The goodness of data: The Optum approach to …...The goodness of data: The Optum approach to cultivating high value data for oncology research Elenee argentinis ADVANCED DATA AND

The goodness of data: The Optum approach to cultivating high value data for oncology research Elenee argentinisADVANCED DATA AND ANALYTICS, LIFE SCIENCESOPTUM

A N A L YT I C S

Agenda

1. The needs of oncology researchers

2. Why Optum is positioned to drive transformation

3. Oncology enrichment at scale — going from breadth to depth

4. Questions

© 2019 Optum, Inc. All rights reserved. 2

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Companies with Pipeline DrugsCompanies with Marketed DrugsMarketed drugs

Oncology dominates pipeline of top 100 companiesThe movement to specialty areas continues

Biomed Tracker 2018 – top 107 biopharmaceutical companies by revenue


https://www.biomedtracker.com/

How many of you are engaged in the care of oncology patients or in oncology research?(select all that apply)

a) Patient care

b) Oncology research

c) Both

d) Neither

CARE REIMBURSEMENT

Optum is positioned to support life sciences oncology research needs…We sit at the intersection of care and reimbursement

Deterministically linked

Pathology

Radiology

Care plans

Clinical assessments

Vital signs, labs

Signs, symptoms

Filled Rx

Reimbursed

Care utilizationSubmitted

claims

Optum clinical EHR and medical and pharmacy claims datasets


How many of you are using real world oncology data?(select all that apply)

a) Using EHR data

b) Using claims data

c) Using genomics/molecular data

d) Using imaging data

e) Not using any

We have the building blocks for high quality research across cancers

Data breadthPopulation size

Continuum of care

Care outside the oncology clinic

Pre- and post-cancer encounters

(signs, symptoms, assessments, tests, procedures, labs)

Data quality(provenance and

traceability)

Good data for oncology research

Data depthCompleteness of cancer

specific variables


How much oncology data does your organization license?a) We license one file for a specific cancer at a time (i.e., PDL-1)

b) We license a few data sets at a time (two to four mutation files)

c) We license the entirety of one or many data vendors datasets

d) We don’t license any data

BreadthThese populations include data from the entire patient journey

PRE- AND POST-CANCER CARE

Labs, procedures, biomarkers

Radiation therapy

Follow up care

BREADTH OF SPECIALTIES(e.g., for breast or ovarian cancer)

Signs, symptoms

Diagnosis/staging

Chemo-therapy

Clinical assessments

Surgery

Oral medication

Cardiology

Osteopathic/ orthopediconcology

Radiology oncology

Gynecology

Primary care

Surgical oncology

Medical oncology

Psychology

A significant portion of cancer patients get their pre-diagnosis screening and intervention outside the oncology clinic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752900/


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752900/

Example of the importance of continuum of careProstate cancer

Urology conducts more PSA tests and prescribes nearly as much as oncologists because they often treat early stages of prostate cancer.

PROSTATE CANCER DIAGNOSIS2016‒2018 | N=424493

Comparison of specialty in prostate cancer urology is highly engaged in both diagnosis and treatment

PHARMACOTHERAPYN=69,568

TESTSPSA, N=141,528

PROVIDER SPECIALTYUrology (N=26,814) | Oncology (N=7,106)

Distribution of pharmacotherapyUrology (N=6,589) | Oncology (N=8,475)

Distribution of testsUrology (N=27,309) | Oncology

(N=2,934)

Source: Optum EHR data (2007 – 2017)


Melanoma Bladder cancer

Cancer patients care outside of oncology clinicPatients with melanoma and bladder cancer get up to 50% of their care from other specialties

Reference: Counts based on ICD 10 diagnostic codes for specific cancer and provider specialty, Optum EHR data 2018


51%

21%

13%

8%

7%

Oncology and related

Dermatology

General phsycian

Surgery (misc)

Other specialties

49%

29%

17%

3%

2%

Oncology and related

Dermatology

General phsycian

Surgery (misc)

Other specialties

Top five other specialties who deliver supportive are• Plastic surgery• Otolaryngologist• Cardiology• Hematology• Ophthalmology

Oncology and related• Oncology 11.57%• Pathology 21.65%• Radiology 12.01%• Anesthesia 5%

Top five other specialties who deliver supportive care• Cardiology• Hematology• Rehabilitation• Psychiatry• Gynecology

Oncology and related• Oncology 5.69%• Pathology 9.26%• Radiology 14.84%• Anesthesia 11.18%

Optum oncology data quality supports publicationsOptum data has been used in many types publications


Cancer types addressed (most common)• Breast, lung, pancreatic, prostate, glioblastoma, ovarian, thyroid,

renal, colon, multiple myeloma

Types of studies• Comparative effectiveness research• Outcomes research (i.e., overall survival studies have been done)• Algorithms to identify cancer types (i.e., pancreatic cancer patients)• Therapeutic choices in specific cancer types• Surveillance of patients specific gene mutations to assess

risk of developing prostate cancer

> 30 articles and abstractsOver the past two years

Optum oncology dataUsed for studies published in peer reviewed journals


1 U.S. prevalence of endocrine therapy-naive locally advanced or metastatic breast cancer Breast cancer 2019 Apr

2 Analysis of Real-World Data on Overall Survival in Multiple Myeloma Patients With >/=3 Prior Lines of Therapy Including a Proteasome Inhibitor (PI) and an Immunomodulatory Drug (IMiD), or Double Refractory to a PI and an IMiD Multiple myeloma 2016 Nov

3 U.S. prevalence of endocrine therapy–naïve locally advanced or metastatic breast cancer Breast cancer 2019 Apr

4 Treatment regimens, treatment duration, and between-treatment duration in patients with small cell lung cancer across lines of therapy: An analysis of electronic health records data Small cell lung cancer 2018 Jul

5 Validation of algorithms to identify pancreatic cancer and thyroid neoplasms from health insurance claims data in a 10‐year follow‐up study Thyroid neoplasm 2018 Aug

6 Comorbidities and concomitant medication use in small cell lung cancer patients treated with third and later-lines of therapy: An analysis of electronic health records data Small cell lung cancer 2018 Jul

7 Incidence of pericardial and pleural effusions in patients with small cell lung cancer treated with third-line or later-line therapy: An analysis of electronic health records data Small cell lung cancer 2018 Jul

8 Incidence of pre-treatment and off-treatment pericardial and pleural effusions by line of therapy in patients with small cell lung cancer: An analysis of electronic health records data Small cell lung cancer 2018 May

9 A real-world evidence study to define the prevalence of endocrine therapy-naïve hormone receptor-positive locally advanced or metastatic breast cancer in the US Breast cancer 2017

10 Analysis of Real-World Data on Overall Survival in Multiple Myeloma Patients With ≥3 Prior Lines of Therapy Including a Proteasome Inhibitor (PI) and an Immunomodulatory Drug (IMiD), or Double Refractory to a PI and an IMiD Multiple myeloma 2016

11 Active Surveillance Use Among a Low-risk Prostate Cancer Population in a Large US Payer System: 17-Gene Genomic Prostate Score Versus Other Risk Stratification Methods Prostate cancer 2017

12 Comparison of Overall Survival Associated with Lenalidomide+Dexamethasone and Bortezomib+Dexamethasone Among Relapsed/Refractory Multiple Myeloma Patients: A Matched Analysis of Real World and Clinical Trial Populations Multiple myeloma 2017

What oncology enrichment at

SCALElook like

Optum oncology data — Going from breadth to depth

B R E A D T H P R E C I S I O N

Marketing insights

Health economics

Post market safety

Med affairs

Clinical trial planning and execution

Regulatory grade evidence

We can give life sciences the benefit of our breadth and tailor our data for depth


Our approachEnrichment starts with tuning the data to answer specific questions

Which intervention is better?

ComparativeEffectiveness

& Quality

Who is the patient?

Study inclusion criteria:population health

What is the cost?

TCOCBurden of illness

Cost effectiveness

What is the risk?

Risk estimationRisk stratification


Cancers with similar features allow us to scale so the staging construct and metastatic concepts shared by solid tumors will allow us to offer a suite of pan-oncology files using similar techniques adapted to each cancer.

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The enrichment plan Sequenced starting with solid tumors

MarketedPipeline

Biomed Tracker 2018 – top 107 biopharmaceutical companies by revenue


https://www.biomedtracker.com/

We can use clinical notes to take our data from broad to deep

140K providers More than 700 hospitals

and 7,000 clinics

4.5 billion free-text medical notes

74 million patientsMore than 45% have activity spanning more than 3 years

More than 30% have activity spanning more than 5 years

Optum Electronic Health Record Data 2007 - 2018


Do you have an internal natural language processing team?

a) No we outsource it

b) We have a few dedicated employees

c) We have a fully staffed department

Architectural flexibilityFlexibility lets us extract and build models on top of the extracted entities

Structured dataDeliver new standardized variables that researchers can use

Modeling dataAdd analytics to create derived variables from combinations of extracted structured and unstructured fields

Extraction dataNLP pipeline extract the terms that define concepts and relationships between them: TNM, stage, grade, biomarkers, tumor characterization, metastatic references

Annotations• Annotators are subject matter experts

with clinical background• Annotations followed by a curation

(reconciliation) phase

Models• Models are constantly evaluated during

development process• Standard metrics such as PPV (precision),

Sensitivity (recall) and F-score are reported on a held-out test set

Output• Output is normalized to reduce variability and

as an additional step to prevent PHI leaks• Quality check are performed (volumetrics,

outliers, distributions, comparisons with available structured data, extrinsic evaluation, …)


We’ve realized the power that linked data can bring to patient care

EHR/EMR

Medical claims

Devices

Storefront pharmacy

Genomics Imaging

Groceries, CPG

Media

SDOHsocio-econ

Diagnostics

Biomarkers

Pharmacy claims

Genetic panel reveals HER2 mutation

Buying cigarettes (told doc she quit)

Patient reports a lumpin her breast

Radiology confirms tumor size, lymph

nodes

Using apps for depression management

Jane SmithAge 57, BMI 22

Stage III Breast Cancer | HER2 positive ER/PR neg

Doesn’t owna car


Now we can support our clients with enterprise linking


Assemble a more holistic view of the patient to expand the set of questions that can be answered in health care

1. ProtectDe-identify datasets to protect patient privacy and reduce risk

2. LinkConnect matching patient records across datasets to increase data completeness and dimensionality

3. ExchangeSecurely exchange data in our open ecosystem as either a data owner or data user

Trial dataProvider populationsDigital apps

Genomics and molecular data

Imaging data

What can we explore linking for our clients?


EHR and claims

EHR and claims

EHR and claims

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#OptumForum2019

Upcoming PresentationsJuly 31, Ironwood 32:15 pmLeveraging EHR and Claims Data to Predict Changing Drug Utilization TrendsConor Wyand, Director of Real World Evidence and Value, Optum Life Sciences

Documents

The goodness of data: The Optum approach to …...The goodness of data: The Optum approach to cultivating high value data for oncology research Elenee argentinis ADVANCED DATA AND