CBI Specialty Product Data Strategies John Giannouris, VP Specialty Pharmacy Services December 14, 2016
Speaker John Giannouris Vice President, Specialty Pharmacy Services ValueCentric john.giannouris@valuecentric.com Mobile: (610) 680-7507 Office: (610) 756-1328
Agenda What is Specialty Pharmacy Data Review of Key Data Sets and Use Examples of Reports and Scorecards
Available Data Sources Manf./ 3PL SD ASC SP Patient/ Provider Services Hub PAP Copay Lab Claims EHR & Other Exfactory Sales SD Inventory -------- Sales -------- Prescriber Qty Feed Prescriber Referrals -------- Patient Data Dispenses & Statuses ------- SP Inventory Referrals ------- Service Utilization Data PAP Dispenses Co-pay Data Diagnostic Results Medical/ Rx Claims Patient Treatment Unified Data & Services Platform Data Aggregation, QC, Analytics & Reporting Longitudinal Patient Tracking Across Key Data Sources
Metric Selection is Key for Data Strategy Monitor Specialty Providers Track Patients & Services Measure Product Performance Data Quality: Completeness, Accuracy, and Timeliness Ex-factory sales, SD/SP Sales, SD/SP Inventory, Service Levels, Days of Supply, Shipment Qty. vs. Prescribed Qty., Shipments vs. Rx TRx/NRx or Medication Orders, Fill Rate Time to Therapy: Enrollment, PA, BV, Copay Assistance, Training Time on Therapy, Patient Adherence (MPR), Therapy Gap Days Time to Therapy, Fill Rate Adherence / MPR Time on Therapy, Drop-off Rate Referral New Fill Refill #1 Refill #2 Refill #3 New Fill Refill #1 Refill #2 Refill #3 Therapy Continued / Discontinued
Sample of Data Elements 3PL, SD, & SP Ex-factory Sales 852 Sales Receipts On Order Ending Inventory Committed Qty Morgue Returns to DC Lost Sales 867 Sales 867 Return 867 Interbranch Patient (for de-id only) Key PHI fields required for patient de-identification Referring & Treating Physician DEA # NPI Name State License # Specialty Address City State Zip Phone Email Primary & Secondary Payer Payer Name Payer City Payer State Payer Zip Payer Type Plan Type BankId Number Processor Control Number Group Number Co-Pay Amount Coinsurance Amount Reimbursement Status Payer Reject Reason Reimbursement Status Date Product Shipment Full Product Name NDC Code Date of 1st Shipment Date of Shipment Quantity Dispensed Qty Unit of Measure Dispensing Unit Patient Actual Out of Pocket Cost Dispensing Location Prescription Ref Number Rx Fill Number Refills remaining Days Supply Dosing Patient Management Patient Case ID Patient Status Patient Status Date Patient Discontinuation Code Referral Date Referred Product Primary Patient Diagnosis Secondary Patient Diagnosis Gender Year of Birth Weight Genotype/Lab Values
Scorecarding, Dashboarding, & Reporting Data Quality Metric Examples % First Time Correct % of Files Received vs. Expected No. of Errors & Time to Resolve Reconciliation of Inventory Performance Metric Examples Time to Fill Patient Aging Fill Rate MPR Therapy Gap Days Time on Therapy Copay Assistance
Sample Metrics: Data Timeliness & Quality Key Inputs: Data contract w/ specific timeliness KPIs Data exhibit(s) w/ required and optional fields Specific data quality KPIs
Sample Metrics: Product Reconciliation Key Inputs: SD sales detail SP inventory detail SP shipment detail
Sample Metrics: Patient Lives & Patient Starts Key Inputs: PHI for ability to de-identify patients longitudinally Separate records with therapy detail Prescriber detail
Sample Metrics: Shipment Quantity & Rx Count Key Inputs: Prescription / shipment detail Prescriber detail
Sample Metrics: Time to 1 st Fill & Medical Possession Ratio Key Inputs: Referral detail Status detail Prescription detail Payer detail
Sample Metrics: Fill Rate & Patient Status Aging Key Inputs: Prescription detail Payer detail Referral detail Status detail
Specialty Pharmacy Performance Scorecard
Specialty Data Aggregation Example Data Sources Data Types Data Management Data Output Manufacturer Data Access 3PL Ex-factory Sales SD Inventory (852) SD SD SD Sales (867) Prescriber/Qty. Feed Receipt & Confirmation Brand/Marketing Market Access AIS AIS AIS Prescriber Referrals Patient Data Processing/ Mapping Data Quality Metrics Commercial Ops Sales Ops SP SP SP Patient/ Physician Services Hub PAP Co-pay Lab EMR SP Inventory Dispenses & Statuses Referrals Service Utilization Data Feed for Hub Services PAP Dispenses Co-pay Data Diagnostic Data Patient Treatment QC & Validation Non-PHI Data & De-identification of PHI ----------- Master Data Management ----------- Daily Operations ----------- Sales & Inventory ----------- Product, Patient & Physician Tracking, Custom KPI Reporting & Alerts DW/ERP/CRM and Reporting Tools Field Sales Supply Chain Finance Account Management Claims Medical/Rx Claims
Thank You!! John Giannouris Vice President, Specialty Pharmacy Services ValueCentric john.giannouris@valuecentric.com Mobile: (610) 680-7507 Office: (610) 756-1328