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Managing risks through enhanced analytics

by World Health Now
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The COVID-19 pandemic has created a perfect storm in healthcare. Mass job losses, closure of healthcare facilities, and patients’ fears about visiting their doctor, scheduling procedures, or even picking-up their prescriptions has all led to physicians and payers no longer being able to rely on traditional data to predict future trends. This has also led to a continued shift to value-based care and digital transformation. The marketplace is now awash in both unexpected risks and paradigm shifts in how we approach our healthcare in general, as providers, payers, and as consumers now require more diverse data to interpret.

To close the gaps, many industry stakeholders are adding external healthcare data sets into their strategic planning and forecasting process. When payers and providers are able to compare their own internal data with that of IQVIA’s medical claims and prescription data, they are better able to interpret the impact of COVID-19 on near-term business, quickly identify market shifts, and implement strategies to mitigate new risks on their operations.

IQVIA’s Medical Claims Database details patient-level diagnoses, procedures, and provider panel demographics from facilities across the United States, while the Longitudinal Prescription Database, provides a near real-time source of data which tracks the flow of prescriptions drugs and therapies from pharmacy to patient in communities across the country.

The insights garnered from these sources are helping customers answer questions about how their businesses will evolve due to the lasting impacts of COVID-19 and mitigate risks related to the following key issues:

1. Requirements and costs of treating the long-term effects of COVID-19

The lack of historic data about the impact of COVID-19 makes it difficult to predict the cost of treatments and the long-term effects of COVID-19 as a co-morbidity with other conditions. While no one has the answers yet, payers and providers can use claims and prescription data to monitor treatment trends to identify variations in outcomes across patient populations or regions. These insights can help them more accurately track demand, anticipate COVID-related complications, and stay abreast of the most effective standards of care.

2. Shifting trends around elective procedures

Elective procedures are key revenue sources for many providers – and a key cost for payers. The closure of healthcare facilities and the cancellation of these procedures has had a dramatic effect on near-term revenues and costs and has made it difficult to predict long-term trends. Adding additional complexity, providers are unsure if patients will return for elective procedures with pre-COVID volumes. Using medical payers and providers can more accurately forecast when ‘pent-up demand’ will drive a surge in elective procedures, and which procedures patients will likely forgo altogether.

3. Impact of COVID-19 on value-based care

The pandemic has left millions of people with the potential for a pre-existing condition(s). In a value-based environment, payers and providers need to understand the long-term implications of the virus on patient outcomes so that they can proactively estimate its impact on the cost and quality of care. Using global healthcare data, payers and providers can monitor trends and treatment paths for these patient populations, ensuring they make informed decisions about their care.

4. The cost and impact of medication adherence rates

The pandemic caused millions of people to lose their jobs – and their employer-sponsored healthcare plans – which impacts their ability to engage with their provider, receive care, and fill necessary prescriptions.1 Even among those who still have medication coverage, quarantines and the fear of the virus have made it seem too difficult or risky to get to the pharmacy. All of this affects treatment adherence, which has a huge impact on both cost and quality of care.

Medical claims and prescription data can help payers and providers track the shift in adherence rates for different patient populations, geographies, and cohorts. They can use these insights to prepare for related negative outcomes, and to implement strategies to support adherence during the crisis.  

5. How cash payments and discount cards affect star ratings

Consumers facing economic hardship may find that cash payments or discount cards can lower their prescription costs beyond their co-pays. For payers, this can look like non-adherence, which negatively affects their quality CMS ratings. Prescription claims data can help them identify these payment trends sooner, so that they can potentially adopt more competitive coverage options and bring those members back in-house.

6. Quantifying new member risk for payers

Mass job losses means millions of people are shifting insurance coverage. This means payers are now in the position of needing to accurately assess impact by business line to identify growth opportunities, accurately risk score potential new members during the quoting process, ensure that they have the optimal provider network, and to plan design packages. Medical and prescription claims data can provide insights into their health needs which can help payers more accurately assess financial risks associated with these new members and optimize provider networks to address their care.

In these unprecedented times, there is no single source of data that can answer every question, but when payer and providers use trusted external analytics, combined with insights from their own internal data and expertise, they have the necessary foundation to support their strategic planning process and mitigate risk through informed decision-making grounded in analytics.

For more information about IQVIA’s healthcare databases, check out IQVIA.com/USHealthcare.


1 IQVIA Monitoring the Impact of COVID-19 on the Pharmaceutical Market, Dec 2020



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