We see health care differently … Comprehensive data Novel insights Transformative actions Lasting value
24 Hours of Optum data: Creating a more complete health picture We capture: More than 150,000 providers 8.3M 2.8M Signs, 2,000 hospitals Largest EHR dataset diseases, Measurements symptoms (provider 7,000 clinics 90 million lives (provider notes) notes) 4.9M $749M Vital signs Health care and costs observations Largest eligibility- Only person-linked, 4.8M 3.2M controlled claims dataset integrated dataset Diagnoses Lab 160 million lives 30 million EHR results 1.9M Medications 4.0M linked Rx claims prescribed, Procedures administered and filled 2
The funnel challenge: What business questions do you need to answer? Quality data manufacturing leads to more useable, research-ready patients Competitor data Optum data Data usability is a function of patients meeting research requirements such as clinical markers of interest and tenure Usable Usable patients patients 3
How did we get here? 4
Dyslipidemia Case Study
Quantifying Statin Intolerance • A common reason for statin-related sides effects is Statin Associated Muscle Symptoms (SAMS). In our study, these qualitative symptoms were limited to: muscle aches, muscle weakness, muscle stiffness, muscle cramps, myalgias, and myositis. Approximately 90% of all statin-related side effects occur within the 1 st 6 months after initiation of therapy. We define statin intolerance as a patient reporting these symptoms within 1 year after initiation of a statin therapy. Description Patients 6,929,680 # Patients Taking a Statin 1,951,936 # Patients Experiencing SAMS 28.2% % Patients Experiencing SAMS # Patients Experiencing SAMS with No • American Heart 924,519 Preexisting History Association’s 13.3% Estimated % With Statin Intolerance Estimate = 10-15% 2,111 Patients Receive PCSK9 Patients Receiving PCSK9 After Statin 900 Intolerance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6
Quantifying Statin Intolerance • A common reason for statin-related sides effects is Statin Associated Muscle Symptoms (SAMS). In our study, these qualitative symptoms were limited to: muscle aches, muscle weakness, muscle stiffness, muscle cramps, myalgias, and myositis. Approximately 90% of all statin-related side effects occur within the 1 st 6 months after initiation of therapy. We define statin intolerance as a patient reporting these symptoms within 1 year after initiation of a statin therapy. Description Patients 6,929,680 # Patients Taking a Statin 1,951,936 # Patients Experiencing SAMS 28.2% % Patients Experiencing SAMS # Patients Experiencing SAMS with No • American Heart 924,519 Preexisting History Association’s 13.3% Estimated % With Statin Intolerance Estimate = 10-15% 2,111 Patients Receive PCSK9 Patients Receiving PCSK9 After Statin 900 Intolerance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7
Statin Intolerance Symptoms by Number of Statins • For patients who did not have symptoms within 1 year before starting a statin, the graph below shows the number of patients with statin intolerance symptoms looking 1 year after being prescribed/administered the medication • ~1/5 of patients already complain of symptoms despite being on only 1 statin, and these symptoms increase as the patient is prescribed different statins – By the time patients try 3 or more statins, almost 40% of the patients show statin intolerance symptoms within 1 year Only a small proportion (<1%) Patients with Statin Intolerance Symptoms from Physician of patients with symptoms are Notes then prescribed a PCSK9 1M 2M 3M 4M 5M 850 (0.1%) 1 Statin 2 Statins 705 (0.2%) 3+ Statins 555 (0.5%) Patients without Symptom Mentions Patients with Statin Intolerance Symptom Mentions Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8
Days Between Statin Intolerance and Prescription for a PCSK9 • It takes > 180 days for many patients to receive a PCSK9 after they are defined as statin intolerant. • Using the integrated data, one could calculate the cardiovascular related costs for the long and short patients, and if the long patients incur greater costs, an argument could be made that PCSK9s should be prescribed earlier in the treatment pathway. Early Patients Late Patients 500 Days Between Statin Intolerance 450 400 and PCKS9 Prescription 350 300 250 200 150 100 50 0 Patients With a PSCK9 Prescription After Statin Intolerance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9
Optum solved one of the biggest problems in health care: Multiple EMR systems that do not communicate with one another Multi-specialty Small group Physician EMR2 practices practices offices EMR1 EMR2 EMR 3 EMR1 EMR3 Integrated delivery networks Rx platform Rx platform Rx platform Rx platform Billing system Billing system Billing system Billing system Medical groups Hospitals Staging area • Provider notes • Demographics • Lab results • Procedures ( NLP ) • Diagnosis • Medications • Outpatient visits • Vital signs • Hospitalizations • Observations Processing: Validation, normalization, standardization, mapping Analytics for Data and Longitudinal providers analytics for life comprehensive sciences clinical dataset 10
Optum’s Cohort Builder quickly defines and profiles study populations, simplifying and speeding time to analysis, insight and evidence generation 11
The Cost of Hypoglycemia 12
Understanding Impact of Hypoglycemia WITHOUT Hypoglycemic WITH Hypoglycemic Events Events COST COST Pharmacy (AWP) Pharmacy (AWP) $27.77 $9.17 PMPM PMPM Medical (Std. Cost) Medical (Std. Cost) $1,019.62 $4,158.73 PMPM PMPM Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
DIABETES WITH DIABETES WITHOUT HYPOGLYCEMIC EVENT HYPOGLYCEMIC EVENT Event of Event of Interest: Interest: Hypoglycemic Diabetes event diagnosis Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Comprehensive data leads to novel insights for brand marketing, value-based contracting, comparative effectives and evidence generation Provider notes Treatment rationale, lifestyle observations, signs and symptoms, biomarkers Medications Vital signs Therapeutic-area-specific BMI, blood pressure, pain scores market baskets Linked EHR Claims EHR/ 80M+ 120M+ claims: Lab values Cost 15M+ More than 260 different labs Disease burden for (e.g., A1C, eGFR, FEV, values) pharmacy, provider, and facility spend Medical procedures Patient and provider details and conditions Physician speciality, age, gender, smoking status, race geography Indications, treatments and comorbidities 15
Holistic view, informed by data and illuminated by tools, guides actions and creates common understanding of value Holistic view of Not just what, but why: patient journey Detailed understanding of drivers of treatment choice at critical care-milestones Enables more precise understanding: who, what, when Who What When Patient, provider, Tailored interventions: At critical junctures payer messaging, support in the patient journey programs and tools Optimization of interventional, promotional, educational spends for patients, providers, payers Optum Patient Journey application 16
Primary Adherence 17
Breast Cancer Oral Medication Overview • Between 2015 – 2016, the overall patients represented in the EHR linked all payor data who have a prescription for one of the medications of interest is ~33K – Just over 1K patients have a prescription for Ibrance Patient Count by Medication (2015-2016) 25,000 n = 33,120 patients 19,441 20,000 15,000 11,848 10,000 4,006 5,000 1,163 0 Arimidex Aromasin Femara Ibrance Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18
Primary Adherence by Brand • Looking at primary adherence differences between the 4 brands shows that Ibrance only has half the fill rate compared to Aromatase Inhibitors – Majority of Ibrance prescriptions are not filled, whereas <40% of Aromatase Inhibitors are not filled Primary Adherence by Brand % of Written Prescriptions 68.0% 66.0% 65.1% 60.4% Legend 39.4% 34.8% Arimidex 33.6% 31.9% Aromasin Femara Ibrance 0.3% 0.0% 0.1% 0.0% 0.0% 0.1% 0.1% 0.0% Filled as Written Filled Another Brand Filled Another Brand No Fills (Different Class) (Same Class) Primary Adherence Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19
Payment Type by Brand • For medications that were filled as written, the addition of the all payor data shows variation in the type of payment – Patients adhering to Ibrance are more likely to use commercial insurance and cash compared to the other payment methods for the Aromatase Inhibitors Payment Type by Product 46.9% 44.9% 41.5% 40.8% 37.7% 36.4% % of Rx Claims Legend 27.0% Arimidex 22.1% Aromasin 16.0% Femara Ibrance 6.0% 2.4% 2.8% 2.8% 2.8% 1.3% 0.9% 0.0% 0.0% 0.1% 0.0% Cash Commercial Manufacturer Medicaid Medicare program Payment Type for Pharmacy Claim Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20
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