IQVIA Research Forum

“The historical evidence belies the notion that a public option will simply be a small addendum to our healthcare coverage options. If you look at Medicare history, you will see that Congress has bowed to pressure and increased provider reimbursement rates. Medicare Part B was designed to be self-sustaining, but within a year after it was passed, Congress began to pass legislation to shield beneficiaries from the true costs. A public option will likely be a pretty popular program and Congress will face tremendous pressure to offset some of the beneficiary costs. We have estimated that over 10-30 years a politically stylized popular public option would add $800 billion to the Federal deficit and result in either significant tax increases or massive spending cuts and become the third largest federal spending program, behind Medicare and Social Security.” Lanhee Chen, Ph.D

“It is true that Congress sometimes has increased provider reimbursement rates, but other times they have cut them. At the end of the day we know that Medicare payments are far below commercial insurance rates. I can’t imagine that Congress will be as generous in payments to providers when it comes to the public option as private insurers have been in their negotiations. At the same time, I don’t know how many people will actually enroll in a public option – that will depend on design details that the Biden campaign has not provided yet.” Sherry Glied, Ph.D.

“The initial wave of infections in Germany hit younger people who were infected during carnival festivities and skiing vacations. This was different compared to Northern Italy, where the first wave of infections mainly hit the elderly population. The lockdown in Germany was initiated relatively early. Germany has a higher number of ICU beds than other European countries. The country also has a large network of testing laboratories, which enabled Germany to provide a testing capacity up to 500,000 tests per week early in the pandemic. Finally, in Germany there is a large, decentralized system of primary care practitioners (about 30,000). They own their practice, they are active and did not wait for national experts and political authorities to give directions for how respond to a pandemic.” Dr. Wolfgang Rathmann

“There is more often a misdiagnosis with a rare disease than with a common disease because people are trained to look for what’s common, not what’s rare. Misdiagnosis is therefore less typical for common diseases. But you can train the algorithm to pick up patterns in almost any population. The data may be different in a common vs. a rare disease. The approach may be similar, but the underlying data you would put in to train the model might be slightly different. As an example, for common cardiovascular diseases, it could be data fed in from wearables; for example, a wristwatch that picks up your heart rate as opposed to coding for a rare disease that may not have as many visits to the hospital. So the technique is the same, but the underlying data different.” Allan Lawrie, Ph.D.

"In this session, Adler-Milstein is asked about the reasons for the yawning gaps between the capabilities of technologies to generate patient-health data and increase patient access to care and the willingness of providers and payers to step up and look at how these technologies can improve patient outcomes and reduce their costs: “The reasons are multifaceted, but one of the key reasons is about control. I don’t think providers and payers believe their ability to change patient behavior is strong. This is still a very hard nut to crack as behavior change is difficult to implement at scale – even with today’s technologies. It is why the focus of providers and payers in risk-based models is more on internal organizational changes before turning to the patient. There is no killer app, or anything close.” Julia Adler-Milstein, Ph.D.

“Working with person-generated data presents challenges that are very different from the way IQVIA normally works with patient data in our registries and trials. We usually recruit through clinical sites, not through social media-type outreach to identify participants. And here we are going directly to people to invite them in. This is a volunteer, patient-centered approach, different from how we recruit and evaluate participants in the work we typically do with our pharmaceutical clients. But the big benefit is that this is near real-time. Most real world registries that IQVIA works with don’t have that timely access to the curated data.” Matthew Reynolds, Ph.D.

“The speed of innovation with AI/ML has prompted whether AI/ML will replace doctors. The answer is no, at least for the foreseeable future. Contrary to common belief, doctors are not resisting ML. If ML alleviates the burden of very simple and repetitive tasks, such as reading retinal scans, ophthalmologists are quite happy, as it enables them to perform more procedures and make more money. This is also a reason for caution when ML is being promoted with the promise it will reduce costs.” Isaac Kohane, Ph.D.

“The emergency department visit, like any clinical visit, is just a snapshot in time. One of the things I love about emergency medicine is that we do have a chance to get to know the whole patient even in that short period of time. In our research work, it is critical that we identify both the structural determinants that brought patients there in the first place, and the barriers to their getting better after they leave. So (with patient consent), we do baseline assessments, we do self-report surveys, we look at social media and electronic health records at the time of enrollment, and then we track our patients longitudinally. We are just about to start a new study where we enroll adolescents in the emergency department and follow them for six months, looking at social media data, daily self-reports of mood, loneliness and violence exposure as well as medical data to try to develop better interventions. So there is an opportunity for getting people involved in longitudinal digital data collection even in the snapshot of the acute care setting.” Dr. Megan Ranney

“Some practices have employed their own pharmacists to help them. In other areas, groups of pharmacists are helping the GPs with their medication management. Pharmacists have told us that having a tool like SMASH is really helpful, because it depersonalizes their feedback. Instead of creating the perception among the GPs that they have done something wrong, and therefore create a lot of pushback, the pharmacists could now point to the dashboard and say that the patient is at risk due to hazardous prescribing. So the pharmacists feel that the care record has helped them build a better relationship with the GPs. The other thing we found is that GPs tend to be very competitive and sharing data between practices has been shown to be an effective tool to drive down hazardous prescribing.” Richard Williams

“We are cognizant of this challenge. One way is to ensure we have good intelligence in each country to support interpretation of data as in this study. In addition, one of the things we are working on In Scotland is to combine hospital prescribing data with primary care prescribing data as well as other sources, so that we have a total patient drug exposure journey. We are therefore less challenged from a system perspective because we are coming at it from a patient perspective. That is one of the ways we can get beyond the structural differences between the countries moving forward." Marion Bennie