Data Model

How Optum assets and iZO capabilities connect

Illustrative synthetic data

Illustrative synthetic dataLogical model, not a database

Typed arrays in one file today; the structure a pilot would map Optum and iZO sources into. Optum's real table layouts are not assumed.

Table definition

payer_segment

Optum claims (access patterns) + payer policy and PA source (to be confirmed)grain: one row per payer segment6 rows

Column	Type	Key	Example
payer_id	text	PK	A
payer_name	text		National PBM Plan A
segment_type	category		National PBM
region	category		Midwest
lives_covered_m	decimal (millions)		18.6
coverage_status	category		Covered, tier 3 with restrictions
barrier_severity	integer 0–100		82
pa_denial_rate_pct	decimal (%)		41
abandonment_rate_pct	decimal (%)		27
patients_affected	integer		14,200
policy_criteria	text		Covered after documented failure of an SGLT2 inhibitor and a maximally tolerated ACEi/ARB. PA requires UACR ≥30 mg/g and eGFR 25–75 within 90 days. 30-day supply per fill.

Sample rows (live values)

payer_id	payer_name	segment_type	region	barrier_severity	patients_affected
A	National PBM Plan A	National PBM	Midwest	82	14,200
B	Regional MA Plan B	Medicare Advantage	South	74	9,800
C	Commercial Plan C	Commercial	Northeast	61	6,300
D	Large Employer Plan D	Employer	West	48	4,100

The restrictions list on each payer is not a column here. It becomes the payer_barrier table, so one payer can have many barriers. Denial, abandonment and policy criteria fields come from a payer policy and PA source that is still to be confirmed. The values here are simulated.