Ryan Bober

Many HEOR teams are working with data that is months or years behind, fragmented across care settings, and unable to connect clinical outcomes with economic impact. Our upcoming webinar will introduce how Truveta Data—our daily-refreshed EHR dataset with complete linkage to claims and mortality—offers a new standard for real-world evidence. Brianna (Goodwin) Cartwright, MS and I will discuss how researchers can measure the full burden of post-treatment complications, speed up insight generation with ready-to-analyze data, and gain a more complete view of patient experiences across payers and care settings. For anyone working to build credible, timely, and comprehensive HEOR, this webinar will offer a practical look at what next-generation RWE can deliver. Save your spot: https://tr.vet/4ih2bvR

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Pharmacies are a massive cost center, so new initiatives are almost always about cutting costs. But what about increasing revenue? Incident-to billing under a collaborative practice agreement is a well-defined model for pharmacy service billing, and it turns out there are specific CPT codes for a laboratory pathologist to bill for complex interpretation of laboratory values. I would say that calculating AUC, or t>MIC, or a random value to a trough are all complex interpretations requiring expertise. Each interpretation may only bring in $20-50, but how many drug levels does your site run every year? I've heard reports that some clinics may already be taking advantage of this, and if so, I imagine a bunch of sites would love to hear your stories!

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🚨 Healthcare pricing is about to get a new set of FHIR APIs: GFE (Good Faith Estimate) and AEOB (Advanced Explanation of Benefits). The promise is simple: Before you get care, your provider sends your planned services to your health plan. Your health plan runs it through their claims engine. You get back a real, personalized cost estimate — before anything happens. These APIs are often described as a breakthrough for price transparency. They are — but not in the way most people think. This is not a consumer price-shopping API. The GFE → AEOB workflow is designed for known care, not browsing: • A specific provider • A specific set of planned services • A specific patient • A specific moment in time In practice, this means: These APIs help providers (and provider-adjacent platforms) generate more accurate, claim-like cost estimates — after a care decision is largely formed. They are a step toward: • Better financial consent • Fewer surprise bills • More reliable “what will I owe?” answers They are not designed to let patients freely shop across providers and scenarios. Why? Because an AEOB is essentially this: “We ran this through our claims engine — as if it were a claim — but in advance.” That requires: • The payer’s full adjudication stack • Their policy engine • Their contract logic • Their accumulator math And payers, if they decide to build this API, are not going to expose that logic for thousands of hypothetical shopping queries. So what actually changes? For providers: • More standardized ways to request pricing certainty • Less manual back-and-forth with payers • Better estimates at scheduling and pre-service For patients: • Clearer prices before care • More trust in estimates • Fewer post-care billing surprises Bottom line: FHIR-based AEOB is a meaningful step toward transparency, but it’s about price confirmation, not price discovery. https://lnkd.in/esHDZVxe

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