Real-World Data May Improve Outcomes, Reduce Specialty Drug Costs

Technology and data surround us every day. From smartphones to medical records, more platforms have allowed data to be collected at a higher level. In specialty pharmacy, software platforms allow physicians to send prescriptions and manage patients without the hassle of paper forms, which may delay care. Harnessing these real-world data, along with other measures, have become important in determining the value of treatments and how patient outcomes can be improved.

In part 3 of a 3-part interview with Specialty Pharmacy Times, Durral Gilbert, president, supply chain services at Premier Inc., and Greg Isaak, president of Commcare Specialty Pharmacy, discussed how technology and data can positively impact specialty pharmacy when used properly.

Click here to read part 1 of this 3-part interview.

Click here to read part 2 of this 3-part interview.

SPT: How has technology transformed health care over the past few years?

Gilbert: Technology has really been helpful in enabling us to collect, analyze, and interpret health care data in new ways. Today, providers can collect more data, from more places, aggregate it and look at it in ways that we couldn’t 5 to 7 years ago. And we’re seeing new data sources come into health care that are giving us a richer picture of the people we are treating. It doesn’t have to be pure black and white data. It can be experiential, quality of life, days worked, or days missed data. Those new sources of information make data more rich.

However, as we collect more and more data, we’re going to have to manage it differently. Big data is much more cumbersome and difficult, and it requires very careful stewardship in order to ensure it’s used right way. Managing that volume of data appropriately, and protecting patient security in the process, is actually going to be one of the biggest challenges for health care.

The other issue on the horizon is leveraging that data for real insights. It’s one thing to have access to a mountain of information, but quite another to be able to mine it to gain specific insights about a population, or even an individual patient. As we sometimes say, it’s like data, data, everywhere, and not a drop to drink. To really unleash the power of data, we need advanced analytics that can help us make sense of it, predict future outcomes and alert clinicians when it’s time to intervene. There’s so much potential here, but only if it can be used and acted upon by individual providing the care.

SPT: How can data be used to improve treatment strategies and patient outcomes?

Gilbert: Data is going to help providers start to see patients as different individuals. Historically, patients with the same conditions were largely treated in the same way. But today, we have more data on how different people may respond to specific treatments, based on variables like their age or gender, and increasingly, their genetic makeup. Data will help us look at treatments through this more specific lens. Look at HIV and hepatitis, where now, more specific, individualized data is helping us deliver the more efficacious drug.

Isaak: Data helps us identify the progress patients are making during their course of therapy. For us, it’s all about how we can keep them adherent, keep them on what’s prescribed. If they take the prescription for 6 to 8 months, that’s a lot better than 6 weeks. As a case mentioned this morning [March 23, 2017 at Premier’s 6th Annual Specialty Pharmacy Executive Retreat], one-third of patients do not finish their full course of therapy for a variety of reasons. How can we use data to prevent that? Can data help us predict when a patient may experience a side effect or at least be in that zone to experience it? Can we take extra steps to get them on a medication that they may respond to better? You can’t be proactive in managing the care unless you have that type of information.

SPT: Can data be leveraged to reduce specialty drug costs for patients?

Gilbert: Data is going to help us understand the patient at a deeper level, and get them on the right therapy sooner. To Greg’s point, when the data tells us the right course of therapy was not administered at first, we can make a change to something the patient will tolerate better, and speed their overall recovery time — the key to saving money.

There will be clear cut examples like this, but most of the time, there will be a lot of interaction with clinicians. On the specialty side, there’s lots of give and take with a few folks providing input into the patients care and their responses to therapy. From folks like patient navigators, social workers and pharmacists, all the way through to the primary care provider. Those interactions are going to give us data and information about the patient that will also help us treat them better and faster.

Isaak: We want to start patients on therapies as quickly as possible. We want to manage any potential side effects or any issues the patient may experience with the product. We want to intervene as quickly as we can so we don’t incur waste. Specialty products are not inexpensive. The costs are $8000, $10,000, and $12,000, $30,000 per dose or per month. If a patient takes two weeks of a $30,000 therapy, and doesn’t take the remaining 2 weeks, then you’ve incurred $15,000 of waste. If you know 1 week into it that there was an issue, you could have made course corrections. That’s data where is important, and why that intervention by the health care professional is critical for the successful use of data.

SPT: Why is real-world data especially important when it comes to costly specialty drugs?

Gilbert: Real-world data is the absolute best data. You want real data from real patients undergoing a similar experience or a near-exact experience so you can make comparisons and predictions. Given the nature of these therapies, the cost profiles, and the patients, data is critical. We also need to remember that a lot of the patients on specialty pharmaceuticals are often taking multiple medications, and sometimes multiple specialty products. We’re not just talking about a patient with rheumatoid arthritis or a patient with MS [multiple sclerosis]. We’re probably talking about a patient with diabetes, congestive heart failure and rheumatoid arthritis. Now, data becomes even more critical because you’re talking about managing multiple, high-cost therapies, as well as drug interactions. To really manage these therapies and get a picture of the long-term cost and quality outcomes, you need to link the inpatient, outpatient medical, and outpatient pharmacy together, and ideally in real time.

Isaak: Very specifically in specialty, as we see it daily, we know how a process should work. We can map how a patient should react to a medication, but with real-world data, we can anticipate how a patient will react to a medication and how they will perform through the course of therapy. The minute we assume how they will perform is the moment we lose that patient. That real-world data on how they are responding — have they lost weight, how did blood tests come back, what are the other markers that tell us how a patient is progressing – those are critical data elements. That’s why real-world and current information helps us treat patients better.

Gilbert: We’re talking about 1% to 2% of the population that are suffering from conditions that require specialty pharmaceuticals. Part of the picture has to be putting that data together and looking at this broader population. For instance, using data on education and socioeconomic issues that then also relate to outcomes. To me, the ultimate destination is real-world data for these therapies, coupled with longitudinal, population data that helps us evaluate the long-term cost and quality outcomes.

SPT: Overall, what are the most important aspects of treating populations taking specialty drugs?

Gilbert: I would underscore the importance of collaboration, data and longitudinal data in treating these high-cost populations. Too often we try and treat them with a slice of that overall data. We have got to look at the data in its totality to really drive a change in the marketplace. Chronic disease patients are going to be living longer than they did 10 years ago, and we are going to be treating them as a population.