Download Using Better Data to Produce Better Patient Outcomes

A not-for-profit health and tax policy research organization
November 30, 2015
Using Better Data to Produce Better Patient Outcomes
By Grace-Marie Turner
The next big challenge in the pharmaceutical
sector is not going to be producing
breakthrough treatments for once-deadly
illnesses. The industry is on track to
accomplish that with 3,400 medicines in
development today in the United States alone,
an increase of 40% since 2005.1 Forty-one
new drugs were approved by the Food and
Drug Administration in 2014, the most in 18
years.2 Instead, the big challenge for the
industry is proving the value of these new
medicines to providers, patients, and payers
who are concerned about the cost of the drugs.
The challenge—and the opportunity—for the
industry is to prove how new medicines
improve patient outcomes and ultimately
reduce other health spending.
Prescription drug spending continues to
represent about one-tenth of $3 trillion in
annual health expenditures in the United
States.
But red flags are being raised because the
annual growth rate of drug spending spiked
more than 13% in 2014, to $305 billion.3 That
is partly attributable to increased prescription
drug use among people who were newly
insured under the Affordable Care Act. But as
the accompanying chart shows, after rebates
and other price concessions, the estimated
price growth for brand name pharmaceuticals
was actually 5.5%. The annual growth in drug
spending is expected to settle to the average
growth of overall health costs over the next
decade—about 6%.4
Invoiced prices increased in 2014
but were offset by rebates and other price concessions
P.O. Box 320010 • Alexandria, VA 22320 • Phone 703-299-8900 • www.galen.org
THE COST OF NEW DRUGS
research dollars therefore began flowing to
developing specialty medicines for patients
with rarer diseases rather than medicines
that impact larger patient populations—such
as cholesterol-lowering drugs.
The new generation of transformational
medicines now reaching patients can lead to
long-term survival and even cures for many
once-deadly illnesses, such as Hepatitis C.
But this progress comes with a high price
tag.
After more than a decade of research and
development, many of these new specialty
drugs are being approved. In 2014, 41% of
newly-approved specialty drugs were firstin-class, meaning they are substantially
different from any other medicine on the
market. That is double the percentage of
first-in-class drugs approved between 1993
and 2003.
Drug costs have risen in part because of
significant development costs, smaller target
populations, the long and expensive
regulatory approval processes, and because
of increased political pressures. While nine
out of 10 prescriptions filled today are
generics, it is essential that research
continue into developing newer and better
drugs.
These innovative treatments are targeted at
"orphan diseases" which may affect less
than 0.1% of the population. Last year, 41%
of medicines approved by the Food and
Drug Administration were "orphan" drugs.
There are more than 450 drugs for rare
conditions in the pipeline today. Many
cancer drugs are “biomarked”—which
means they are tailored to
physiologically impact only certain groups
of people with particular genetic markers.
According to researchers at Tufts
University, pharmaceutical firms spend an
average $2.6 billion to develop a single new
medicine. That is more than triple the cost of
developing and bringing a new drug to
market 15 years ago, when it was estimated
to cost $800 million.5
In addition, the industry began responding to
political pressures more than a decade ago to
funnel more research dollars into specialty
medicines. Lawmakers and regulators
wanted pharmaceutical companies to invest
less in developing "me-too" drugs—
medicines that improve already-approved
therapies as part of the evolutionary process
of scientific progress—and instead focus on
new, first-in-class drugs. Pharmaceutical
The shift from me-too drugs to innovative
specialty and orphan drugs is worth
celebrating. But due to their smaller patient
populations and higher development costs,
these medicines are unavoidably expensive
since the still-high cost of developing the
drugs and getting them approved must be
spread over a smaller population of people
needing the treatments.
Congressional Budget Office. Research and development in the pharmaceutical industry. Washington, DC: CBO;
October 2006. Accessed March 2014.6 Pharmaceutical Research and Manufacturers of America (PhRMA).
PhRMA annual membership survey, 1996-2014. Washington, DC: PhRMA; 2015. Profile Figure 13
As science evolves and as we understand the
genesis of various disease states, “poly
therapy” will become a reality where multiple
medicines may be needed to cure or manage
life-threatening ailments. These advances in
medical care mean physicians will need more
robust information, including real-time
outcomes data, to choose the appropriate
therapy and combinations of therapies for their
patients. In addition, there will be a need for
appropriate evaluation of outcomes from
various treatments since paying for outcomes
is a key element in our health reimbursement
ecosystem.
needing specialty drugs often face the highest
costs.
Patients are desperate to receive these new
medicines, but for too many, obtaining the
drugs can be a significant financial strain. The
health law requires health insurers to cover a
wide range of products and services—
“essential health benefits”—including
pediatric dental and maternity care. A long list
of treatments deemed "preventive" carry no
out-of-pocket costs to patients.
To try to keep premium costs as low as
possible while providing these mandated
benefits, insurers have increased patient costsharing in other areas, including medicines
that are not considered "essential" under the
ACA. This means that insurers skimp on
higher-end medical treatments to keep
premiums from soaring while still covering
the required benefits.
DISPARITIES IN PATIENTS COSTS FOR
MEDICINES
Part of patient experience, unfortunately, is
exposure to a higher share of the costs of
medicine than of other health care. Especially
in the ACA exchanges, patients are exposed to
higher out-of-pocket costs for prescription
drugs.7 This means the sickest patients
The most commonly subscribed Silver plans
actually cover a lower share of prescription
sponsored plan.”8 The actuarial firm found
that participants in ACA Silver plans pay 38%
more in cost sharing for prescription drugs, in
aggregate, than those in a typical employer
plan.
drugs than other medical services, as the chart
below indicates. Milliman found that Silver
plans with combined deductibles (for both
medical and pharmacy benefits) “impose
significantly higher member cost sharing for
pharmacy benefits than a typical employer-
Source: Impact of Health Insurance Marketplace on Participant
Cost Sharing for Pharmacy Benefits, Milliman, May 2014.
http://www.phrma.org/sites/default/files/pdf/milliman-impact-of-hix-on-pharmacy-benefitsreport.pdf
Yet as the chart on the next page shows,
patients bear a significantly larger share of the
costs of medicines than hospitals. For
example, Medicare patients pay 19% of the
cost of medicines out of pocket compared to
only 9% of hospital costs. Yet hospital costs
represent 40% of overall Medicare spending
compared to 12% for pharmaceuticals.
(Prescription drugs represent a slightly higher
percentage of drug spending in Medicare than
for the overall population.)
If a medicine that a patient needs isn't on an
insurer's list of approved drugs, then the
patient could be responsible for its full cost
(with little or no co-insurance to help offset
that cost). More than 60% of policies sold in
the ACA exchanges put multiple sclerosis
drugs in the highest tier of patient cost
sharing, for example. Many cancer drugs are
also in the priciest tier.
Medicines are the only intervention in health
care that reduces costs for other segments.
National Health Expenditures 2014, and
Kaiser Family Foundation, “How Much Is Enough? Out-of-Pocket Spending Among Medicare Beneficiaries”
A recent study in Health Affairs used data on
more than 1.5 million Medicaid recipients to
examine the impact of changes in prescription
drug use on medical costs.9 The researchers
found decreases in total non-drug Medicaid
costs associated with increased use of
prescription drugs: “Our results indicate that
although improved medication adherence by
people with four chronic vascular diseases
increased pharmacy costs, it also produced
substantial medical savings as a result of
reductions in hospitalization and emergency
department use,” according to Christopher
Roebuck and his fellow researchers. “We
found that a 1 percent increase in overall
prescription drug use was associated with
decreases in total nondrug Medicaid costs by
0.108 percent for blind or disabled adults,
0.167 percent for other adults, and 0.041
percent for children.”
For most medical services, consumers are
better insulated from prescription drug costs
once they hit their insurance deductibles. But
many people with ACA health insurance
policies face much higher exposures.
It is therefore critical that physicians, patients,
and payers have access to the best information
to make sure that the right patient is getting
the right drug at the right time.
PROOF OF VALUE
Public and private purchasers are demanding
more evidence that the cost of the new drugs
is worth the investment and are examining
economic and outcomes data in making
determinations about drug selection and in
price negotiations. In addition, the ACA is
bringing significant changes to payment
models. Accountable Care Organizations,
Meaningful Use requirements, the Value
Based Payment Modifier, bundled payments,
and a long list of new pilot programs and
policy requirements are forcing
pharmaceutical firms to prove value.
The Congressional Budget Office reached
similar conclusions, saying that “a 1 percent
increase in the number of prescriptions filled
by beneficiaries would cause Medicare’s
spending on medical services to fall by
roughly one-fifth of 1 percent.”10
But many more tools are needed to assess and
prove value.
Access to data sets by entities with a
commercial interest has been a problem, but
improvements have been made to allow wider
access to information in government-funded
databases. The Centers for Medicare and
Medicaid Services (CMS), for example, is
allowing pharmaceutical companies, device
manufacturers, and qualified non-profit
organizations much broader access to
previously-restricted CMS data.
TOOLS TO ASSESS VALUE
Real Time Data is being used to help
physicians make informed decisions about the
best course of patient care among the
bewildering array of options available.
We described the value of Real World Data in
a paper11 published by the Galen Institute in
2014:
But retrospective data is only part of the
picture; researchers and clinicians also need
information based upon real-time patient
information, including feedback about patient
experience.
Better access to data about real world
patient experience holds enormous
potential to help achieve many of the
goals of health reform, including
improving the quality and delivery of
medical care, reducing costs, and
improving safety and outcomes by
accelerating the knowledge base upon
which the development of new
treatments and cures relies.
COST CONSIDERATIONS AND
CLINICAL DECISIONS
According to a survey by PwC Health
Research Institute (HRI), 92% of physicians
said they considered cost when deciding
whether or not to prescribe a drug,13
particularly for diseases such as cancer,
multiple sclerosis, and arthritis.
Capturing data about the actual
experience of patients outside of the
carefully controlled clinical trial
setting—Real World Data—can help
fill the knowledge gap between
clinical trials and clinical practice.
RWD offers a treasure-trove of
information that could allow
providers, innovators, health plans,
researchers, and others in the scientific
and medical communities to make
faster, more efficient, and less costly
advances in medical research and
clinical treatment. Life sciences
companies can use this data to explore
the benefits and risks of treatment
options including their effectiveness in
patient subpopulations, expedite
enrollment in clinical trials, identify
new targets for research and
development, and transform the value
equation in medical care.12
A number of collaborations are emerging
between public and private purchasers who are
opening up their datasets to mine more useful
information to support physicians’ decisionmaking.14 “Putting drug costs into context
requires access to patient data, and evidence
connecting drug intervention with patient
health outcomes,” according to HRI.
“Collaboration is the key to demonstrating
value and ultimately boosting revenues in a
system that rewards outcomes and quality over
volume.”
New firms are emerging to help aggregate
and mine data derived from actual clinical
experience to help clinicians better anticipate
which drugs will work for which patients
before the treatment is administered.
A three-year-old company named Flatiron
Health has developed technology that helps to
gather data on cancer and is building the
world’s largest database of real-world
intelligence about cancer treatment. The
technology is being used by between 1,500
and 2,000 clinicians and administrators at
more than 200 cancer centers.
cancer,” Snow said. “Aggregate the data, store
it, and license it to the community with tools
so you can ask the questions you need to ask.”
COLLABORATIONS IN INFORMATION
SHARING
The PwC Health Research Institute (HRI) says
a number of factors are converging to force
collaboration among various players in the
health sector, including “rising drug costs;
increasing competition in key therapeutic
areas such as oncology, diabetes, multiple
sclerosis and rheumatoid arthritis; inefficient
and outdated clinical trial models; shifting
provider regulations and incentives; and a new
emphasis on patient-reported outcomes.”17
Fortune15 describes the “seismic shift”
toward evidence-based medicine taking place
in the health sector and explains Flatiron’s
innovative solutions. Flatiron’s primary
mission is to help doctors narrow down the
almost “unmanageable” number of
possibilities for treatment for cancer patients.
Fortune explains:
Many newer cancer drugs are
“biomarked,” which means they are
tailored to physiologically impact only
certain groups of people, rather than
the entire population. “If you’re an
oncologist practicing in a community
hospital in Nebraska, how are you
possibly going to keep up with all
that?” asks Skip Snow, [a senior
analyst for health care with Forrester
Research].
HRI conducted dozens of interviews with
industry leaders for a report on “21st Century
Pharmaceutical Collaboration: The Value
Convergence” and concluded:
x
Purchaser groups are linking
administrative claims data with
electronic health records to conduct
population research—with biopharma
collaborators—to better understand
important population segments, like
patients with more than one chronic
disease.
x
Health care providers, pushed by new
payment incentives, are collaborating
with the drug industry to measure the
effectiveness of therapies on the
patients they treat. Prescribing
practices increasingly reflect
sophisticated cost/benefit analyses.
x
New entrants are bringing biosensor
technology and digital tools to health
care to help biopharmaceutical
companies better understand the lives
of patients and how they change in
response to drug intervention.18
Flatiron is using big data to fight cancer, using
a cloud-based data platform:
Flatiron’s OncologyCloud16
platform includes an analytics section,
an [electronic medical records]
piece…a patient portal, and a billing
portion. Together, the technologies
provide what the company calls the
world’s largest single source of
structured real-world oncology data
and intelligence.
The technology also alerts physicians when
their patients are eligible for a particular trial.
The goal of the three-year-old company is to
accelerate personalized medicine and research.
Flatiron “wants to be the Lexis-Nexis of
x
x
other new medical technologies to support
drug therapy and compliance.
Patient advocacy organizations are
creating disease-specific registries for
research, and consulting with industry
players on clinical trial design and
protocols.
Google’s life science group, Google X, is
launching a wearable device designed
specifically for patients participating in
clinical trials.
Proposed legislation such as the 21st
Century Cures bill would make it
easier for drug companies to promote
cost effectiveness data as an additional
product attribute.
Other collaborations are developing
informatics to help expedite recruitment for
clinical trials.
Aetna’s Healthagen19 uses a model
combining clinical and financial data to enable
better decision-making. It says the return on
investment is high if pharmaceutical
companies can think in terms of “population
health management, and use data to build the
necessary story to demonstrate
effectiveness.”20
NEW TARGETING TOOLS
New technologies are enabling “precision
medicine” in which a person’s genetic
information is used to diagnose and treat
illness. Genetic information can be used by
researchers to target the particular subgroup of
patients most likely to benefit from the
treatment and by researchers to develop the
treatment in the first place.21
Being able to collect and use relevant data as
they pertain to specific tasks, businesses, or
populations is “the key to demonstrating
value,” HRI writes.
Precision medicine can be used to deliver
“personalized medicine” to manage the best
course of treatment for patients. Using these
two tools together “will lead to improvements
in drug effectiveness, reduction of drug
toxicity and eventually a decrease in overall
health care costs,” according to Pfizer senior
director of U.S. Government Relations and
pharmacist Robert Popovian. 22
“What matters now is data of a certain kind,”
said Dolors Terricabras, director, neurology,
new solutions development at USB, a global
biopharmaceutical company. “If you can start
collecting the same type of data in a structured
manner from a very specific patient
population, that’s where you can really start
comparing and generating quality insights.”
Physicians need better and more reliable
information to determine how to manage both
precision and personalized medicine.
Other examples:
USB has collaborated with MC10 Inc. to
develop a “Biostamp” device for use with
UCB’s drugs to treat movement disorders such
as Parkinson’s disease and restless leg
syndrome. The device tracks movement
around the clock to gather information to
optimize treatment.
Pfizer has entered into an agreement with
AARP, UnitedHealthcare, and the Georgia
Tech Research Institute to better understand
how Americans over age 50 use technology,
including wearable devices for health
monitoring and maintenance. “The biometric
trackers may serve as ‘innovative solutions to
challenges such as medication management
and adherence for older adults,’ Wendy
Mayer, vice president for worldwide
innovation at Pfizer, [said] in a statement.”
Teva Pharmaceutical Industries Ltd. is
working with collaborators to develop
implantable drug delivery microchips and
PROVING VALUE
AstraZeneca’s new drug, Crestor, is
designed for patients with very high
cholesterol who don’t respond to standard
statins. But the new drug carries a retail price
of about $200 for a month’s supply compared
to $4 a month for generic statins. The
challenge: How to prove to payers the value
of the much-higher-priced drug?
data, and analytics to improve care
management and population health outcomes.
The organizations are creating a new Center
for Population Health to “allow clinical and
administrative teams to develop and test
innovative population health management
strategies and train health care providers to
improve care management.”
Joseph Antos, a scholar at the American
Enterprise Institute, writes about the price
battles over these higher-priced injectable
cholesterol medicines known as PCSK9
inhibitors.23 He explains that there are patients
for whom traditional statins “are not
sufficiently effective (including persons with a
genetic predisposition to extremely high
cholesterol levels) or who suffer severe side
effects. The new class of PCSK9 inhibitors
have proven effective in lowering cholesterol
to heathy levels in those patients.”
The greatest opportunities to improve health
outcomes and achieve a value-based health
care system lie in information, including datasharing collaborations. Insurance companies,
pharmacy benefit managers, and provider
clinical data are all beginning to be aggregated
into data bases that will allow a “learning
health system” to evolve.
Optum and Mayo Clinic joined together to
create OptumLabs, working more than 20
partners ranging from hospitals to medical
device firms to pharmaceutical companies,
using massive data and analytic tools. It has
deidentified claims data for about 150 million
people, clinical data for 50 million, and linked
data between the two for about 15 million
people.
AstraZeneca entered into an agreement with
Cigna to “create a predictive model that
identified patients at a higher risk for
atherosclerosis,” according to HRI. “Patients
meeting the high-risk criteria were given
access to Crestor as a preferred brand-name
statin, with a lower co-pay and without a
requirement for prior authorization.”
“That amount of linked claims and clinical
data in a specific population can lead to big
insights into populations and groups of people
within them,” said Paul Bleicher, CEO of
OptumLabs. The information can help
researchers to better understand how people
use medications, live with their diseases, and
obtain health care services.
Antos also explains how some claims inflate
the cost of the drugs without accounting for
discounts, higher rebates, and step-therapy
programs. As we have seen with other drugs,
the impact of competition in a class of drugs
drives prices lower—a much better tool than
government’s threatened price controls.24
Qualcomm Life is working to help
pharmaceutical companies shorten the time of
a clinical trial, reduce the cost, and improve
the quality and speed of collection of data for
trials. “Instead of the traditional trial process
of asking patients to document and self-report
their health information and behaviors
periodically, connected devices ‘such as blood
Partners HealthCare, based in Boston, has
established a $30 million “strategic
collaboration” with Salt Lake-City based
Health Catalyst, a data warehousing and
analytics company, to focus on improving
outcomes.25 The goal is to use technology,
larger populations, the research costs must be
spread over a smaller number of patients
needing the drugs.
pressure patch, activity monitor and weight
scale, for example, can result in more
frequent, near real-time data exchange
reducing the potential of patients’ transposing
or modifying their data incorrectly, or making
errors,” HRI reports.
Insurance coverage used to be designed to
provide for just this instance: A few people
needing care for an expensive medical
condition whose costs would be shared with
others in the insurance pool. However, the
original concept of “insurance” has been
overridden by political dictates to cover a long
list of routine treatments and services, leaving
less revenue to provide coverage for patients
needing high-cost treatments, including these
specialty medications.
“Pricing pressure will only increase as more
specialty drugs enter the market,” HRI
concludes. “An ability to demonstrate value
based on real patient experiences, in the real
world, can serve as a release valve.
“Pharmaceutical companies have an
opportunity to improve health outcomes,
especially with chronic disease patients, by
collaborating with clinicians and tech
companies to improve care management,
promote medication adherence and lower the
total cost of care,” according to HRI. “Data
collection and monitoring with wearables and
other connected devices, present an
opportunity to provide a valuable service to
both patients and physicians.”
More legislation, additional price regulation,
and further rulemaking will not solve the
problem and will actually exacerbate it. A key
to lowering drug development costs lies, not in
more government regulation and hurdles to
market, but in getting drugs to market faster
while meeting safety standards. The 21st
Century Cures Initiative, led by House Energy
and Commerce Committee Chairman Fred
Upton, is making its way through Congress to
provide the opportunities to do just that. The
bill received overwhelming bi-partisan support
in the House and is now being considered by
the Senate. Final passage should be a top
priority for Congress.
CONCLUSION
While spending for prescription drugs has
consistently remained at about 10% of
national health expenditures for several
decades, it nonetheless gets disproportionate
attention from policymakers seeking to lower
health spending and costs.
The new challenge for the industry is to
make sure that the right drugs get to the right
person to maximize their chances of long term
survival and even cures. That means adding a
coordinated care element to make sure patients
are receiving support for their medications
regimen.
A historically large part of drug spending—
88%—is for generics. But medical progress
requires the industry to continue its search for
newer and better drugs so there will be a
steady stream of drugs going off patent to
become generics.
The key is for the industry to use data to
support access to these medicines and
supporting care management to ultimately
produce better outcomes. A smarter, more
robust use of information technology is
essential. “Ideally, the information will be a
combination of guidelines, expert opinion,
providers’ own data based on past patients for
whom they have provided care and data from
The industry has begun to focus, at least partly
because of political pressures, on developing
specialty medicines. These drugs are needed
and used by a relatively small percentage of
patients with rare diseases. But since their
development costs are the same as or even
higher than the earlier drugs serving much
In the longer term, new payment models can
be developed based upon this more robust
collection and use of more accurate data,
paying providers for outcomes to entice them
to get serious about using and participating in
the collection of data.
peers,” according to Pfizer’s Robert Popovian.
“Patient-experience data and clinical trial
information are also important parts of the
information platform. 26
“As physicians are diagnosing patients, they
are provided supportive guidance based on
information gathered in real time, utilizing
multiple data points. In addition, every time a
physician diagnoses and provides treatment to
the patient and inputs that information, the
database becomes even more robust, and data
provided back to the clinician will have
greater statistical confidence. The guidelines
and clinical trial data are also updated as these
resources become available,” he writes.
In this paper, we have highlighted a number of
initiatives using real world data, especially
patient experience, to produce more and better
information to assist clinicians in providing
better outcomes. Using information to
manage care and achieve better outcomes is
the challenge and the opportunity for the
industry through use of real world data and
aggregation of information into large,
deidentified datasets that can support better
clinical decision-making.
“Such a system will also allow us to develop
metrics that track and reward providers for
making the care decisions that matter to
patients, while also considering cost
efficiency.”
Congress and administrative agencies would
do well to support rather than impede those
efforts in the private sector.
In the short term, that means examining data
fields in electronic health record for
interoperability and standardization and
identifying solutions that can trace an
individual product to a medical outcome.
Grace-Marie Turner is president of the Galen
Institute, a non-profit public policy research
organization focusing on market-based health policy
solutions. www.galen.org
ENDNOTES
1
Medicines in the Pipeline, PhRMA, http://www.phrma.org/pipeline.
2
Robert Langreth, “The Drug Pipeline Flows Again,” Bloomberg Business, Feb. 26, 2015,
http://www.bloomberg.com/news/articles/2015-02-26/pharma-drug-pipeline-flows-again-yet-costs-threaten-innovationi6mndk06.
3
National Health Expenditure Projections 2014-2024, Centers for Medicare and Medicaid Services,
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/Downloads/proj2014.pdf.
4
Altarum Institute and 2014 CMS National Health Expenditures Report.
5
“Cost to Develop and Win Marketing Approval for a New Drug Is $2.6 Billion,” Tufts Center for the Study of Drug
Development, Nov. 18, 2014, http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study.
6
Congressional Budget Office. “Research and development in the pharmaceutical industry.” Washington, DC: CBO;
October 2006. Accessed March 2014 http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/76xx/doc7615/10-02drugr-d.pdf
7
Impact of the Health Insurance Marketplace on Participant Cost Sharing for Pharmacy Benefits, Milliman Client
Report prepared for PhRMA, May 13, 2014, http://www.phrma.org/sites/default/files/pdf/milliman-impact-of-hix-onpharmacy-benefits-report.pdf.
8
Ibid.
9
M. Christoper Roebuk et al, “Increased Use of Prescription Drugs Reduces Medical Costs in Medicaid Populations,”
Health Affairs 34, No. 9 (2015); 1586-1593. http://content.healthaffairs.org/content/30/1/91.full
10
“Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services,” Congressional Budget
Office, Nov. 29, 2012, https://www.cbo.gov/publication/43741.
11 Grace-Marie Turner, “Real world data and its promise for medicine and research,” Galen Institute, Aug. 2014,
http://www.galen.org/assets/RealWorldDataFinal1.pdf.
12 Tanisha Carino, “Real-World Data Will Drive the Future of Healthcare Innovation,” The Morning Consult, June 16,
2014, http://morningconsult.com/opinions/real-world-data-will-drive-the-future-of-healthcare-innovation/.
13
“21st Century Pharmaceutical Collaboration: The Value Convergence,” Health Research Institute, PwC, July 2015,
http://www.pwc.com/us/en/health-industries/health-research-institute/hri-pharma-life-sciences-fda.html.
14
Ibid.
15
Katherine Noyes, “Flatiron Health's bold proposition to fight cancer with big data,” Fortune, June 12, 2014.
http://fortune.com/2014/06/12/flatiron-healths-bold-proposition-to-fight-cancer-with-big-data/
16
http://www.flatiron.com/.
17
“21st Century…” Health Research Institute, PwC.
18
“New entrants are already having an impact,” PwC, http://www.pwc.com/us/en/health-industries/healthcare-newentrants/innovators.html.
19 Dan Finke, New Clinical and Financial Models for Long-Term Success, Healthagen, June 11, 2015,
http://www.healthagen.com/blog/new-clinical-and-financial-models-long-term-success.
20
“New entrants…” PwC.
21
Robert Popovian, “A distinction that makes a difference in healthcare,” Morning Consult, July 23, 2015,
http://morningconsult.com/opinions/a-distinction-that-makes-a-difference-in-healthcare/.
22
Ibid.
23
Joseph A. Antos, “What are the new anti-cholesterol drugs worth?” American Enterprise Institute, Sept. 9, 2015,
https://www.aei.org/publication/what-are-the-new-anti-cholesterol-drugs-worth/.
24 Grace-Marie Turner, “First Biosimilar Poised For FDA Approval,” Forbes, Feb. 13, 2015,
http://www.forbes.com/sites/gracemarieturner/2015/02/13/first-biosimilar-poised-for-fda-approval/.
25 Shannon Barnet, “Partners HealthCare, Health Catalyst collaborate and create $30M Center for Population Health,”
Becker’s Hospital Review, Sept. 11, 2015, http://www.beckershospitalreview.com/population-health/partnershealthcare-health-catalyst-collaborate-and-create-30m-center-for-population-health.html.
26 Robert Popovian, “We Have Smart Phones And Soon Will Have Smart Cars, So Why Not Smart Evidence!”
Morning Consult, Oct. 28, 2015. http://morningconsult.com/opinions/we-have-smart-phones-and-soon-will-havesmart-cars-so-why-not-smart-evidence/