Targeting Assessment of Alternative Claims Data Source

A small biopharma company needed to understand if an alternative claims data source could 1.) effectively replace its current claims data source for targeting and 2.) be used to enhance the methodology for predicting short-term potential.

We began by processing and verifying the available claims data. During the QC process, we identified and adjudicated minor discrepancies between the two sources. We also performed desk research to validate key diagnosis (Dx) and prescription (Rx) codes. Next, we back-calculated the client’s targeting through sensitivity testing of known business rules, then performed crosswalk and overlap analysis with the current target list. Based on this foundation, we defined an initial set of hypotheses and developed business rules to generate hypothesis metrics. We validated our hypotheses based on real world behavior. This work informed a set of recommendations that we developed regarding the client’s targeting methodology.

We determined that the client’s current claims data source was the optimal one for creating their target list. However, based on results from the alternative data source, we also identified 6 ways to improve their methodology. We provided a series of recommendations, which the client implemented, to better predict short-term potential.