Clinical trial data and claims data have long been the standard resources used by managed care plans to make decisions about their members' health. But both have their limitations.
While clinical trials give us insight into how a treatment works under ideal circumstances, they are typically developed based on a narrow set of circumstances and often don't reveal how medical treatments are used in more real-life settings.
Claims data provides excellent real-world information that help us better understand how members use their medications, but claims databases weren't designed to answer some of the more complex clinical questions that we need to answer.
Post-approval clinical trials and registries also have been helpful, but infrequently are combined with other sources of information, such as claims data, to provide a more comprehensive view of the patient. Fortunately, information resources are beginning to broaden, opening up opportunities to facilitate better decision-making.
One example, specifically conducted within the WellPoint population by HealthCore, its outcomes research subsidiary, was a comparative effectiveness research study on asthma that assessed how well oral asthma controller medications worked for members versus inhaled corticosteroids. We found that some members are better treated with inhaled corticosteroids and others have better outcomes with oral asthma controllers depending on how compliant they are.
When members took their medication as directed, those taking inhaled corticosteroids had fewer inpatient and emergency room visits and lower total healthcare costs. However, among those members who weren't taking their medication properly, those taking oral asthma controllers were less likely to have inpatient and emergency room visits.
WellPoint's Pharmacy and Therapeutics Committee used this real-world evidence, along with other clinical data, to maintain this oral controller on a less-expensive, preferred tier and remove prior authorization for its use. The committee wanted to ensure members who weren't as compliant with their medications had an incentive to be on the medication that works best for them.
While comparative effectiveness research studies and their implementation represent the next evolution of information to assist healthcare leaders in making better decisions for their patients and their members, we also believe there's another step that can be taken to strengthen the connection between research and the practicing physician.
HealthCore is developing the Integrated Research Network (IRN), a collaborative community of physicians, pharmacists and other providers to help identify clinical issues for study, provide clinical data for ongoing studies, respond to health-related surveys, and participate in safety and comparative effectiveness studies in real-world settings. The IRN is one of several efforts nationwide that aims to better integrate practicing physicians into the research process and implement the results at the point of care.
The physician-gathered information derived from patients in a real-world setting over time, along with other clinical data and information from clinical trials and claims-based research, should produce more realistic information about the clinical effectiveness, cost effectiveness and safety of products and devices. The better our information, the greater our ability to treat members.
Mark Cziraky is vice president, research development and operations, HealthCore Inc.