The research is clear: Data drives better health outcomes.
Data has the power to transform how healthcare is delivered and guide organizations toward more patient-centered, value-driven care. Even though data is abundant, it’s often siloed or delivered in disparate data sets, and companies commonly lack the necessary resources to turn the data into insights.
Making the most of the complex data ecosystem starts with understanding claims data sets and how to harness the power of open and closed claims data alongside the burgeoning realm of real-world evidence (RWE) and real-world data (RWD). Working together with all of this data serves as a vital tool for comprehending patients’ progress and engagements throughout their healthcare voyage.
Open and Closed Claims Data
Open claims data provides insights into patient interactions across the healthcare spectrum over an extended period. It’s generated when clinicians, pharmacy benefit managers or insurance providers submit medical claims and includes data from diverse healthcare sources, including clearinghouses, pharmacies, lab results and software platforms.
Healthcare organizations can find insights into patient interactions through open claims data in standard data fields like ICD-10 codes and CPT codes, referring NPI among other fields. These provider-centric claims enable organizations to better understand the complete patient journey. Without open claims, organizations have a limited view of claims, narrowing their scope of understanding and making it difficult, if not impossible, to effectively identify trends in their member or patient communities.
Closed claims data is gathered from health insurance providers (payers) and includes almost all healthcare activities for a patient within a specific enrollment timeframe. Closed claims include data from doctor visits, urgent care, hospital admissions and retail and specialty pharmacies to provide detailed insights into the patient journey, allowing companies to link diagnoses, actions and decisions.
Combining Data Sets
Open claims data is provider-centric and might not include data from all clinicians, pharmacies, laboratories or other healthcare sources.
Closed claims data offers a comprehensive view of healthcare activities across settings, but the data is limited to the enrollment period. Integrating the data sets provides greater insights into patient behaviors, diagnoses, treatment and adherence before, during and after the enrollment period.
“Why does [working with open and closed claims] matter to healthcare leaders? If we look at a health plan, for example, greater visibility to claims data will help plans better manage their members with chronic conditions,” says Jared Safran, PharmD, Director of Clinical Services at PurpleLab. “We know that about 20 percent of commercial health plan members disenrolled from their plans each year. When this occurs, the health plan with only closed claims data would have a limited view of claims. Although members may come and go, chronic diseases do not. Without open claims providing a broader perspective, the plan may not have visibility to identify trends and issues needing to be addressed.”
Leveraging Claims Data for Insights
Advanced claims data generates unparalleled insights that allow clinicians to make more informed decisions for their patients and helps plans better manage their members, all for the shared goal of improved health outcomes. This shift toward using RWE and RWD to practice personalized medicine.
Open and closed claims data provide invaluable insights: Open claims are beneficial for longitudinal studies while closed claims provide a concise snapshot of a defined period; combining them is essential for patient-centric research, care and improved outcomes.
In harnessing the power of open and closed claims data together, RWE and RWD can address critical business needs in healthcare organizations both efficiently and effectively. PurpleLab® makes it easier than ever to access those insights and empower healthcare organizations to transform their successes and outcomes.
By leveraging PurpleLab claims data, healthcare organizations will accelerate the discovery and adoption of healthcare innovations and improve health outcomes for their members and patients. Built on one of the largest medical and prescription claims data warehouses, PurpleLab builds solutions to improve collaboration across the healthcare ecosystem and allows healthcare to speak a single unified language, driving better outcomes with data accessible by anyone.
Originally published August, 2024 on HealthcareDive. This article was written in collaboration with Industry Dive and PurpleLab®.
Why PurpleLab®?
PurpleLab provides a real-world data [lab], accelerating the discovery and adoption of healthcare innovations. We want to improve collaboration across the total healthcare marketing ecosystem from life science companies to agencies to advertising technology companies. Built on one of the largest medical and prescription claim data warehouse including specialty data.