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Why Claims Data Alone Leave Gaps in Understanding the Patient Journey –

Spluk.ph by Spluk.ph
June 18, 2025
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Why Claims Data Alone Leave Gaps in Understanding the Patient Journey –
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Noah Nasser, CEO at datma

In right this moment’s precision drugs panorama, pharmaceutical firms and entry groups face a important problem: understanding not simply whether or not therapies work, however how they’re accessed, adopted, and skilled by real-world sufferers. This requires going past conventional information sources, significantly claims information, which—whereas helpful—typically fails to seize the nuanced medical and diagnostic steps that outline the affected person journey. To really perceive and enhance remedy adoption, stakeholders want a extra full, context-rich view of real-world care pathways.

The Limits of Conventional Information Sources in Market Entry

In precision drugs right this moment, market entry isn’t nearly producing real-world proof; it additionally requires understanding how therapies are adopted throughout the complicated care pathways sufferers expertise in precise medical follow. From analysis to testing to therapy, every step can introduce friction. But many business and analytics groups nonetheless rely virtually completely on claims information to raised perceive entry and adoption patterns. 

These datasets are foundational, however they’re not the entire story. They typically fail to seize diagnostic particulars, therapy timing, and medical decision-making that contribute as to if a remedy reaches the best affected person on the proper time. 

What Claims Information Misses

Claims information gives a standardized and scalable view of healthcare utilization. It tracks procedures, remedy fills, and billing exercise throughout hundreds of thousands of sufferers. It’s particularly helpful for analyzing payer combine, therapy adherence, and high-level healthcare prices. However as a result of claims information is constructed round billing, it typically lacks the context wanted to totally perceive what occurred through the affected person journey. It might present {that a} molecular check was billed, however not what the consequence was, whether or not it was actionable, or the way it influenced therapy. Timing will also be troublesome to interpret, as billing occasions could not align exactly with when medical choices have been made. Claims information might also miss non-billable companies, resulting in gaps within the full image of a affected person’s care journey. For entry groups making an attempt to grasp remedy adoption or therapy delays, this lack of context can go away important questions unanswered. 

Why Diagnostic Context Issues

With out these necessary items, market entry groups face challenges that transcend conventional information evaluation. They battle to quantify the real-world affect of diagnostic testing on remedy initiation and therapy outcomes. Questions similar to, “Had been sufferers delayed in beginning therapy as a result of check outcomes weren’t out there on time”” or “At what level within the care pathway are sufferers dropping off?” stay troublesome to reply. Furthermore, understanding variations in doctor habits, how suppliers throughout completely different establishments or areas interpret diagnostic checks and make therapy choices, requires information that extends past what claims information can provide. 

The Penalties of an Incomplete View

The consequence is a fragmented view of the affected person journey. When resolution makers rely solely on claims information, they could overlook necessary alerts associated to diagnostics timing, check outcomes, or how sufferers are shifting, or not shifting, via care. This incomplete image can result in market entry methods that don’t totally account for obstacles in real-world therapy adoption, leading to missed alternatives to optimize remedy entry and affected person outcomes. 

Augmenting Conventional Information with Structured Molecular Insights

To bridge these gaps, there’s a rising want for options that may entry and standardize the lacking layers of knowledge. That is the place new fashions can begin to fill within the gaps. 

Federated information fashions current a promising method. In these techniques, information stays securely inside every collaborating establishment’s management whereas enabling pre-approved queries throughout a number of sources. These fashions can seize structured information from laboratory techniques, imaging platforms, and pathology reporting techniques, providing insights into the timing of checks, the outcomes of molecular and diagnostic assays, and the next care sequence. Though federated platforms don’t seize each nuance, such because the narrative behind a clinician’s resolution, they do present a clearer, data-driven view of what really happens throughout care pathways. By integrating these structured diagnostic parts with claims information, market entry groups can receive a extra full image of the affected person journey. This complete view permits them to establish the place sufferers expertise delays or drop-offs, perceive regional variations in supplier habits, and finally alter methods to make sure that the best therapies attain the best sufferers extra effectively. 

The Path Towards a Extra Complete Market Entry Technique

Claims information will at all times be a foundational a part of real-world proof era. Nonetheless, to fulfill the evolving calls for of market entry, it is very important increase these information sources with structured diagnostic insights. Because the business strikes towards fashions that protect institutional management whereas unlocking deeper, extra granular information, the chance to attach the total care journey, from analysis to therapy, is feasible. 

Because the stakes rise for delivering well timed, equitable entry to life-changing therapies, market entry methods should evolve past one-dimensional information sources. By combining the breadth of claims information with the depth of diagnostic insights enabled via federated fashions, pharmaceutical firms can lastly illuminate the blind spots within the affected person journey. This built-in method isn’t only a information improve—it’s a strategic crucial for guaranteeing that improvements in precision drugs attain the sufferers who want them, after they want them most.


About Noah Nasser
Noah Nasser is the CEO of datma, a number one supplier of federated Actual-World Information platforms and associated analytical instruments. With greater than twenty-five years of expertise in biotechnology, Noah brings a broad background in creating and commercializing novel know-how to advance human well being, together with serving because the CEO of Serimmune and Chief Industrial Officer roles at Human Longevity and Counsyl. Noah led Counsyl’s business workforce via its acquisition in 2018 by Myriad Genetics. He beforehand held senior management positions at AltheaDx and Verinata Well being, a frontrunner in non-invasive prenatal testing (NIPT), the place he led his workforce via the corporate’s 2013 acquisition by Illumina.



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