Arlington, VA — One of the biggest practice-based trends we’re watching was born of a shift in insurer strategy.
The largest payers in healthcare – including Aetna, UHC, WellPoint, and Medicare – are now compensating physicians for value in addition to volume of services. That’s part of what we call more accountable care. At UHC, for example, at least 50% to 70% of its physician bonuses are for reaching cost and quality targets and/or participating in new care models.
That shift to more outcomes-driven reimbursement is changing the kind of data doctors want. Traditionally, the key data points for new drugs come from the big, multi-phase, randomized, controlled clinical trials conducted by pharmaceutical companies. Those results show how a drug works compared to another drug or compared to placebo across a broad population.
What they don’t show is how well they’ll work on any one doctor’s population of patients. Imagine the difference between treating lung cancer patients in West Virginia vs. Manhattan. Of treating diabetes in Mississippi vs Colorado. Or depression in Alaska vs. Florida. Let alone adding in the other complex considerations of age, co-morbidities, and resources.
Doctors who are looking for more local data have a powerful new tool: real world data. Electronic medical records are now in use in most practices, which makes mining outcomes on particular drugs or treatment approaches at a local level a real possibility.
According to a recent study of 3,700 physicians in eight countries by Accenture, doctors are putting the patient at the center of how they use EMR:
- 45% of US physicians are using the health information exchange to access clinical data outside their own organization
- 45% also use EMR for basic clinical tasks, such as receiving alerts while seeing patients
- 57% regularly using electronic lab orders
- 62% receive their clinical results, such as lab tests, directly into their EMR system
That combination of deep data and practice integration is powering a new trend: The Investigator-Initiated Mini Trial
Physicians working in large practices or across networks will leverage EMR to create what are essentially mini investigator-initiated trials on their specific population. They’ll increasingly pilot new drugs with a small part of their total patient base and mine/compare the data before rolling it out to larger segments.
That could create entirely new kinds of KOLs – ones driven by numbers, relevant to small groups of peers, and connected across digital networks. They’ll increasingly share their findings in micro interactions with other physicians who are in their region or working with similar demographics.
Posted by: Leigh Householder