The inability to obtain these insights makes it impossible to capture a therapy's comprehensive impact, affecting payer formulary/market access decisions.
HCRU & Cost Analyses

>50% of teams report it is a "significant to very significant challenge" to obtain:

  • Payer cost data
  • Hospital chargemaster data
  • Longitudinal enrollment coverage at the patient level
  • HCRU by setting of care
  • Patient insurance assignment/status

What’s behind the challenge? 

  • No access to a comprehensive data source that tracks the patient journey —  across HCPs, HCOs, care settings, and payers — capturing switches in patient insurance
  • Lack of access to coverage/cost data for treatments, procedures, products, and services
  • Using data that doesn’t include all payers or includes payers but not health plan type (e.g., PPO vs. high deductible or Medicare FFS vs. Medicare Advantage)
  • No access to patient enrollment data to confirm the payer coverage listed on claims