Payment/claims data was never fit for the purpose of understanding patients’ use of medicines, yet we still rely on it for critical strategic decisions - there is a better way.
Written by: Jeff Wandzura, RPh, CEO of KEEP
During my time as a pharmacist, I realized the core function of pharmacy fill (payment/claims) data was to solve an accounting problem, yet we’re trying to repurpose it to inform critical strategic and clinical decisions around real world use of medicines. This simplistic and surface level view has left a void in our ability to understand, support and optimize the treatment journey.
Out of convenience, and constrained by data availability, the healthcare community has relied on a significant assumption that a patient who receives and has ‘access’ to their therapy is in fact using it properly on a day-by-day and dose-by-dose basis. However, our line of sight to the medication experience has traditionally stopped once a medication leaves the pharmacy.
As someone who spent many years as a pharmacist, I know first-hand this is often far from reality, and can cause us to miss the plot line, especially with more complex, specialty medications being shifted from the hospital/clinic setting to now being managed to the new front-line of care; the home.
Imagine driving a car and you’re forced to close your eyes for 30 seconds at a time. At that point, you can look at your rearview mirror to see where you’ve driven and take some vague guesses on the road ahead based on what you observe. You repeat this cycle over and over, till one time the music stops after you veer off course. No, of course you wouldn’t, it would be reckless for you and others – yet we do this with our customers, physicians and patients.
That’s the reality when you’re relying on claims data – you get a snapshot in time with 30 days blacked out and you’re blind to the information in between those data points from the financial claims data being repurposed to measure adherence. Then, the dated data stream stops. Did the patient switch to another therapy, stop treatment altogether or was there another issue? After that, you wait another 30 day cycle to see if the patient was simply late with their refill.
