RamaOnHealthcare September 24, 2023
Helping Health Systems & Life Sciences Organizations Accelerate Innovation
Today, RamaOnHealthcare welcomes and talks with Denise Juliano, Group Vice President of Life Sciences at Premier, Inc. from the PINC AI™ Applied Sciences (PAS), Premier’s data, research, and analytics division of Premier Inc. She is responsible for developing strategic business relationships with life sciences companies and health systems and expanding the utilization of PINC AI Applied Sciences solutions.
Denise Juliano, Group Vice President of Life Sciences, Premier
This interview is provided in two parts. Part One covers Retrospective and Clinical Trial Data, Actionable Data, Real World Evidence, and Improvement Science. Part Two will discuss Real World Data, Social Drivers of Health, Patient-Centric Care Model, and Health Equity Index.
RamaOnHealthcare (ROH): Welcome to our Thought Leadership series, Denise. Can you tell us about yourself and the PINC AI™ Applied Sciences (PAS) team and how they aim for success?
Denise Juliano (DJ): I lead the PAS team – the data, research, and analytics division of Premier that includes retrospective data, prospective interventions, and clinical trials. Clinical trials are a new area where we have helped accelerate evidence into practice and introduce innovations into the healthcare ecosystem more rapidly.
…we have helped accelerate evidence into practice and introduce innovations into the healthcare ecosystem more rapidly.
My professional “North Star” is helping health systems and life sciences organizations accelerate innovation and achieve smart, provider-led care that focuses on the patient’s needs. This patient-centered care needs actionable data to be analyzed effectively and leveraged to guide decision-making.
…patient-centered care needs actionable data to be analyzed effectively and leveraged to guide decision-making.
The PAS team aims for success by continuously cultivating and maintaining strategic collaborations across healthcare to help healthcare systems, life sciences, and medical device organizations improve clinical intelligence, margins, and value-based care.
ROH: What are some of the most pressing needs life science organizations face regarding clinical trials? Explain some challenges and share how PAS works with partners to solve them.
DJ: Modern therapeutics and devices can take a decade to come to fruition and cost upwards of $1 billion to develop. Adding to the high cost is that more than 80 percent of clinical trials in the U.S. fail to meet patient recruitment timelines.
The PAS team leverages the PINC AI™ Healthcare Database (PHD) and technology-enabled solutions such as machine learning and natural language processing (NLP) to help entities enhance clinical trial design, feasibility, execution, and accelerate life cycle management.
As part of protocol modeling, the PAS team leverages qualitative forums to generate real-world evidence that informs study protocols, design, and execution. Starting with the proper study design can help life sciences, as half of clinical trials fail due to flawed study designs.
…the PAS team leverages qualitative forums to generate real-world evidence that informs study protocols, design, and execution.
Traditionally, clinical trial sites were selected solely based on experience and relationships at the site level. Our technology-enabled solutions allow clinical trial developers to assess the suitability of sites on a larger scale based on appropriate patient populations, investigator availability, experience in therapeutic areas, and historical performance metrics.
It also permits clinical trial staff to rapidly screen for potential patients at scale instead of manually identifying those who met complex inclusion/exclusion criteria. This can help compress clinical research timelines and aid in the potential delivery of solutions at reduced costs.
This work is critical for overall health equity and clinical trial diversity. By identifying barriers to enrollment and informing strategies to reach underrepresented populations, we can better support the real-world use of therapies for all populations. This includes Black Americans, who were underrepresented in clinical trials with only five percent participating, and Latin patients, who represented seven percent. We also must address that less than five percent of U.S. adult cancer patients participate in clinical trials.
As one example, PAS is partnering with a large pharmaceutical company in two large-scale real-world clinical trials focused on using real-world evidence to expand understanding of the benefits of treatments beyond clinical trials for Chronic Obstructive Pulmonary Disease and Asthma patients.
The PAS team also has expertise in working with clinical trials utilizing synthetic external comparator arms to help researchers use real-world data to model the results and potentially reduce the required number of patient participants.
Additionally, our team collaborates with partners to streamline decentralized clinical trials with data, AI, and patient-centered methods. This allows telemedicine, mobile/local healthcare providers, and remote patient monitoring options to increase patient accessibility, improve patient retention, and potentially shorten clinical study timelines.
ROH: How is your team helping with early-stage disease identification?
DJ: Data can help generate evidence-based, sustainable solutions to help researchers and clinicians understand patient treatment patterns, resource utilization, and clinical and economic outcomes.
For example, the PAS team was tasked with helping find patients with early-stage Alzheimer’s Disease who were not scheduled for a follow-up visit with their provider. We sought partners with expertise and solutions to successfully find patients and diagnose and treat their cognitive impairment earlier. The PAS team utilized AI, Natural Language Processing, and a data ontology to mine the unstructured narrative of clinicians’ notes and pathology reports for statements like “mom seems a bit agitated” or “mom is confused” to identify patients for early intervention.
The PAS team utilized AI, Natural Language Processing, and a data ontology to mine the unstructured narrative of clinicians’ notes and pathology reports….
Additionally, the team recently conducted a study based on a hypothesis that people were getting lung scans (e.g., chest X-rays) mostly during treatment for COVID-19 that may have shown pulmonary nodules but were not followed up on for various reasons. These incidental pulmonary nodules (IPNs) may indicate early-stage lung cancer. After applying technology, the team identified 151,000 patients with incidental pulmonary nodules in a population of 5.5 million patients across seven institutions in New York. We flagged them for follow-up, returning them to the health system before potential lung cancer progression. Forty-seven percent of patients had evidence of workup care for their pulmonary nodules.
After applying technology, the team identified 151,000 patients with incidental pulmonary nodules in a population of 5.5 million patients across seven institutions in New York.
This work combined actionable data and technology to mine a dataset, help uncover details, and identify which risk factors, clinical signs, and symptoms most predict subsequent disease development.
In the second phase, the PAS team plans to work with study sites to identify implementation approaches to improve IPN assessment. The study will include developing and implementing care pathways and tools to foster specific guideline-directed surveillance and management. Data will be shared with the participating providers for their patients meeting the study criteria and to review patients whose follow-ups were missed to determine gaps in procedures and processes to inform the tools and resources to be developed.
ROH: How is the PAS team utilizing improvement science to impact clinician behavior change and encourage the use of evidence-based guidelines?
DJ: Our collaboration with life sciences organizations enables evidence-based guidelines to impact clinician behavior change and speed the uptake of evidence-based practices.
Our collaboration with life sciences organizations enables evidence-based guidelines to impact clinician behavior change and speed the uptake of evidence-based practices.
For example, we’re working together to identify underlying causes of chronic kidney disease (CKD) to help increase the chance of prevention, earlier detection, and timely treatment, which led to the Uncover CKD Project. The PAS team developed a comprehensive provider and patient outreach plan and related educational tools and materials to help raise awareness regarding early diagnosis and treatment among providers and patients.
The team is building a framework based on PAS’s Improvement Science framework methodology to help organize a clinical approach to improving chronic kidney diagnosis and care. This project is also leveraging our database for patient identification and creating individual reports to share with health systems to track their data better.
This improvement science process has been replicated in many other chronic diseases, including Alzheimer’s disease, diabetes, heart disease, and hepatic encephalopathy. These are areas where PAS has current expertise. The collaborations aim to help clinicians and health systems with processes to diagnose, close gaps, and optimize timely care for patients.
Abbreviations
AI – Artificial Intelligence
CKD – Chronic Kidney Disease
IPN – Incidental Pulmonary Nodules
NLP – natural language processing
PAS – PINC AI™ Applied Sciences (PAS) team
PHD – PINC AI™ Healthcare Database
SDOH – Social Drivers of Health
More about Denise
Denise spent 30 years with Merck before joining Premier. She graduated magna cum laude with a degree in Health Science from Seton Hall University and obtained a master’s degree from East Stroudsburg University in Exercise Physiology/Cardiac Rehabilitation. Denise participated in the Executive Education at the Harvard Business School of Harvard University and the Wharton School of the University of Pennsylvania.
In 2022, Denise was appointed to CancerCare’s board of trustees. She serves on the Strategic Account Management Association (SAMA) board. She was recognized as one of the Top 50 Women Leaders of North Carolina by Women We Admire and one of the Top 25 Women Leaders in BioTechnology in 2022.
Her hobbies include boating, pickleball, golf, cooking, and spending time with her family as she cheers on The New York Giants, New Jersey Devils, and New York Rangers. She is also – incongruously – a Chicago White Sox fan.