Generating real-world evidence from chargemaster data: Q&A with Myla Maloney of Premier, Inc.
Most real-world data (RWD) sets are based on claims data, which provides useful information, but misses the context of what takes place for a patient during a visit to a hospital or clinic. Premier, Inc., a new Aetion data collaborator, offers a robust hospital chargemaster database with detailed information on the treatments, procedures, and devices used during a patient’s visit to a medical facility. Biopharma and government partners then use these data—which are sourced from over 1,000 medical facilities across the U.S. and report on one in every four or five U.S. patients—to answer key questions around drug costs, clinical outcomes, and utilization patterns.
We spoke with Myla Maloney, Vice President of Strategy and Commercial Operations, Applied Sciences at Premier, about what makes the Premier Healthcare Database unique, and how biopharma can leverage its chargemaster data to learn more about how their drugs perform in the real world—and how to demonstrate a treatment’s value to health care systems.
Read more to learn how biopharma can use chargemaster data to generate real-world evidence (RWE) on their treatments’ performance in real clinical practice, and how these data can uncover insights about COVID-19.
Responses have been edited for clarity and length.
Q: Tell us about the Premier Healthcare Database. What does it include, and how is it differentiated from other real-world databases?
A: The Premier Healthcare Database is unique because it is based on chargemaster data. This is important because a lot of what happens in a hospital or clinic is grouped under a diagnosis-related group in claims data, meaning that rather than showing an itemized list of what happened during a patient’s visit, the data will only show that a patient went to the medical facility. With chargemaster data, you can see every intervention that was used, allowing researchers to learn a lot more about costs, clinical outcomes, and utilization than they could in claims databases.
Q: What kind of information can biopharma gather from chargemaster data to inform decision-making?
A: Our data contains robust information on drug utilization, including drugs used in hospitals and those administered in infusion clinics. We also see the resulting patient outcomes and the associated costs. This level of detail is necessary when looking at comparative effectiveness or burden of illness.
In many cases, we’ve been able to demonstrate that a drug worked differently than the standard of care—which is important to know when launching a new drug—or that a drug benefits total cost of care. Ultimately, we can help biopharma prove to health care systems and payers that they can’t afford not to use their product, or that the total cost of care will actually be higher than the cost of the drug alone.
Q: How has COVID-19 impacted Premier’s database?
A: When the pandemic first hit, we looked in our database to assess its utility for COVID-19 research. Recognizing the need for current data to study the pandemic, we found that over 800 of our 1,000 reporting sites send us data daily, weekly, biweekly, or monthly. With that, we created a COVID-specific release of the Premier Healthcare Database.
We’ve seen these data used to study different trends, for example: When will certain elective surgeries start to reappear in the data? When will patients with cancer return to seeing their oncologists?
We have also been able to leverage these data to look for comorbidities for COVID-19. Recently, we were working on a study in a specific disease area and found that the condition was likely a comorbidity for COVID-19. We are now conducting additional analyses to assess whether treating this condition could have a positive impact on patient outcomes specific to COVID-19.
Q: What kinds of questions do your clients and partners hope to answer with your data? Has that changed since the start of the pandemic?
A: Pharmaceutical companies are most often interested in looking at total cost of care. With the shift from volume to value, we know that hospitals and outpatient facilities are stretched. As their margins reduce, they’re looking to cut costs, and often look first to the more expensive drugs. We work with biopharma to show that their drug is worth the price they’ve come to market with, and prove that it can save on hospital readmissions, length of stay, or other complications.
Our other common request is around burden of illness. Biopharma companies often launch products to solve problems that independent delivery networks don’t yet know they have, so we help the manufacturer demonstrate that there is a problem that their product can solve.
Since the start of the pandemic, most requests from biopharma have been for help understanding the implications of COVID-19 on their products and companies. We’ve also seen a lot of requests around telehealth, and understanding what its emergence means for different organizations. We see robust telehealth data in the Premier Healthcare Database: There are over 40,000 telehealth visits in our data from 2020—compared to about 30 telehealth visits in 2019.
Q: How do Premier’s government clients work with the data? Does the way they use the data differ from biopharma?
A: In general, there are similarities between the ways the government uses the data and the ways biopharma uses the data. Government researchers are especially interested in seeing what we’ve learned so far from COVID-19, how we can apply those learnings to predict future trends, and then, hopefully, blunt their impact.
For example, we see over 400,000 patients across over 800 hospitals in our COVID-19 data, which several government agencies have found valuable. Among other things, they’re using it to predict future hotspots with past trend analyses. They’ve also done resource utilization analyses to assess the impact of different COVID-19 interventions.
Q: What are some challenges you’ve observed as your customers and partners have tried to adopt RWE in their work? How do you help them troubleshoot?
A: One challenge our customers face is figuring out the right things to measure in the data. Compared to the controlled environment of clinical trials, there is some hesitation around using real-world evidence and seeing how a drug performs outside of a perfectly controlled setting.
Biopharma sometimes worries whether they’ll get what they need—or what they hoped for—from an RWE study. But with the robustness of Premier’s data, even if the first variable a researcher is looking at isn’t exactly what they’d hoped, they can often find other interesting trends in the data: for example, previously unrecognized risk factors that their drug has solved for.
Q: Where are you seeing the most increased RWE adoption among clients, and where do you expect to see increased adoption in the future?
A: Recently we are getting more requests in areas of rare disease, oncology, and cardiovascular, however we continue to see interest across a spectrum of disease areas. This makes sense with the pipelines and areas of investment among biopharma companies, and also represents the work needed to better understand these disease areas. I think we’ll continue to see increases in these areas, and anywhere there’s still new science to unfold.
With that, though, comes the challenge of identifying patients—there isn’t always a diagnosis to search for to help find patients in these disease areas, but there are leading factors that could indicate if a patient has MS or certain cancers. We’ve been able to leverage our data and create algorithms to help biopharma find these patients.
At the same time, we’re also bringing together different parts of pharmaceutical organizations. Years ago, data sat within a particular part of a company. Now it’s more distributed, and even some commercial teams are interested in looking at the data and identifying trends; for example, marketing teams can use the data to better understand where to market their messages and who needs to know about their products.
Q: In combining Premier’s data with the Aetion Evidence Platform®, what benefits do you envision for biopharma?
A: The key benefit is the ability to more rapidly analyze the data. In using a platform that makes the data easily consumable—especially if it’s a platform biopharma researchers are already comfortable using—the data can come to life.
Our hope is that by combining our data and Aetion’s platform, we can help illuminate findings in the data, and help biopharma analyze it more rapidly and more deeply.
Q: What are you most excited about when it comes to future opportunities and applications for RWD?
A: Recently it has been great to see how data companies, including Premier, have come together to link data and provide a fuller, longitudinal view of a patient’s journey. We have found that other data companies are interested in these partnerships as well, and to me that’s exciting.
The more data you put together, and validate that it doesn’t lose its accuracy, the fuller the picture of a patient’s journey will be, and the more questions we’ll be able to answer. This is great for health care systems, but the true beneficiary is the patient. We’ll be able to see things we may have missed before about their disease, and we can figure out how to treat them.