Secondary Data in the Hospital Setting

1
Secondary Data in the Hospital Setting

• Presented by Anthony Palkovic
• Director of Analytics, The Medicines Company
• November 17, 2008

2
Introduction

• Not a data expert!
• Not selling (or disparaging) secondary data
• Challenges in Hospital/Non Retail
• Changing rapidly
• Scope of this presentation
• Market research, forecasting, sales operations,
  business development
• Primarily US focused highlight ex-US
  opportunities
• Not in scope contracting hospital networks (GPO,
  IHN, etc)
• Which data best supports your organization or
  team(s)?
• How can this data be leveraged in primary
  research projects?

3
Objectives

• Review various available secondary data sources
• Defining the market
• Tracking product flow through the distribution
  chain
• Understanding activity within the hospital
• Promotion Tracking
• Business Development and Competitive Intelligence
• Industry Trends/Syndicated reports
• Audits
• Longitudinal Data
• Highlight uses of each to provide information for
  your team(s)
• Suggest best practices for secondary data
  evaluations and the value primary data can add
• QA

4
Macro View of Hospital Distribution and Secondary
Data

• Ex-Manufacturer sales to wholesalers and direct
  shipping to hospitals
• Sales into Hospitals
• WK Source Non-retail, PhAST
• IMS DDD, National Sales Perspective (NSP)
• SDI/Verispan Vector One Vona Data
• Others?
• Account level utilization (sub-national demand)
• Thomson
• SDI/Verispan
• Premiere
• Others?
• Physician or Salesforce Activity/Targeting
• HMS
• Cegedim
• SDI/Veripsan Hospital Personal Selling Audit
  (HPSA)
• SFA systems
• Others?

5
Weekly Ex-Manufacturer Data

• Sales data is measured by
• The amount of units (boxes) shipped out of the
  wholesaler distribution centers or directly to
  the hospitals (measured in ex-factory sales data)
• Not audited
• There are non-reporters
• Inventory data (ex-factory/pre hospital) is
  measured by
• The amount of units on hand in the distribution
  channel (wholesaler level)
• Used to monitor months inventory on hand and
  supply chain management
• Not audited

6
Data Challenges Limited and/or Outdated Data
Data for specialty products can be found at
different points along the distribution chain
however, these data are often limited and/or
outdated. This can make it difficult to gauge a
products potential and devise a sales force
strategy.
PATIENTS
DIRECT SHIP
CHANNELS
Fed. Facilities
WHOLESALERS/CHAINS
Thomson Premiere SDI/Verispan HMS HRA
Non-Fed. Hospitals
Company Warehouse
McKesson Corp. Cardinal Health ABC, etc
Clinics
TRx
Retail / LTC/ MO
Inventory Data Ex-Factory Shipments
Other Wholesalers Chains
Home Health Care
Limited Sources
IMS Drug Distribution Data (DDD, MIDAS) Wolter
Kluwer (Source Non Retail/PHAST)
HMOs / Misc.
7
Data Challenges Limited and/or Outdated Data

• What happens inside the hospital?
• It is not the retail environment!
• Visibility is difficult

• Thomson, SDI, Premier
• SDI/Verispan Healthcare Institutional (30
  different audits)
• Salesforce effectiveness (GfK, Health Strategies
  Group)
• HRA hospital audits
• HMS physician activity
• Cegedim - promotion
• Longitudinal Data (SDI, IMS, Verispan)
• Others?

8
Different Departments and Patient Flows
Home
TreatmentCenter
CCU
Point of Entry
CHF ACS
IC
ED
ICH Ischemic Stroke SAH Aortic Dissection Renal
Crisis Eclampsia
ICU
Cardiac Surg Vascular Surg Neurosurgery Orthopedic
Surg Abdomenal Surg General Surg
OR
9
Defining the Market

• International Statistical Classification of
  Diseases and Related Health Problems (ICD-9, 10,
  11 in 2015)
• provides codes to classify diseases
• published by the World Health Organization (WHO)
• used worldwide for morbidity and mortality
  statistics, reimbursement systems and automated
  decision support in medicine
• ICD-10 used in much of the world
• Since 1988, the US required ICD-9-CM codes for
  Medicare and Medicaid claims, and most of the
  rest of the American medical industry followed
  suit
• Provides codes for both in-patient and
  out-patient procedures
• Know the Procedural Reimbursement rates
• Who are the Competitors?
• ATC
• USC
• Products
• Which Physician Specialties are your customers?

10

• Tracking Sales into the Hospital Setting

11
Tracking Hospital Purchases
IMS Drug Distribution Data (DDD, MIDAS) Wolter
Kluwer (Source Non Retail/PHAST)
DIRECT SHIP
CHANNELS
Fed. Facilities
WHOLESALERS/CHAINS
Non-Fed. Hospitals
Company Warehouse
McKesson Corp. Cardinal Health ABC, etc
Clinics
Retail / LTC/ MO
Other Wholesalers Chains
Home Health Care
HMOs / Misc.
12
IMS

• Drug Distribution Data (DDDTM) sub-national
  (direct and indirect) sales data with about 97
  coverage in the US market and hospital data for
  45 global markets
• providing a complete view of product movement
  from manufacturers to suppliers, distributors and
  outlets.
• Applications include territory alignment,
  salesforce deployment, targeting, profiling,
  performance management and compensation
• DDD Weekly sent 10 days after the close of the
  prior week Monthly delivered between the 45 days
  after the close of the prior month.
• MIDASTM Analysis tool and viewing platform for
  IMS data from worldwide markets
• Information includes therapy class, manufacturer,
  launch date, brand and molecular name, price,
  formulation, patent status, chemical composition
  pack data
• Updated on a monthly basis on or around the 25th
  of the month
• Xponent Hospital monitor the volume of Rx
  that go out the hospital doors to retail
  pharmacies.
• Applications include hospital sales force
  evaluation, territory management, strategic
  planning
• Should be combined with DDD hospital purchasing
  data for a more complete picture of each
  hospitals value (both in-patient and out-patient
  activity)
• National Sales Perspective Measures sales
  volume of units and dollars of pharmaceutical
  products purchased by retail and non-retail
  channels. This data is projected to the national
  level

13
Wolters Kluwer (formerly NDC)

• Source Non-Retail Data Audited outlet level
  drug units and sales for defined markets with
  approx. 98 of coverage (Kaiser - largest
  non-reporter).
• Applications include target sales and marketing
  efforts, pursuing market opportunities, goals
  setting, and for sales compensation
• Distribution activity is captured from shipment
  invoices as inflow into Non-Retail institutions,
  instead of the outflow of product to the consumer
• Delivered monthly Flash Report sent on the 20th
  of the month for the prior months data, and the
  hospital-level detail is sent around the 23rd
• Pharmaceutical Audit Suite (PhAST) Sub-national
  level units and sales for all non-retail products
  and markets (retail also available).
• Data content Includes
• reporting by therapeutic class, product or NDC,
  drug manufacturer, corporation, payment type,
  non-retail class of trade, and geographic area.
• Five years of monthly history is also available.
  Data is available in both custom and pre-defined
  reports.
• Updated on a monthly basis on or around the 25th
  of the month.
• Can also be updated weekly
• PhAST is a web-based analytical reporting tool.
• Caveats
• US Only
• Competitive products are grouped so the
  confidentiality of each outlets exact purchasing
  patterns is protected. The main product in each
  grouping makes up 97 of the groupings units.
• A manufacturer cannot see competitive data unless
  they share theirs.

14

• Activity and Utilization within the Hospital

• Thomson
• SDI/Verispan
• Premiere
• HMS
• HRA
• Cegedim
• DTW

15
Thomson (formerly Solucient)

• MarketScan Hospital Drug Database (formerly AC
  Tracker)
• Data statistically adjusted for patient severity
  to represent the entire short-term, general,
  non-federal US hospital discharges.
• Data Content includes
• Hospital inpatients and outpatients (hospital
  stay lt 24 hours)
• Diagnosis with and without associated procedures
• Average dose used by month
• Geographic diversity of hospitals (4 Regions
  Northeast, Midwest, South, West)
• Identified specialty units
• Payer type (Medicare, Medicaid, Commercial,
  Uninsured)
• Physician charges (Total Billed, Mean Billed and
  Mean Paid expenses)
• Used by Marketing and Senior Management to gauge
  current market trends, sales forecasting purposes
  and product demand (share and volume, both
  overall and by diagnosis)
• Updated monthly and quarterly on or about the
  20th of each month (eg. Data received on December
  20th will reflect October information)
• Rolling 24 months of data
• Caveats
• Projected data based off of a sample size of
  approx. 500 hospitals with monthly and quarterly
  reporters
• Data is based on physician claims
• Monthly and Quarterly reporters result in prior
  period adjustments
• Inpatient data set is more robust (outpatient
  data is also available, but not as robust)

16
Surveillance Data Inc (SDI)

• SDI Hospital Data Services (Now SDI/Verispan)
• Claims to be one of the largest longitudinal
  patient data warehouse of electronic transactions
  gathered from physician office visits, pharmacy
  claims, inpatient hospital stays, outpatient
  hospital visits, laboratory results, and upon
  request, customer datasets.
• Data Content includes
• Analyses on drug utilization, length of
  therapy/length of stay, location of care, and
  admission/discharge source
• Projection of all hospital inpatients
  outpatients via ER Non-ER admits.
• Filters include10 diagnosis and procedure buckets
  of interest, diagnosis type, hospital setting,
  and payer.
• Payer type (Medicare, Medicaid, BC/BS,
  Commercial, etc.)
• With its patient de-identifying system, all
  patients can be tracked within and among all SDI
  channel specific datasets.
• Robust in-patient and out-patient data set
• Rolling 24 months, updated daily on medical and
  pharmacy data
• Caveats
• Projected data based off of a sample size of
  approx. 500 hospitals with monthly reporters
• Data is based on physician claims

17
Premier Inc.

• Premier Inc. is a hospital performance
  improvement alliance of 500 Premiere hospitals
  and health systems
• Total alliance members 1,700 1,498 hospitals
  including 305 group purchasing affiliates
• Data Content includes
• Hospital bed size (6-99, 100-199, 200-299,
  300-499, 500)
• Geographic diversity of hospitals (9 Regions)
• Hospital teaching status (Teaching
  Non-Teaching)
• Hospital location (Urban vs. Rural)
• Identified specialty units (16 Specialty Units)
• Exclusive provider of inpatient data to the FDA
• Caveats
• Premiere alliance data is not available to other
  suppliers

18
Overview of 3 Data Sources
19

• Other Inside-the-Hospital Secondary Data Sources

20
SDI/Verispan (formerly SMG)

• Hospital Procedures and Diagnoses Database (HPD)
• Provides outlet level (hospital) procedure and
  diagnosis data for the defined markets (ICD-9
  codes provided to SDI/Verispan to define the
  market).
• Assists in determining hospital market share and
  factors into the territory goals setting.
• Other patient information, such as reimbursement
  rates, age, length of stay, and discharge
  destination are also included
• HPD data is delivered once a year (usually
  December)
• Healthcare Market Index Profiled Solutions
  (HMIPS)
• Includes a wide variety of information including
  facility demographics, hospital services offered,
  IHN/GPO relationships, and other non-procedure
  based hospital information.
• The HMIPS data is refreshed continually by
  SDI/Verispan, with updates provided quarterly
• Caveats
• Due to the majority of data collected being
  government sourced, HPD data is only updated
  annually, at the end of each calendar year
• 2007 diagnosis and procedure data available end
  of 2008
• Although a portion of the data (non-reporting
  states) is projected, the vast majority is not

21
Physician Hospital Affiliation Data

• Health Market Science (HMS)
• Physician affiliations and deciling data (PxDx)
• HMS data is refreshed once a year in January.
• Client must provide the applicable market
  definition (ICD-9 codes)
• Caveats
• HMS data is based on claims data (what the
  physician billed)
• Deciling rationale must be discussed and
  developed collaboratively
• IMS available through Xponent Hospital
• SDI/Verispan Hospital Physician Affiliations
• Database draws from more than 1M practitioner
  hospital affiliations.
• Use this information to accurately target and
  reach the physicians
• Includes employment or admitting privileges data
• Available physician profile data include contact
  information, demographics, educational
  background, professional practice information and
  unique identifiers (UPIN, DEA, state license,
  etc.)
• Database is updated continuously and offered as a
  one-time deliverable, quarterly delivery

22
HRA Research

• Primary Research Audits and Research programs
  within the hospital setting to provide
  understanding of the complex hospital market
• Analyzing the hospital by departments, operations
  and web of influence
  
• Relationships with hospital-based physicians,
  nurses, pharmacists, technicians and allied
  health professionals
• Access to all departments/specialties of every
  institutional segment
• Access to spill-over into retail market
• Complete kit of proprietary market research
  tools
• Pre-Launch Product Awareness study
• Medical Trends in Hospital Formulary Committees
• Seek Find (initial case identifying study)
• ProductTrak (product utilization study)
• DispenseTRAK (dispensing study)
• Awareness Trial Usage (ATU) study
• Internet Omnibus study

23

• Promotional Audits for Hospital Sales

24
Verispan

• HPSA (Hospital Personal Selling Audit) panel
  based database providing insight into promotional
  efforts within institutions
• Covers 31 specialties
• Targeting 3,780 physicians per month
• Respondents report one week per month
• History to January 1991
• Caveats data may not robust enough for certain
  products/markets within the hospital

25
Cegedim Strategic Data

• Promotional Spending Data from 38 countries
• Panels of 150,000 GPs and specialists worldwide
• Control Return On Investment
• Monitor call impact on prescribing intention
  compared to competitors
• Benchmark competitors marketing spend
• Sales force effectiveness
• SOV positioning of competitors on your target
  segments
• Launched in 1977
• Detailing follow-up
• Sales Force Effectiveness
• Competitive Intelligence on your targets
• Know how much do competitors invest on promotion
• See competitors promotional strategy (Promotion
  Mix)
• Also offer other services including primary
  research, patient data, medical research, product
  communication research

25
26
DTW CD Promo

• Claims to be the only database with historical
  trending data from 1996 to present.
• Competitive intelligence and surveillance
  coverage spans the universe of audiences from
  physician to pharmacy, managed care and
  consumers.
• Online subscriptions available for all
  therapeutic categories as well as E-Alerts.
• Agency-of-Record support services.
• Market analysis support services.
• Personalized attention by our dedicated
  solution-oriented staff helps you to rest assured
  that you have the most complete overview of your
  competitors messaging.

26
27

• Business Development
• and
• Competitive Intelligence

28
Drug Pricing

• Price Rx by WK (formerly Medi-Span)
• Drug pricing (WAC and AWP) for any product or
  market. Is a web-based software application that
  provides access to Medi-Spans pricing and
  product reference information with analytical,
  formulary, and reporting tools. Also provides
  historical pricing.
• Redbook by Thomson Reuters
• First DataBanks National Drug Data File (NDDF)
  by DMD America
• Analysource Web-based analytical software tool
  designed to manage the most comprehensive
  product, pricing, and trade incentive databases
  available.
• WAC, AWP, Direct (Retail), Federal Upper Limit
  (FUL), Alternative Benchmark Price (ABP)

29
Business Development and Competitive Intelligence

• Datamonitor (www.datamonitor.com)
• Decision Resources (www.decisionresources.com)
• Thomson Pharma (www.thomson-pharma.com)
• Advisory Board Company (www.advisoryboardcompany.c
  om)
• SDI/Verispan (www.sdihealth.com)
• Evaluate Pharma (www.evaluatepharma.com)
• Windhover Invivo (www.windhover.com)
• TDR Incidence and Prevalence (www.tdrdata.com)
• Hoovers (www.hoovers.com/pharmaceuticals)
• Mattson Jack (http//www.mattsonjack.com/epidataba
  se.asp)
• Others?

30
Datamonitor

• Knowledge Center provides access to all of
  Datamonitor content, which is based on primary
  and secondary research and covers 200 disease
  indications and over 1000 companies.
• Knowledge Center is much more strategic in nature
  in that it provides analysis on all areas
  covered.
• Subscription provides access to reports, models
  and presentations for two years past and any
  content produced in the 12 month subscription
• MedTRACK corporate intelligence tool for BD
  officers, librarians and executives of biomedical
  companies, as well as vendors and consultants who
  serve those companies
• Comprehensive database of private and public
  biomedical companies
• Contains pipeline, financial, competitive
  product, MOA, partnering and patent information
  on more than 8,400 biomedical companies worldwide

31
Decision Resources

• More than 150 disease-specific and industry
  reports per year in ten major therapeutic areas
• network of more than 10,000 physicians,
  researcher, and formulary directors.
• integrates epidemiology, clinical evaluations,
  and commercial dynamics into a comprehensive
  analysis and a 10-year forecast of the G7
  markets.
• Epidemiology and Forecasting
• Prevalence and/or incidence
• Diagnosed percentage and population
• Drug-treated percentage and population
• Country
• Gender and Age
• Co-morbidity
• Relevant disease subpopulations, including
  severity, lab measure, discharge diagnosis, time
  to presentation, seasonality, and subtype
• Consulting and Advisory services

32
Thomson Pharma

• Gather information on competitor performance,
  activity and sales projections
• Look at the strengths, weaknesses, opportunities
  and threats to particular drugs
• Analyse actual and predicted market share
  information
• Review competitors drug development pipelines and
  patenting activity
• Identify the key players in a therapy area
• Identify new markets and opportunities
• Keep up-to-date with the latest licensing deals
• Monitor competitors collaborations and deals
• Search for patents indexed for specific therapy
  areas or mechanisms of actions

33
The Advisory Board Company
Advisory Board Overview
The Advisory Board Company in Brief

• Thought leader to the acute care industry
• Founded in 1984
• Publicly traded (ABCO) since 2001
• 1000 professionals
• 350 researchers subject-matter experts
• 100 with PhDs, MDs, MHAs, MBAs

• 2,600 hospital and health system members
• 2,000 CEO relationships
• 32 distinct membership programs
• Research, consulting, leadership training,
  business intelligence tools

The Advisory Boards Provider Membership

• Members across the U.S.
• 100 of Top 14 Best Hospitals as ranked by U.S.
  News and World Report
• All sizes and types large and small, academic
  and community, urban and rural
• Typical member has belonged 5 years

• 350 dedicated researchers
• 1000 research interviews per year
• 140 national meetings per year
• 100 site visits per year
• 1000 consulting engagements

34
Online Tools Research, Analysis, and Health Care
News
Email a subject-matter expert Contact your Member
Services Manager
Search our online database
Review event calendar and monthly sector
newsletters
Link to information on specific Advisory Board
research programs
Screen shot of HCIC website
Download a publication catalogue and the latest
Onsite Topic Library
Learn more about timely information and events
Commission an Original Inquiry project
Register for meetings and teleconferences
Online News Briefing Services
Weekly and Monthly Briefings
The Daily Briefing

• Best of the days health care news written for a
  five-minute read
• Five to ten stories each day
• Delivered to your inbox at noon daily

• Clinical Strategy Watch
• Oncology Watch
• Health Care Industry Committee Monthly

• Cardiovascular Watch
• Finance Watch
• Innovations Center Weekly Update

• HR Watch
• Nursing Watch
• Marketing and Planning Flash Report

35
SDI/Verispan

• InSite Next Generation - National Patient Profile
  (NPP) is a powerful web-only application designed
  for targeting all areas within the healthcare
  spectrum.
• tool allows a user to create custom outputs via
  report builder in addition to standardized
  reports.
• news-feed service allows users to search the
  database based on keywords or save searches based
  on key accounts or topics
• home page allows user access to various
  publications including InSum, User News, Market
  Reports, Market Letters and Data Release
  Highlights.
• Various data can be integrated into this platform
  (at additional cost) including a clients sales
  and territory data, Verispan medical data (ICD-9
  codes) and Verispan hospital affiliated
  physicians.

36

• Longitudinal Data

37
Wolters Kluwer Source Lx patient level data
Product Lifecycle
Early
Late
Launch Segmentation and targeting Tactical
planning Performance measurement
Pre-Launch Market assessment forecasting
Peak Growth Resource Optimization

• Maturity and Brand Extension
• Segment/Target
• Tactical planning
• Performance measurement

Commercial Development/ Business Development
Marketing/ Market Research, Business Development
Marketing / Market Research
Marketing / Market Research

• 72 million hospital claims per year
• Understand dosing and concomitant drug use
• Understand how consistently a patients takes
  medication or how long a patient stays on
  medication
• Measure the value of treatment or of a patient
  over time
• Understand what medical condition the drug is
  used to treat (for example an ace inhibitor can
  be used for hypertension or heart failure).
• Understand the patient profile. i.e. ages and
  gender of treated patients. For example, heart
  disease is often under treated in women. LPD can
  identify which segments of women are impacted the
  most.

38
SDI/Verispan Data

• SDIs longitudinal healthcare claims database and
  unique, HIPAA-compliant patient de-identification
  methodology
• measure patient flow
• sequencing of drug usage or procedures
• line of therapy
• Switching
• Regimens
• Remission
• Off-label utilizations across all care delivery
  channels.

39
Cegedim Longitudinal Patient Databases

• 9 longitudinal patient databases launched in 1990
• Understand and validate your patient market
  segments
• Opportunity Segments Where you can gain market
  share
• Monitor the implementation of your marketing
  strategy.
• Evaluate your market position relative to
  competitors
• Prescriber loyalty through observation of
  patients and prescriptions
• Incidence Prevalence
• Rx brand volume MS, therapeutical regimens,
  posology duration
• Co-morbidities Risk Factors

40
Review Ex-US Hospital Data

• Ex-Factory and Inventory information
• Check within your organization for source and
  availabilty
• Wholesaler agreements should include reporting
• IMS
• National
• Sub-national (in many, but not all markets)
• Cegedim promotional and longitudinal data
• Business Development Tools
• Incidence and Prevalence data sources

41
Best Practices for Evaluating Secondary Data
Sources

• Conduct annual reviews rapidly changing dont
  wait for contract renewal time
• Compare offerings in terms of
• Fit to your market
• Quality of data collection and reporting
• Cost
• Ask for match of data panels to your customer
  file
• Measure overlap
• Review Hospital demographics, characteristics or
  decile
• Understand projection methodologies
• Ask colleagues for recommendations
• Gain buy-in from internal customers

42
Secondary Data as a Supplement to Primary Research

• Cross-referencing available secondary data to
  primary research results adds value to both as
  they provide a more complete picture for our
  audience
• Always source your secondary data in your
  presentations
• Helps to remember where data originated
• Slides often are used by your teams
• Suppliers who understand secondary data can
  provide additional value to clients
• Some suppliers have the capabilities to conduct a
  full-scale commercial evaluation that combines
  primary research with secondary data, KOL
  feedback and forecasts
• Third Party Agreements must be in place before
  sharing data with external partners regardless
  of confidentiality agreements

43
Summary

• Learn to love secondary data!
• Secondary data is a cost-effective
  supplement/substitute for primary research
• Rapidly changing environment for hospital data
• More robust product offerings
• Mergers/acquisitions and consolidations
• Leveraging capabilities for advanced
  services/products
• Annual Reviews recommended
• Go to conferences and meet with vendors to learn
  whats new
• Learn to negotiate aggressively to get the most
  for your limited resources
• Get the maximum number of seats
• Global licenses to access information company
  wide
• Bundle products
• Work with secondary data suppliers to improve
  data offerings
• Be compliant when using/sharing secondary data

44
Questions?
45
WORLDWIDE PROMOTIONAL SPENDING
Promotional investment slow down, but the channel
strategy keeps the same
TOTAL SPENDING (B)
74,6
79
81,3
80,8
1,7
- 0,6
5,8
Source CSD PROMOTION DATA
45
46
TOP 10 PROMOTIONAL STRATEGIES MAT Q2/2007
Promotional investments evolution is very
contrasting from one pharma company to another
5,5
2,5
2,4
2,5
3,0
3,1
3,5
3,9
4,0
4,9
TOTAL SPENDING 2007 (B)
Evolution 2006-2007
Source CSD PROMOTION DATA
46