right away researching trends in statin use, insulin pumps versus insulin injections, hemodialysis versus peritoneal dialysis outcomes and much more.
Anti-amyloid therapy in Alzheimer’s disease
Alzheimer’s disease is another condition that requires data longitudinally to fully understand a patient’s path to diagnosis. Dementia and Alzheimer’s have been shown to disproportionately affect women, non-Hispanic Black and Hispanic patients. Therefore, including these demographics is extremely important. With HealthVerity taXonomy, we discovered nearly 900,000 patients with Alzheimer’s, providing the following attributes:
- Year of birth
- Region
- Race
- Mortality
- Gender
- Treatment for chronic comorbid conditions, such as hypertension, heart disease and depression
- Interventions over time, including imaging procedures and therapy uptake
- Hospitalizations
- Cost of care
The path to conclusive diagnosis is rarely simple and requires a barrage of cognitive and behavioral tests, diagnostics and imaging procedures. Additionally, recently approved treatments designed to decrease the amount of beta amyloid protein in the brain to slow neurodegeneration require patients to be tested for APOE, amyloid beta p-tau and other diagnostic tests to even be considered. This diagnostic testing can only be found in labs. Therefore, labs, EMR and hospital chargemaster data must be synchronized for a clearer picture. If patients are subsequently prescribed these cutting-edge therapies, physicians have to monitor for signs of edema or hemorrhage, neither of which are clearly defined by just a diagnosis code. HealthVerity taXonomy can be synchronized with imaging report text, which allows you to identify instances of these side effects in the real world without delay in delivery and with no additional administrative burden.
Discover how you can claim better outcomes
We’ve been listening to our clients around the elements that you would like to see in an ideal closed claims dataset. We introduced HealthVerity taXonomy to be that comprehensive, consistent and curated clinical dataset.
Discover for yourself and explore HealthVerity taXonomy in our exclusive sandbox environment:
