Claims Intelligence IQKomodo · Optum · IQVIA · Flatiron · Truveta to Insights
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Real-World Data Intelligence · Multi-Source · HIPAA Safe

From Raw Claims to Strategic Decisions

Connect Komodo, Optum, IQVIA, Flatiron, Truveta, and TriNetX. AI extracts patient journeys, prescribing patterns, payer dynamics, line-of-therapy progression, and switching behavior — synthesized into commercial and medical insights ready for executive decisions.

Lives Analyzed
320M
across 6 data sources
▲ Multi-source linked
Patient Cohort
487K
NSCLC · 2L+ treated
▲ Refreshed daily
Mean Time to Insight
4.2 min
vs 6-8 wk analyst pull
▼ 99.7% faster
Insight Confidence
96%
statistical validation
▲ Audit-ready

Multi-Source Data Connection

Connect, link, and normalize across the leading real-world data sources. Auto-deduplicate patients across sources for the largest possible cohort.

Komodo Healthcare Map ● Connected
320M lives · Closed claims + linkage
Most comprehensive linked claims + EHR. Best for longitudinal patient journey.
IQVIA PharMetrics Plus ● Connected
235M lives · Comm + MA claims
Commercial + Medicare Advantage. Best for payer mix and switching analysis.
Optum Clinformatics ● Connected
75M lives · Claims + lab values
Claims with lab linkage. Best for surrogate biomarker analysis.
Flatiron Health ● Connected
3.5M oncology patients
Curated oncology EHR. Best for line-of-therapy, biomarker, OS endpoints.
Truveta ○ Available
120M lives · Real-time EHR
Multi-system EHR. Best for safety surveillance.
TriNetX ○ Available
280M patients global
Federated EHR. Best for trial feasibility & comparative effectiveness.
Medicare LDS / CMS ○ Available
63M lives · Federal claims
Federal claims. Best for IRA negotiation evidence.
Aetion Evidence Platform ○ Available
Analytical platform · tokenized
FDA-grade RWE analytics layer. Best for regulatory submissions.

🔗 Linkage & Deduplication

Patients are matched across sources using HIPAA-safe tokenization (Datavant, Privacy Hub) to maximize cohort size while preventing double-counting.

Patient overlap deduplication 98.4%
Source-to-source data validation 96.7%
Cohort completeness 87.2%
Diagnosis code mapping 99.1%

📊 Data Source Coverage Comparison (NSCLC 2L+)

📍 Linkage Insight
Combining Komodo + IQVIA PharMetrics + Flatiron yields the largest unique-patient cohort (487K) with full longitudinal claims plus oncology EHR detail. This is the optimal stack for both commercial and medical analytics on this indication.

🔒 Compliance & Privacy Layer

HIPAA Safe Harbor + Expert Determination
Privacy ControlImplementationStatus
HIPAA Safe Harbor de-identificationAll 18 identifiers removed before analysis✓ Verified
Expert Determination MethodStatistical certification by qualified expert (Datavant)✓ Verified
Tokenization for cross-source linkagePrivacy-preserving record linkage (PPRL) tokens✓ Verified
Small cell suppressionCohorts <11 patients suppressed in outputs✓ Verified
Audit trailEvery query logged with user, timestamp, output✓ Verified
Data Use AgreementsAll 6 source DUAs current and signed✓ Current

Visual Cohort Builder

Build patient cohorts with drag-and-drop logic. ICD-10, HCPCS, NDC, lab values, dates — all addressable without writing SQL.

🎯 Cohort Definition

Active cohort: 2L+ NSCLC Real-World Cohort (Q3 2026)

✓ ICD-10 C34.x ≥2 diagnoses
✓ ≥1 systemic therapy claim
✓ Continuous enrollment 12+ mo
✓ Age 18+ at index date
✗ Prior other cancer (5y)
✗ Clinical trial enrollment
✗ Hospice/EOL claim

👥 Cohort Composition

N = 487,234
Total cohort
487,234
Median age
68 y
% Female
52.4%
Median F/U
19 mo

📋 Cohort Subgroups

🧬
EGFR-mutant subgroup
EGFR L858R or exon 19 deletion
62,318
12.8%
🧬
KRAS G12C mutant
G12C mutation confirmed
38,492
7.9%
🧬
ALK rearrangement
ALK fusion positive
14,617
3.0%
🧬
PD-L1 high (TPS ≥ 50%)
High expression subset
142,719
29.3%
👵
Elderly (≥ 75y)
Special population focus
156,484
32.1%

Patient Journey & Line-of-Therapy Analysis

Trace patient pathways from diagnosis through multiple treatment lines. Identify drop-off points, treatment durations, and progression patterns.

🛤️ Line of Therapy Funnel

📍 Funnel Insight
Only 54% of 2L patients progress to 3L. The 46% drop-off represents either patient death, hospice transition, or treatment abandonment. This is a critical commercial whitespace for new 2L therapies that extend treatment durability.

⏱️ Median Treatment Duration by LoT

📍 Duration Insight
2L median duration is 5.4 months — well below trial efficacy. Real-world drop-off driven by toxicity (24%), progression (38%), patient choice (12%), administrative reasons (26%).

🔄 Treatment Sequence Sankey (Top Pathways)

Top 10 of 84 pathways
Pathway1L → 2L → 3LPatient CountMedian Duration% of Cohort
1Pembrolizumab+Chemo → Docetaxel → Ramucirumab+Docetaxel42,38914.2 mo8.7%
2Pembrolizumab+Chemo → Atezolizumab → Docetaxel28,64811.8 mo5.9%
3Pembrolizumab → Docetaxel → Ramucirumab+Docetaxel24,87213.4 mo5.1%
4Carboplatin+Pemetrexed → Pembrolizumab → Docetaxel21,94012.1 mo4.5%
5Osimertinib (EGFR) → Carboplatin+Pemetrexed → Docetaxel18,12422.8 mo3.7%
6Pembrolizumab+Chemo → Nivolumab+Ipilimumab → Docetaxel14,38713.6 mo3.0%
7Atezolizumab+Chemo → Docetaxel → Ramucirumab12,19610.4 mo2.5%
8Pembrolizumab → Carboplatin+Paclitaxel → Docetaxel9,74311.1 mo2.0%
9Osimertinib → Carboplatin+Pemetrexed → Pembrolizumab7,86019.4 mo1.6%
10Alectinib (ALK) → Brigatinib → Lorlatinib5,43228.6 mo1.1%
⚡ Patient Journey Strategic Brief
Three key strategic findings from line-of-therapy analysis:
  • 2L whitespace: The dominant 2L therapy is Docetaxel monotherapy (used in 38% of 2L patients) — a 25-year-old chemo with significant toxicity. A new 2L IO with better tolerability would capture meaningful share even with modest efficacy improvement.
  • EGFR pathway protection: Osimertinib remains dominant in EGFR+ 1L (22.8-month median duration), creating a strong "moat" for the EGFR franchise. New 2L therapies should plan around post-osimertinib positioning.
  • Combination chemistry IO continuation: 67% of 1L pembrolizumab-combo patients progress directly to 2L within 14 months — a large addressable population for new 2L therapy launches.

Prescriber Behavior & Switching Analytics

Provider-level prescribing patterns, switch dynamics, and physician segment analysis. Identifies which prescribers drive volume and how to influence them.

👨‍⚕️ Prescriber Concentration Curve

📍 Concentration Insight
Top 10% of prescribers (480 physicians) drive 62% of 2L NSCLC prescribing volume. Focus field activation on this segment for highest commercial leverage.

🔄 Switch Pattern Volume

📍 Switch Insight
Switches from Pembrolizumab → Docetaxel dominate (28% of all switches), driven by progression. A 2L therapy positioned as "post-IO progression" captures this exact transition point.

🏥 Prescriber Segment Analysis

Top 5,000 of 47K active prescribers
SegmentCountVolume ShareAvg Patients/Mo2L Switch RateKey Driver
Academic NCI Cancer Centers21814.2%4268%Trial enrollment + biomarker-driven
Large Community Practice (10+ MD)68428.4%1854%Pathway adherence + payer policy
Mid Community Practice (3-9 MD)1,54224.6%848%Sales force + peer referral
Solo Practice2,40612.8%338%Local KOL + medical education
Integrated Health System48615.4%2862%System-level pathway + P&T
VA / Federal1564.6%1442%Federal formulary policy
⚡ Prescriber Targeting Brief
For a new 2L NSCLC launch, the highest-ROI field force allocation is:
  • Tier 1 priority: 218 NCI Cancer Center physicians + 684 Large Community Practice physicians (902 total = top 1.9% by volume share) capture 42.6% of 2L NSCLC prescribing. Allocate 12 dedicated oncology specialists.
  • Tier 2 priority: 1,542 Mid Community Practice physicians capture 24.6% of volume. Hybrid coverage model with 8 oncology specialists + digital engagement.
  • Tier 3 efficiency: 2,406 Solo + 486 Integrated System physicians capture 28.2% combined. Digital + KOL peer-to-peer model — no dedicated rep coverage.

Payer Mix & Cost Analytics

Payer-level prescribing patterns, prior authorization analytics, gross-to-net economics, and IRA exposure modeling.

💳 Payer Mix by Volume

📈 Prior Authorization Rate by Payer

💰 Cost & Reimbursement Analysis

PayerVolume ShareWAC ($/mo)Allowed AmountEffective NetGtN%PA Approval RateDays to Approval
UnitedHealthcare14.2%$18,400$15,392$11,40838%86%4.2
Anthem (Elevance)13.8%$18,400$14,392$10,67242%82%5.8
Aetna (CVS)11.2%$18,400$14,024$10,30444%78%6.4
Cigna5.4%$18,400$15,024$11,04040%81%5.1
Humana6.6%$18,400$13,392$9,93646%74%8.2
Medicare Part B18.8%$18,400$16,752$14,35222%94%1.4
Medicare Advantage12.4%$18,400$14,896$11,40838%80%4.8
Medicaid (Managed)8.6%$18,400$11,392$8,09656%62%9.8
BCBS Federal3.4%$18,400$14,656$11,77636%84%4.6
Tricare/Federal2.6%$18,400$15,584$13,24828%92%2.1
⚡ Payer Strategy Brief
Three high-leverage payer actions for the next 12 months:
  • Medicaid PA rate problem: 62% approval rate is 18 percentage points below commercial average. Develop standardized PA template for Medicaid Managed Care plans. Estimated impact: 15-20% volume recovery in this 8.6% volume segment.
  • Humana PA delay: 8.2 days to approval is 2x the commercial median. Engage Humana medical director directly to align PA criteria with NCCN guidelines. Risk: patient drop-off during long approval wait.
  • IRA exposure modeling: Medicare Part B + MA = 31.2% of volume. If included in IRA Cohort 3 (small molecule, post-9-year window), modeled NPV erosion is $890M-1.4B over 5 years. Begin pre-negotiation evidence package now.

AI-Generated Strategic Insights Brief

One-click executive brief synthesizing all claims intelligence into commercial and medical strategic recommendations.

Generated September 2026 · Synthesized from 487K patient cohort · 4.2 min compute time · 96% confidence · Click sections to expand

📋 2L NSCLC Strategic Intelligence Brief — Q3 2026

Executive Summary

Analysis of 487,234 real-world 2L+ NSCLC patients across Komodo, IQVIA PharMetrics, Optum, and Flatiron reveals 5 strategic insights for commercial and medical leadership: (1) Docetaxel monotherapy dominates 2L creating clear whitespace for new 2L IO; (2) Top 1.9% of prescribers drive 42.6% of volume enabling focused field force investment; (3) Medicaid PA delays represent the largest access barrier; (4) EGFR+ patients have 22.8-month median 1L duration creating timed engagement opportunity for 2L; (5) IRA modeled NPV erosion of $890M-1.4B for Medicare-exposed therapies.

Insight 1: 2L Commercial Whitespace Opportunity

Finding: Docetaxel monotherapy accounts for 38% of 2L NSCLC therapy — a 25-year-old chemotherapy with significant toxicity (24% discontinuation rate due to AEs in real-world setting).

Implication: The dominant 2L therapy has well-documented tolerability issues but no superior alternative has displaced it because of cost and access barriers.

Recommendation: New 2L IO entrants should position around "better tolerability + meaningful efficacy" rather than "best-in-class efficacy alone." Real-world 2L treatment duration of 5.4 months suggests addressable market of $4.2B at peak penetration of 35%.

Insight 2: Field Force Concentration Strategy

Finding: Top 902 prescribers (1.9% of universe) drive 42.6% of 2L NSCLC volume. These are concentrated in NCI Cancer Centers and large community practices.

Implication: Traditional broad-coverage rep model is wasteful. A focused specialty team of 20 reps can cover 80%+ of these prescribers vs ~150 reps needed for traditional 80/20 coverage.

Recommendation: Build 20-FTE oncology specialty team focused on top 902. Pair with digital + peer-to-peer for next-tier 1,542 prescribers. Annual SG&A savings vs traditional model: $32-48M.

Insight 3: Payer Access Optimization

Finding: Medicaid Managed Care (8.6% volume) has 62% PA approval rate vs 80%+ commercial. Humana (6.6% volume) has 8.2-day approval delay vs 4-day commercial median.

Implication: Two distinct access barriers requiring different solutions — Medicaid criteria template work and Humana medical director engagement.

Recommendation: Q4 deliverables — (a) NCCN-aligned PA template for top 5 Medicaid Managed Care plans (Centene, Molina, CareSource, AmeriHealth, AvMed); (b) Humana medical director engagement with utilization data. Estimated volume recovery: 15-20% in target segments.

Insight 4: EGFR+ Timed Engagement

Finding: EGFR+ patients on 1L Osimertinib have median 22.8-month treatment duration — a long "engagement window" before 2L switch.

Implication: Patients can be identified, educated, and pre-positioned for 2L therapy 18+ months before they need it.

Recommendation: Launch EGFR-specific patient identification program with prescribers managing > 20 EGFR+ patients. Develop "post-osimertinib progression" educational content. Estimated EGFR 2L share gain: 8-12 percentage points.

Insight 5: IRA Exposure & Mitigation

Finding: Medicare Part B + Medicare Advantage represent 31.2% of 2L NSCLC volume. Small molecule therapies face IRA Maximum Fair Price negotiation 9 years post-approval.

Implication: Modeled NPV erosion under base IRA scenario (30% MFP cut): $890M-1.4B over 5 years post-negotiation.

Recommendation: (a) Build pre-negotiation evidence package now — real-world OS validation, comparative effectiveness vs SoC, value-based contract pilots; (b) Pursue value-based contracts with top 5 commercial payers to demonstrate confidence in efficacy; (c) Pre-emptive ICER submission for independent value assessment.

⚡ Workflow Impact
This brief was generated automatically from 487,234 patient records across 4 data sources. Manual production of equivalent intelligence requires:
  • Before Claims Intelligence IQ: 3 RWE analysts × 6 weeks × 40 hours = 720 hours × $145/hr = $104,400 per quarterly brief
  • With Claims Intelligence IQ: 1 senior analyst × 4 hours review = 4 hours × $180/hr = $720 per brief
  • ROI: 99.4% time reduction · $103,680 cost savings per brief · 716 hours of senior analyst time redirected to higher-value strategic work
Action completed