How to optimize your sales outreach efforts by analyzing claims data

Selling into the healthcare industry is hard. Ask any sales leader. If you’re selling into the healthcare market, you need to be prepared to navigate a complex ecosystem, tailor your sales pitch to numerous stakeholders, and withstand long sales cycles.

As the healthcare industry grows more complex, claims and diagnosis data are becoming an ever more valuable resource for companies selling into the space. Claims data is a goldmine of information about a patient’s medical journey across service providers and locations – and it can help you discover the insights you need to expand your footprint in the market.

In this guide, we’ll delve into the world of claims data and explore how you can leverage it to optimize your sales outreach efforts for greater success.

1. Understand claims data

Every time a patient interacts with the healthcare system, it opens up a treasure trove of information, all neatly organized and coded for analysis. That treasure trove is claims data. Claims data contains valuable insights about the clinical care that patients receive, including details about diagnosis, procedures, costs, and more. It’s captured on bills, or claims, and submitted by healthcare providers for reimbursement by third-party payors.

Because healthcare providers want to be paid for their services, nearly every encounter a patient has with the healthcare system leads to the generation of a claim. De-identified to protect patients’ privacy, claims data has the unique benefit of providing a long-term view of patient care across multiple service providers and locations. Armed with this information, you can gain the necessary market context to have informed conversations with your prospects.

2. Estimate your total addressable market (TAM)

Claims data can help you identify your total addressable market by pointing you toward patient populations within your therapeutic area or target disease state. Using claims data, you can uncover claims volumes for a specific diagnosis, a certain medical procedure, or a prescription drug. You can also discover where patients are seeking care and which facilities and physicians are providing that care.

Let’s consider an example. Say you’re selling a medical device used to treat sleep apnea. The first step is to identify the diagnosis and procedure codes that are relevant to the medical device. You might look for diagnosis codes for obstructive sleep apnea (ICD-10 code G47.30) and procedure codes related to sleep studies and sleep apnea treatment.

Once you’ve identified relevant claims, you can estimate your TAM by extrapolating the number of patients who could benefit from your device. This may involve making assumptions about the likelihood that these patient populations will seek treatment. By using this approach, you can gain a better understanding of the potential market for your device and discover new market opportunities.

3. Focus on the right patients and target high-value prospects

When selling into the healthcare market, it can be tempting to cast your net as wide as possible. But this approach can hurt your overall sales strategy. Your job is not to sell to every patient, physician, hospital, clinic, and facility out there. Instead, you need to figure out who’s facing the specific problem that your product, solution, or therapy can solve.

Claims data can also be a powerful tool for identifying patient populations that are ready for treatment and for targeting the most promising prospects. By drilling down into claims histories, you can discover patterns in shared patient comorbidities, prescription use, and treatment histories — giving you the insights you need to turn that data into action. You can also use claims data to uncover physicians performing the highest volume of procedures or treating your target patients.

Let’s look at another example. Say you’re selling a new drug to treat a rare genetic disorder. To find treatment-ready patient populations, you might look for groups that have received multiple treatments for the disease or have been hospitalized for complications related to the disease. You could also analyze demographic data, such as age and gender, to find patient groups that are more likely to have the disease.

Based on your analysis, you can isolate patient populations that are likely to benefit from your drug. You might focus on populations that have already been diagnosed with the disorder and have received the standard therapy but are still experiencing symptoms. You might also target patient groups that have been hospitalized for complications related to the disease, as they may need more aggressive treatment.

Taking a deeper dive into the data can also help you find specific market segments based on the facilities or physicians who are treating the most patients with the disease. These are the providers most likely to benefit from your product. By focusing on the right prospects, you can maximize your chances of success.

4. Perform competitive analysis

To execute a successful sales or marketing strategy, you also need to understand where you stand against your competitors. Using claims data can be an effective method for doing competitive analysis and gaining insights into the performance of your product relative to competing products. If you’re selling a drug for a certain disease, you can pull claims data for drugs that are used to treat the same or similar conditions.

Once you have the data, you can begin to analyze it to gain insights into how your new drug is performing relative to the competition. For example, you could compare the number of prescriptions filled for your drug to the number filled for competing drugs or look at the number of patients receiving treatment with each drug. You could also compare the cost of your drug to the cost of competing drugs to see how it stacks up in terms of affordability.

Based on your analysis, you can understand the strengths and weaknesses of your drug relative to the competition. You might find that your drug is more affordable than competing drugs, but that fewer patients are receiving treatment with it. Or you might find that your drug is being prescribed more often than competing drugs, but that it’s not as effective in treating certain symptoms.

You can use these insights to identify new opportunities for growth, craft a more compelling value proposition, and address any weaknesses in your new drug’s performance relative to the competition.

What it all means

When selling into the complex healthcare market, one of the most valuable resources is healthcare data. By analyzing claims data, you can gain insights into the unique needs of your target audience. You can use this information to fine-tune sales strategies, identify new opportunities, and stay ahead of your competitors. If you’re selling into the healthcare market, don’t be intimidated by the complexity of the puzzle. With the right data, you can put all the pieces together and achieve success.