information assets and outcomes research capabilities at the medstat group, inc. ron ozminkowski,...

Information Assets and Outcomes Research Capabilities at

The Medstat Group, Inc.

Ron Ozminkowski, Ph.D.

Director, Health and Productivity Management Research

Copyright 2002 Thomson Medstat2

Agenda

• Medstat is ….

• Thomson Corporation

• MarketScan® Research Databases

• Pharmaceutical Research Capabilities

• How Do We Get Started?

• What Happens Next?

• Market Signals


Medstat is ….

A healthcare information company that:

• Helps customers manage the cost and quality of health services and benefits– Research services

– Analytical consulting

– Software applications

– Databases

• Serves all major market segments

• Has longest track record in industry (founded 1981)

• Employs approximately 750 employees in nine locations

• Is part of The Thomson Corporation


Medstat is Part of the Thomson Corporation

• Global e-information and solutions company with annual revenues of approximately $7.2 billion

• Operations organized into four market groups:– Thomson Legal & Regulatory

– Thomson Financial (includes First Call)

– Thomson Learning

– Thomson Scientific & Healthcare

• Thomson Scientific

• Thomson Healthcare

• Medstat


Medstat Customer Profile

• Pharmaceutical Most U.S.-based manufacturers

• Employers 70+ large employers

• State Gov’t 20 state programs

• Federal Gov’t CMS, AHRQ, CDC, SAMHSA, DOD

• Health Plans 100+ health plans

• Providers 1,000+ hospitals, IDNs, etc.

Market Sector Customer Overview


Three Principal Product Lines

• Decision Support Systems and Solutions– Adding value to internal information by developing databases,

applying methods to help understand the data, and developing the tools necessary to organize the data for better decision making.

• Information Solutions– Integrating external market intelligence and applying methods to

benchmark, forecast, and analyze for improved decision making.

• Research– Helping the research community uncover important information for

better decision making and to fuel internal product development and innovation


MedstatMarketScanDatabases

Data Management Process

Privacy Protection Integration Standardization Customization Enhancement QA/Improvement

Customer Internal Data

Eligibility

Inpatient claims

Outpatient claims

Prescription drugs

MarketScan Database Development

75 million facility and professional claim lines and 40 million drug claims annually


MarketScan® Research Databases

• Large multi-source database of privately insured claim and encounter data

– These sources ensure that MarketScan reflects the complexity of the real world of healthcare delivery

– Databases represent true continuum of care, including carve-outs

– 4 million+ annual covered lives

• Longitudinal data– Databases support person-level analyses, with three to five

years of follow up

• The basis of more than 40 peer-reviewed journal articles in the last three years


How MarketScan Databases Are Built

• Raw data are collected from approximately 100 payers to build individual client databases

– Variables standardized

– Clinical detail added

– Inpatient cases built

• Standard variables from individual databases are combined to form the MarketScan Databases

– Synthetic patient identifiers assigned, consistent across years

– Clinical categories added (e.g., DRGs, DCGs)

– Plan type identified (e.g., PPO, POS, comprehensive)

– Place, service types, provider types, and industry classifications standardized

– MSA and FIPS state-county codes added


MarketScan Features

• Fully adjudicated claims data

• Consistent data definitions

• Inpatient and outpatient claims can be linked to enrollment and drug data

• Consistent patient identifiers across years, for longitudinal analysis

• Linked drug files containing NDC, therapeutic class, copayment, total payment, etc.

• Clinical classification systems such as MDCs, DRGs, DCGs, and Disease Staging can be applied to the data


MarketScan Database Organization

Standard Files

– Inpatient Admissions File (one record per admission)

– Inpatient Services File (one record for each service)

– Outpatient Services File

– Outpatient Pharmaceutical Claims File

– Person-Level Enrollment Files


Medical Claims: Sample Data Elements

Demographic Clinical Provider Financial

Patient ID Admit Date Provider ID

Age Admit Type Provider Type Copay Amount

Gender Length of Stay Place of Service Deductible Amount

Employment Class DRG Provider Specialty Hospital Payment/Charge

Relationship to Benefic. Principal Diagnosis Physician Payment/Charge

Geographic Location Dx2-Dx14

Industry MDC Other Payment/Charge

Principal Procedure Total Payment/Charge

Proc2-Proc14 Payment/Charge

Service Date

Service Type


Drug Claims: Sample Data Elements

Demographic Drug Provider Financial

Patient ID National Drug Code Pharmacy ID Payment

Age Dispense As Written Pharmacy Class Code Average Wholesale Price

Gender Date Filled Copay Amount

Employment Class Therapeutic Class Ingredient Cost

Relationship of Therapeutic Group Dispensing Fee

Patient to Beneficiary Days Supply

Geographic Location Generic Product ID

Industry


Commercial Claims and Encounters (CC&E)

• Inpatient and outpatient medical claims linked to drug data, person-level enrollment data, and benefit plan design data

• Fee-for-service (FFS) with drug data available since 1992, encounter with drug data available since 1994

• FFS and fully and partially capitated plans represented– Exclusive provider organizations

– Preferred provider organizations

– Point of service plans

– Indemnity plans

– Health maintenance organizations


Commercial Covered Lives

Database/ Year

Total Covered Lives*

With Drug Data* With Drug and Enrollment Data*

Commercial Claims and Encounters

1997 4,800,000 1,950,000 (41%) 1,190,000 (25%)

1998 4,000,000 1,900,000 (48%) 1,580,000 (40%)

1999 3,550,000 2,620,000 (74%) 2,500,000 (70%)

2000 3,620,000 2,790,000 (77%) 2,790,000 (77%)

2001 3,530,000 3,060,000 (87%) 3,060,000 (87%)

• *Numbers are rounded Note: Approximately 85 percent of covered lives have at least one claim


Medicare Supplemental and COB

• Inpatient and outpatient Medicare supplemental medical claims linked to drug data, person-level enrollment data, and benefit plan design data

• Available since 1995

• Both the employer-paid and Medicare-paid components of care represented


• Numbers are rounded

Database/ Year

Total Covered Lives*

With Drug Data* With Drug and Enrollment Data*

Medicare Supplemental and COB

1997 590,000 220,000 (37%) N/A

1998 700,000 490,000 (70%) 290,000 (41%)

1999 550,000 450,000 (82%) 420,000 (76%)

2000 540,000 480,000 (89%) 480,000 (89%)

2001 500,000 460,000 (92%) 460,000 (92%)

Medicare Covered Lives


MarketScan Databases

• Commercial Claims and Encounters (1992–2002)– 2002 data to be complete in December

• MarketScan Early View Data Set (July, 2002 – June, 2003)– A subset of the CCAE data set for 42 large employers

• Medicare Supplemental and COB (1995–2002)– Ditto re: 2002 data

• Benefit Plan Design (1995–2002)– 2002 data to be complete in January

• Health and Productivity Management (1997–2001)– Contains information about illness-related absenteeism, STD, and WC

use, linkable to medical and drug claims and enrollment files

• Medicaid – three states (1999-2001)– 2 more states to be added soon, with 2002 data


How Customers Access MarketScan

• Database licensure– Complete database, multiple years

– Subset of database, multiple years

• Custom reports

• Outcomes research studies

• Web-based products

• Clinical trial recruitment products


Pharmaceutical Research Capabilities


Pharmaceutical Research Overview

• Total staff of more than 40– Many with advanced degrees, including

• 10 PhDs

• 2 MDs

– Widely published in peer-reviewed journals

– Multiple research disciplines, including economics, health services research, psychology, and statistics

• Focus on pharmacoeconomics and clinical effectiveness– Retrospective database studies

– Prospective observational studies

– Disease management and program evaluations


Solutions for the Pharmaceutical Marketplace

• Burden of illness

• Product differentiation

• Market assessment– Pricing strategy

– Market sizing

– Portfolio selection

• Economic protocol design

• Decision analytic and budget impact modeling

• Clinical trial recruitment


Methods Often Used in Outcomes Research Studies

• Selection bias adjustments (Heckman, IV)

• Decision analytic models

• Treatment-effect models

• Multivariate techniques– Hazard regression

– Linear regression (OLS)

– Logit, probit, and propensity score models

– Multinomial logit, ordered probit

– Latent class analysis

– Count models

– Duration/time-to-event

– Simultaneous equations


Prospective Studies: The Medstat Advantage

• Assessment of the economic implications of clinical trials

• Development of economic protocols for clinical trials

• Evaluation of quality of life, productivity, and health status

• Support for multi-site clinical and economic studies

• Site selection, training, and management


Sample Prospective Study

• Schizophrenia Care and Assessment Program (SCAP)– Multi-year study of 2,400 people with schizophrenia at six sites

– Baseline and repeated assessments of functioning

– Detailed medication tracking

– Several research themes, including diffusion of new technologies, outcomes, differential treatment, and outcomes by race

– Results described in several conference presentations and a few publications


Clinical Trials Examples

• Depression trial– Used MarketScan data to derive prices for service utilization

observed during a clinical trial. Statistical bootstrapping was applied to compare cost effectiveness for alternative measures of effectiveness (responders and remitters) as well as direct and indirect costs.

• Bowel motility trial – Linked hospital discharge and UB-92 data to clinical trial data and

found length of stay reductions and subsequent cost savings for study patients.

• Intermittent claudication trial– Assessed the cost-effectiveness of a medication for in the

treatment of intermittent claudication (IC).


Decision Analytic and Budget Impact Modeling

• Combine clinical trial efficacy data on patient/drug response with cost information from naturalistic claims data

• Estimate real costs based on expected response using age, gender, dose, medication switching

• Model impact of proposed drug by entering characteristics of health plan or employer population into software

• Econometric modeling programs include those developed for allergic rhinitis, GERD, cholesterol management, and health risk reduction programs


Clinical Trial Recruitment

• We can locate the best clinical investigators in the best locations

• We can find the best patient groups to whom you should advertise

• We can tell you the best way to reach them

This means much faster and more effective patient recruitment


Depression Age 65+: Affective PsychosesClinical Investigator: Dr. KatzArea: Philadelphia, PA DMA

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Dr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. Katz

Pop 65+ Hospital Visits Physician Visits Total Visits

Quintile 1 637,230 6,575 16,159 22,733Quintile 2 277,124 2,842 6,989 9,831Quintile 3 116,787 1,186 2,931 4,116Quintile 4 28,810 292 720 1,012Quintile 5 7,333 74 183 257Total 1,067,284 10,968 26,981 37,950

Copyright 2002 Claritas/The MEDSTAT Group

5 Mile Radius10 Mile Radius15 Mile Radius20 Mile Radius

Dr. Katz is in a high area (red) for depression office visits.

He has a clear recruiting advantage.


Depression Age 65+: Top Cluster LocationsClinical Investigator: Dr. KatzArea: Philadelphia, PA DMA

CamdenCamdenCamdenCamdenCamdenCamdenCamdenCamdenCamden

DelawareDelawareDelawareDelawareDelawareDelawareDelawareDelawareDelaware

PhiladelphiaPhiladelphiaPhiladelphiaPhiladelphiaPhiladelphiaPhiladelphiaPhiladelphiaPhiladelphiaPhiladelphia

Dr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. KatzDr. Katz

Pop 65+ % Pop Depressed Pop 65+ % Pop 65+

Single City Blues 39,791 17.68 3,975 10New Empty Nests 57,741 25.65 3,796 6.6Gray Collars 41,722 18.53 3,261 7.8Inner Cities 43,638 19.39 3,195 7.3Middle America 42,210 18.75 2,481 5.9Total 225,102 100 16,708 7.4

5 Mile Radius10 Mile Radius15 Mile Radius20 Mile Radius

Copyright 2002 Claritas/The MEDSTAT Group

Inner Cities (green) and Single City Blues (red) are the best PRIZM clusters near Dr. Katz.

These are the perfect targets for direct mail.


How Do We Get Started?

• Sometimes prospective clients come to us with a question

• For example, do patients who use SSRIs for depression cost less than patients who use TCAs?

– The issue is total cost, not just cost of the drug– (Want to know the consequences of drug choice)– Also want to know how it works in real life, not in a clinical trial in this case.

• We talk to the client, then write a proposal– Background on depression and pharmaceutical treatment– Description of study questions and hypotheses to test– Description of data assets that can be used to test those hypotheses– Statistical methods designed to provide most accurate answer to the

questions of interest (descriptive and multivariate approaches)– Description of project tasks, timeline, logistics– Pricing– Medstat experience and capabilities– Project staff


What Happens Then?

• If we are selected to perform the work, a contract is negotiated.

• Then we do the work, and hopefully publish the results in a peer-reviewed journal and make conference presentations

– In the past, we have done a lot of both.

• When clients are happy, they come back for more, and business thrives.

• If clients are not happy, we try to make them happy.

• But credibility comes first and is never sacrificed.


Market Signals

• The market suggests we are good at what we do.– Business has grown from about $0.5 million in 1998 to over $5

million this year.

• We recruit good people and often hear compliments about their work.

• We have fun!

information assets and outcomes research capabilities at the medstat group, inc. ron ozminkowski,...

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