Real-world data (RWD), especially healthcare claims data, has become essential for understanding how patients interact with the healthcare system beyond clinical trials. Generated from routine doctor visits and pharmacy transactions, this de-identified data offers a wealth of insights into treatment patterns, comorbidities, and outcomes. But how does this everyday data help pharmaceutical companies and healthcare providers make smarter decisions about product development, pricing, and care delivery? Let’s break it down.
Let's consider a typical patient’s journey. A patient visits their doctor for a routine check-up. The doctor discovers a nodule during the exam and recommends an imaging test. The patient then sees a radiologist for the imaging, and the results are reviewed. The report is shared with the original provider, who then refers the patient to a specialist for further evaluation and potential treatment.
At each step of this process, the diagnoses, procedures, and evaluations are documented and coded into claims for reimbursement. These claims are each linked to the same patient, forming a connected, longitudinal view of their healthcare journey. Each claim includes details such as the date of service, type of service provided, and the referring and treating healthcare provider (HCP) involved. Once processed, the claims are de-identified to remove any personal health information to ensure patient privacy and HIPAA compliance. The resulting dataset is made available to researchers, healthcare organizations, and pharmaceutical companies.
Multiply that single journey by more than 270 million patients annually, and you have billions of datapoints that are the foundation of Forian's hybrid claims ecosystem: a vast, privacy-compliant, real-world view of healthcare in action.
Healthcare claims data is a crucial source of information to understand patient interactions with the healthcare system. Claims data is created every time a patient receives care or fills a prescription, capturing key details like service type, date, and cost.
Below is Forian’s hybrid claims data pyramid, which shows how claims feed through integration, enrichment, and analytics to power real-world applications.
Though all Personally Identifiable Information (PII) is removed to protect patient privacy, the remaining data still holds immense value. When aggregated and analyzed across those stacked layers, claims data helps pharmaceutical companies, healthcare providers, payers, and researchers uncover treatment trends, identify gaps in care, and evaluate healthcare outcomes.
Healthcare claims data plays a critical role in shaping business strategies, understanding patient behaviors, and improving market access efforts for pharmaceutical and biotech companies. Its value comes to life in several areas, including:
In short, healthcare claims are far more than just billing documents. They're a rich, real-world view into how patients interact with the healthcare system every single day. For pharma and biotech, this translates into a goldmine of insights. With expert analysis, we can pinpoint unmet patient needs, understand how treatments are really being used, and generate crucial real-world evidence that complements clinical trials.
This isn't just about tracking numbers; it's about gaining a deeper understanding of patient journeys and treatment realities to drive smarter drug development, improve market access, and ultimately, deliver better patient care. Think of claims data as a strategic asset that, when leveraged effectively, empowers us to make more informed decisions and build a more efficient healthcare future.