Episode 2 - Gaps in Data Exchange From a Payer Perspective

Peter Salgo, MD; John L. Fox, MD, MHA; Michael Kolodziej, MD; Ira M. Klein, MD, MBA, FACP; and Bryan Loy, MD, further explore the use of data in oncology and highlight issues that commonly impact payers.

Dr Fox explains that although billions of dollars are being spent on cancer therapy, payers have no way of collecting, aggregating, and interpreting data regarding the way treatments work in a real-world setting. While other stakeholders may not necessarily believe that payers are interested in clinical information, Dr Fox argues that payers are in fact interested, as this information helps ensure that patients receive the right treatments.

Dr Loy comments that although certain data are available, non-standardized coding affects the use of this information. He notes the disconnect between medical claims and pharmacy claims, and also comments that the services or medications for which a payer provides pre-authorization may not always match up with actual claims paid.

Dr Klein adds that regulatory statutes may stand in the way of the sharing of data. Together, the panelists conclude that changes in regulatory statutes and data collection and processing can help payers determine how therapy options work in the real-world setting, and can help clinicians identify the appropriate treatments for patients. Furthermore, data collected during noninterventional studies can be used in addition to claims data and electronic health record data; however, the format for data collection is not standardized, which presents another barrier to data exchange.