(294) Reduction in Data Lag Using Optum Pre-Adjudicated Health Insurance Claims

Publication Number: 1339

Background: Healthcare claims databases used for drug or vaccine safety monitoring typically include fully adjudicated claims. The adjudication process adds to the time between the occurrence of healthcare services and their presence in the database. This lag may limit the utility of claims databases when rapid detection of adverse events is needed, as with COVID-19 vaccine monitoring. Pre-adjudicated claims may have a shorter data lag and enable more timely analyses.

Objectives: To compare the data lag in Optum’s pre-adjudicated claims database with the data lag in fully adjudicated claims from the Optum Research Database (ORD).

Methods: Optum compiled pre-adjudicated claims including enrollment, adjudicated prescription drug and pre-adjudicated hospital and physician health insurance claims from December 1, 2017 to October 23, 2021, in a database. Hospital and physician claims from U.S. providers who accept patients with health insurance are incorporated, weekly, into the database following initial processing. The ORD contains adjudicated medical and pharmacy claims with linked enrollment information with data as early as 1993 available for approximately 70 million individuals with both medical and pharmacy insurance coverage. Data lag was measured as time to percent completeness and was calculated for both inpatient and outpatient claims in the pre-adjudicated claims and the ORD, as well as adjudicated pharmacy claims present in both databases.

Results: There were 28,798,114 enrollees in the pre-adjudicated claims database during December 2017–October 2021. In the pre-adjudicated claims, 52% of patients were female, compared to 48% female in the ORD. The median enrollment length in the pre-adjudicated claims was 2.3 years, while it was 2.6 years in the ORD. The pre-adjudicated claims had an approximate two-month delay to achieve 90% completeness for inpatient claims and over 70% completeness at one-month for outpatient claims. In the fully adjudicated claims, outpatient claims had 90% completeness at three months and inpatient claims reached 90% completeness at six months. The adjudicated pharmacy claims in both databases had 90% completeness at approximately 1.5 months.

Conclusions: Optum’s pre-adjudicated claims database offers a four-month shorter lag time for inpatient claims and at least one-month shorter lag time for outpatient claims compared to the ORD. This shorter lag time enables the pre-adjudicated claims database to be used for time-sensitive drug or vaccine safety and effectiveness studies.