The Silent Leak™ is the population of patients who leave the path to therapy before any system records them: not denied, never counted, gone before a prior authorization, a claim or a support enrollment was ever created.
Why it matters
Approval metrics only capture requests that were submitted, so an organization can report a healthy approval rate while losing patients it never saw. Because nothing in the commercial data set records why those patients stopped, the loss surfaces later as an unexplained variance in accruals, true-ups and support spend. It is usually the largest line on the revenue waterfall with no assigned owner. Your approval rate is not your access rate.
Origin
Named by Patrick R. Coyle from his own experience running a finance organization, described in the case file The Leak I Built. The 10 Exits of Therapy™ are the framework for measuring it.
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Related terms
The 10 Exits of Therapy™, Patient Friction, Gross-to-Net
Part of the Patients + Profitability™ Glossary. Canonical definitions by Patrick R. Coyle; the same terms on nextgengtn.com and novusproximus.com carry these meanings.