We see health care
differently …
Comprehensive data
Novel insights
Transformative actions
Lasting value
Largest eligibility-
controlled claims dataset
160 million lives
2
24 Hours of Optum data: Creating a more complete health picture
We capture:
Only person-linked,
integrated dataset
30 million EHR
linked Rx claims
Largest EHR dataset
90 million lives
More than
150,000 providers
2,000 hospitals
7,000 clinics
8.3M Signs,
diseases, symptoms (provider
notes)
4.0M Procedures
2.8M
Measurements (provider
notes)
4.9M Vital signs
and observations
3.2M Lab
results 1.9M
Medications prescribed,
administered and filled
4.8M Diagnoses
$749M Health care
costs
How did we get here?
3
Optum solved one of the biggest problems in health care:
Multiple EMR systems that do not communicate with one another
Longitudinal comprehensive clinical dataset
Medical groups
Integrated delivery
networks
Staging area
Hospitals
Multi-specialty practices
EMR1
Small group practices
EMR2
Physician offices EMR 3
Rx platform
Billing system
Rx platform
Billing system
Rx platform
Billing system
Rx platform
Billing system
EMR1
EMR2
EMR3
• Demographics • Lab results • Provider notes
(NLP) • Procedures
• Diagnosis • Medications • Outpatient visits • Vital signs
• Hospitalizations • Observations
Data and analytics for life
sciences
Analytics for providers
Processing: Validation, normalization, standardization, mapping
4
Comprehensive data leads to novel insights for brand marketing, value-based
contracting, comparative effectives and evidence generation
Linked
EHR/
claims:
15M+
Claims
120M+
EHR
80M+
5
Lab values More than 260 different labs (e.g., A1C, eGFR, FEV, values)
Patient and provider details Physician speciality, age, gender, smoking status, race geography
Vital signs BMI, blood pressure, pain scores
Medical procedures and conditions
Indications, treatments and comorbidities
Cost Disease burden for
pharmacy, provider, and facility spend
Medications Therapeutic-area-specific
market baskets
Provider notes Treatment rationale, lifestyle observations, signs and symptoms, biomarkers
Claims + EHR data expanS ion
Adding Rx claims for:
1. Individuals with EHR capture
and Optum insurance claims
2. Individuals with EHR
capture alone
More than 1 billion prescriptions per year
from 76 million patients per year:
• 25‒30% is eligibility controlled
(30 million lives)
• Includes data from 90%+ of HCPs
• 90%+ of pharmacies
• All payers, including cash
6
One of the largest and most
complete claims data assets
in the United States
One of the largest and
broadest EHR data assets
in the United States
Optum EHR
Optum insurance
claims
Linked EHR/ claims
All-payer Rx claims
Adding one of the largest aggregators of pharmacy claims
The funnel challenge: What business questions do you need to answer?
Quality data manufacturing leads to more useable, research-ready patients
Competitor data
Usable patients
Optum data
Usable patients
Data usability is a
function of patients
meeting research
requirements such as
clinical markers of
interest and tenure
7
What our journey has yielded
8
Dyslipidemia Case Study
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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 1st 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.
10
Description Patients
# Patients Taking a Statin 6,929,680
# Patients Experiencing SAMS 1,951,936
% Patients Experiencing SAMS 28.2%
# Patients Experiencing SAMS with No
Preexisting History 924,519
Estimated % With Statin Intolerance 13.3%
Patients Receive PCSK9 2,111
Patients Receiving PCSK9 After Statin
Intolerance 900
• American Heart Association’s
Estimate = 10-15%
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11
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
1M 2M 3M 4M 5M
1 Statin
2 Statins
3+ Statins
Patients with Statin Intolerance Symptoms from Physician Notes
Patients without Symptom Mentions Patients with Statin Intolerance Symptom Mentions
Only a small proportion (<1%)
of patients with symptoms are
then prescribed a PCSK9
850 (0.1%)
705 (0.2%)
555 (0.5%)
Optum’s Cohort Builder quickly defines and profiles study populations,
simplifying and speeding time to analysis, insight and evidence generation
12
The Cost of Hypoglycemia
13
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Understanding Impact of Hypoglycemia
COST
Pharmacy (AWP)
$27.77 PMPM
Medical (Std. Cost)
$1,019.62 PMPM
COST
Pharmacy (AWP)
$9.17 PMPM
Medical (Std. Cost)
$4,158.73 PMPM
WITHOUT Hypoglycemic
Events
WITH Hypoglycemic
Events
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Each node is a the next sequential place of service for the patients journey
- Custom journey design possible
- Treatment Flow available
Event of Interest: Diabetes diagnosis
Event of Interest:
Hypoglycemic event
DIABETES WITHOUT
HYPOGLYCEMIC EVENT
DIABETES WITH
HYPOGLYCEMIC EVENT
Primary Adherence
16
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 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
19,441
4,006
11,848
1,163
0
5,000
10,000
15,000
20,000
25,000
Arimidex Aromasin Femara Ibrance
Patient Count by Medication (2015-2016)
n = 33,120 patients
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
68.0%
0.0% 0.0%
31.9%
60.4%
0.1% 0.1%
39.4%
65.1%
0.0% 0.1%
34.8% 33.6%
0.3% 0.0%
66.0%
Filled as Written Filled Another Brand(Different Class)
Filled Another Brand(Same Class)
No Fills
% o
f W
ritt
en
Pre
scrip
tio
ns
Primary Adherence
Primary Adherence by Brand
Arimidex
Aromasin
Femara
Ibrance
Legend
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
1.3%
40.8%
0.0% 2.8%
37.7%
0.9%
41.5%
0.0%
6.0%
36.4%
2.4%
44.9%
0.1% 2.8%
27.0%
16.0%
46.9%
0.0% 2.8%
22.1%
Cash Commercial Manufacturerprogram
Medicaid Medicare
% o
f R
x C
laim
s
Payment Type for Pharmacy Claim
Payment Type by Product
Arimidex
Aromasin
Femara
Ibrance
Legend
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20
Biomarker Status and Primary Adherence
• Out of patients with medications of interest and eligible for primary adherence:
• For patients with an indicated biomarker status of HR+/HER2-, the filled as written rate is
increased for Ibrance, but slightly decreased for aromatase inhibitors
10,388
7,840
7,407
HR Positive
HER2 Negative
HR+/HER2-
Prescriptions for Patients with Biomarker Status
66.0% 55.5%
62.7%
36.1% 34.0% 44.5%
37.1%
63.5%
Arimidex Aromasin Femara Ibrance
% o
f W
ritt
en
P
rescrip
tio
ns
Filled as Written vs. No Fill Rate for HR+/HER2- Patients
Filled as Written Filled as Written Filled as Written Filled as Written No Fills No Fills No Fills No Fills
n = 7,407
21
Expanded Offerings for Enterprise-Wide Enablement 2017-2018
NEAR
>
23
A New World of Use Cases
• “Moment-of-Truth” based
• Weekly updates
• Most recent information:
– Written → Filled prescription tracking
– Most recent lab value
– Dx indication for prescription
– Admissions & Re-admissions
• Patient-Centric
• Quarterly updates
• Full history of information:
– Visits
– Labs
– Meds
– Dx’s
Fast, Representative and Actionable Robust and Precise
• Panther
• Smart Files
• CDMs
• Clinformatics
• Provider RWE
• Patient Journey
• Cohort Builder
• Comparative Analytics
• Integrated All-Payer Panther (with weekly updates)
• North Star
• Commercial Analytics
Commercial and Sales Audiences Medical & Scientific Audiences
Evidence Generation Data Insight Expansion Data
P r o d u c t s
F e a t u r e s
24
SEB DATA
CLINICAL DATA
$ CLAIMS DATA
Electronic Health Records
Electronic Medical Records
Clinical Notes
Genomic Data
Registry Data
Care Management Program Data
Healthcare Delivery Data
Medical & Pharmacy Insurance Claims
Eligibility & Enrollment Data
All-Payer Pharmacy Claims
Point of Sale Data
Payment & Access Data
Socio-Demographic
Health Risk Assessment
Media & Digital Exposure
Wearable / Device Data
Patient Engagement Data
Promotional Exposure
Purchasing Patterns
Loyalty / Membership
Survey Responses
Reported Outcomes
Social, Environmental & Behavioral Data
Orange: In production: The largest deterministically linked Claims – Electronic Health Record data asset on the market; additional data assets listed are part of Optum’s expanding data eco-system
Optum integrates data from across the health care ecosystem, enlarging and enriching our view of the patient, provider and payer
25
Near Term Focus 2017-2018
C o n t i n u e t o b u i l d E H R - b a s e d p o p u l a t i o n
E x p a n d a l l - p a y e r m e d i c a l a n d p h a r m a c y p o p u l a t i o n s
D e e p e n g e n o m i c i n s i g h t s : •B i o m a r k e r s •T u m o r t y p i n g
I n c o r p o r a t e n o v e l d a t a :
•C o n s u m e r D a t a •W e a r a b l e D a t a •P a t i e n t R e p o r t e d O u t c o m e s ( P R O )
$
Boost denominator and scope of insights
• Organic growth of EHR patients
• Multi-sourced EMR patients
• Integrated (claims + EHR) patients
• Increased speed at the time of prescriptions (Dx, Labs, NLP-
derived)
Diversify payer representation
• Boost integrated patient counts
• Improve cost / utilization perspective for research
• Provide broad market representation of brand share / formulary
choice for commercial audiences
Demonstrate pharmaco-genomic interactions
• Oncology
• Auto-immune disorders
• Rare diseases
Incorporate patient’s perspective and behavior outside of the
health system
• Front Store Pharmacy
• PRO’s
• Media
Steve Davis
SVP, Data and Advanced Analytic Tools
26