How Payer Claims Data Strengthens Medtech Value Stories: Examples from Peer-Reviewed Publications

For medical technology leaders, proving the value of innovation can be an uphill battle. While randomized controlled trials (RCTs) remain the gold standard for clinical evidence, they are often impractical for capturing the long-term benefits of a technology. The reality is that funding multi-year studies to track complications, healthcare utilization, and comparative effectiveness is financially and logistically daunting.

This challenge leaves many medtech innovators at a crossroads—how can they demonstrate real-world value to payers, providers, and policymakers without the burden of long, expensive studies? One answer lies in leveraging payer claims data, a powerful but often underutilized resource that provides insights into healthcare costs, patient outcomes, and treatment patterns in real-world settings.

From establishing the burden of illness in a target population to evaluating therapy adherence and cost-effectiveness, claims data allows medtech companies to strengthen their value proposition without needing to conduct new, resource-intensive studies. Below are some examples of studies using payer data to build compelling value stories.

Note: Studies referenced here are not behind paywalls; full text is available at the corresponding links.

Establishing Burden of Illness in Target Populations

Understanding the burden of illness within specific patient populations is crucial for developing targeted interventions. Payer claims data provides comprehensive information on disease prevalence, comorbidities, and associated healthcare utilization. For instance, a study analyzing electronic health records characterized patients with uncontrolled hypertension, revealing patterns that inform treatment strategies and resource allocation.

Assessing Long-Term Complications

Longitudinal analyses of claims data enable the identification of long-term complications associated with diseases or treatments. By tracking patient outcomes over extended periods, researchers can detect trends and potential issues that may not surface in shorter studies. This approach enhances the understanding of a medical technology's impact on care over time, such as this study investigating long-term opioid medication use after spinal stimulation.

Real-World Evidence on Healthcare Utilization and Costs

Claims data offers a window into real-world healthcare utilization and associated costs, providing a pragmatic perspective on a medical technology's economic impact. For example, an analysis of patients with chronic pain treated with peripheral nerve stimulation using a micro-implantable pulse generator system demonstrated significant insights into healthcare resource utilization and costs, underscoring the therapy's value proposition.

Evaluating Therapy Adherence

Adherence to prescribed therapies is a critical determinant of clinical outcomes. Claims data facilitates the assessment of medication adherence by tracking prescription refills and persistence. A study examining patients with chronic obstructive pulmonary disease (COPD) initiating single-inhaler triple therapy utilized claims data to evaluate adherence and persistence, informing strategies to enhance patient compliance.

Analyzing Care Settings and Provider Types

The effectiveness of medical technologies can vary across different care settings and provider types. Claims data enables comparisons of outcomes in diverse environments, such as hospitals, outpatient clinics, and nursing homes. For instance, a study analyzing the impact of device sourcing on real-world adherence and cost implications of continuous glucose monitoring (CGM) in patients with diabetes found that individuals who obtained their CGM devices through durable medical equipment suppliers exhibited higher adherence rates and lower healthcare costs compared to those who acquired devices from pharmacies. This research highlights how the source of medical technology can influence patient outcomes and economic factors, guiding stakeholders in optimizing care delivery models.

Comparative Effectiveness of Different Technologies

Payer claims data serves as a robust platform for comparative effectiveness research, enabling stakeholders to evaluate how different medical technologies perform in real-world settings. By analyzing outcomes, costs, and utilization patterns, decision-makers can discern which innovations offer superior value. For instance, a study assessing the cost and quality of healthcare services across multiple states utilized all-payer claims databases (APCDs) to standardize disparate data and calculate comparable cost and quality measures for ambulatory cardiac monitoring strategies. This approach provided valuable insights into the relative effectiveness of various interventions, informing policy and reimbursement decisions.

The strategic utilization of payer claims data empowers stakeholders to construct compelling value narratives for medical technologies. This real-world evidence complements traditional research methodologies, offering a comprehensive view of a technology's impact on patient outcomes and healthcare systems. As the healthcare industry continues to prioritize value-based care, leveraging claims data will be increasingly essential in demonstrating the tangible benefits of medical innovations.

Nicole Coustier is a medtech startup advisor and U.S. reimbursement consultant. Schedule a conversation here.