InetSoft Webinar: Insurance Claims Analytic Views

Below is the continuation of the transcript of a Webinar hosted by InetSoft in August 2019 on the topic of Using Claims Intelligence in Healthcare. The presenter is Abhishek Gupta, Chief Data Scientist at InetSoft.

Now with this insurance claims data, in the context of healthcare provider and physician profiles, there's a bunch of different analytic views that we're able to show you right off the bat. Not only can we provide you detailed analytics on diagnoses and procedures and financial breakouts, but what we can also do is bring you insight and intelligence related to those prescription drug claims that might be processed and incorporated into a physician's profile.

Each of these data discovery tools gives you not only the ability to get a lot of great detail on an individual provider, but also gives you the opportunity to do some powerful searching, whether that might be a particular ICD code, whether that be by a CPT code, or maybe that's a drug class or an NDC code. Really as a result what we've seen is that being able to integrate all of this information into each of their profiles gives you the sense of understanding of what's actually taking place in market today. But also having the option to go ahead and understand how trends have been impacted over time by having access to that historical information is a big plus.

With this data in context of all of the other healthcare industry intelligence that you track, now I'd like to go ahead and walk you through three different use cases in which we really have seen some of our customers and clients really gain some extreme value out of by having access to the commercial claims intelligence. The first use case that we're going to go ahead and explore is really around mapping influence and being able to understand how you can think about targeting physicians.

The key question that we're going to take a look at with this use case is how a midsize pharmaceutical company might be able to identify key influencers that may impact how they bring a new drug to market and actually see that drug take off over time. Mapping influence is really important to being able to watch a new drug because it enables you to use a multi-prong strategy that you can use to support both your marketing efforts as well as your sales strategy and efforts for boots on the ground.

Traditionally speaking, what you think you might do is actually understand and assess who are the providers and the physicians in market that are really writing the scripts or any of their prescription claims for the actual drug that you have. You can assess who those physicians are. You can look at them by their specialty. Then you can rank order them on the number of scripts that they're actually writing to be able to see who you might want to influence over others.

That's a great way to think about going out and actually understanding what the traction is for a new drug launch. But there is another approach that you can actually take. You can understand who is actually influencing those docs upstream. It creates another way for you to think about being able to influence the physician or the healthcare professional that may be sending patients to those doctors that are actually writing the script or the prescription for the drug of interest.

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In this example, what we'd like to do is go ahead and walk you through what this might look like within the congestive heart failure space or for that diagnosis related to the prescribing of an ACE inhibitor. As we just discussed, we're going to go ahead and dig into an example where we go ahead and look at cardiologists who are doing electrocardiograms in an effort to go ahead and treat any patients with congestive heart failure to be able to think about what it means to map out an influencer strategy.

Whether at the level of a referral or potentially thinking about this upstream, to be able to influence when it might be the right time to engage physicians and teach them about ACE inhibitors to support being able to treat these types of patients and being able to support the uptake of your drug. As we take for example, let's go ahead and select all physicians who are doing CPT code 93010 which is for that electrocardiogram. Let's go ahead and narrow this down to physicians who are practicing in Boston in the state of Massachusetts and who identify as that primary specialty as a cardiologist to go ahead and take a look at the list.

If we go ahead and run this particular search, what we see is that there's 181 unique physicians that actually meet that criteria. This gives us a sense, really to think about that boots on the ground strategy to understand who are the cardiologists who I may want to target to teach them about my drug. It would be useful for being able to bring more ACE inhibitors into their treatment patterns for the patients that they're seeing.

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Not only do I know who these physicians are, but I potentially want to take that step back up in the process and understand who else is it possible for me to influence just based on the referral patterns of how patients are flowing to these physicians. Let's take a look at Kevin Monahan's profile. If we go into his particular profile, not only do we have a lot of great detail on where he's practicing, who he's affiliated to, but we can start to drill into that medical claims detail that we have for this particular cardiologist.