Healthcare claims data are an excellent resource to deeply understand how facilities and physicians deliver care. Healthcare codes allow you to better understand your market, target new opportunities, and segment your campaigns with precision.
To fully leverage this invaluable resource, it’s helpful to know how the underlying mechanics of healthcare billing and reimbursement work
Healthcare providers, including facilities and physicians, by and large get paid through insurance programs funded by private insurance (i.e. UnitedHealthcare, Aetna, BlueCrossBlueShield, etc), federal programs (i.e. Medicare) or state programs (i.e. Medicaid).
Providers must submit claims for all services rendered in order to be paid or reimbursed for the care delivered. It’s the information found on these claims that can be leveraged to understand who is treating what types of patients and how those diseases are being addressed with various interventions whether it procedures, prescriptions or any of the many combinations of possible treatments..
More specifically the information found on insurance claims can tell you:
In general physicians get reimbursed based on each of the services delivered. In contrast, facilities expect to get paid based on a bundle or grouping of the services delivered. A bundle is assigned based on the underlying diagnoses and procedures delivered. These bundles of care represent additional codes that are useful for investigating utilization and care treatment patterns. The most common codes marketers will encounter are summarized in the table below.
How can I use healthcare billing and diagnosis codes to identify providers?
By leveraging knowledge of these codes, you can build a profile of the various types of physicians or facilities you are trying to target. These healthcare codes allow you to get super granular and find the exact providers your sales team members should be talking to. It's one of those rare win-wins where your sales team is more effective and your messages will resonate more with your prospects given the laser focus your applied to your segmentation.
Check out two examples of how you may build out a physician segmentation strategy based on very specific signals of how those doctors practice medicine.
Example 1: Focus on docs who use diagnosis specific diseases AND perform a range of procedures
Example 2: Raise awareness focusing on docs who use select products while excluding certain diagnoses
Carevoyance was created to enable medical device companies to transform their commercialization strategies. Sales Ops, Marketing and Sales Reps Marketing teams become tightly coordinated and deliver more value with the most relevant data and easy to use tools to build and execute sophisticated physician campaigns.
Request a free report to understand the power of super targeted provider marketing campaigns
Many medical technology companies purchase data annually, only to use it in some perfunctory way, and then dismiss the data before the next purchasing cycle. Historical claims data can have a profound impact on your sales, marketing, operations and reimbursement - so long as this data contains the right level of detail and is licensed to be used across your entire organization. Beyond change-over-time metrics, there are myriad of ways to leverage your data purchase to extract business value.
Elusive big data ROI
We've all heard about the mythical high returns on big data projects in the enterprise, but to this day, many big data projects fall short of any return, much less the predicted ROI. There are many reasons why big data projects don't perform, and we'll address many of these in the coming months. Today, we'll talk about organizational alignment in using data effectively across the enterprise.
When I write about organizational alignment, what I am really talking about is all parts of the organization working together to achieve common goals, sharing resources and helping each other succeed. For medical technology commercialization teams, organizational alignment means sales, marketing and operations working together, using the same source of truth, to drive commercial success for their device; including measuring success appropriately for the organization (beyond units sold, looking at referral pipelines, online metrics and even new physician pipeline to judge success).
Here are a four ways that we've worked with our customers to improve their organizational alignment and leverage of data purchases to move the entire commercialization organization forward.
1. Sales enablement
Sales enablement is providing your sales team, including inside sales, field sales and key account reps, with the tools, know-how, targeting and other solutions to help them sell better. The foundation of sales enablement is to provide your sales staff with what they need to successfully engage the buyer throughout the buying process.
When your company purchases prescription, utilization or any other healthcare data, you should try to ensure that the data comes with permissive licensing so that your can use it beyond your primary use case. Ensure that your data purchase extends your capabilities, so that you can create custom presentations for each key account for your sales team, help your marketing department mine the data to come up with highly-targeted leads and even to help your sales operations team clean up your provider directory.
As you request your data, ensure that the fields you request reflect the primary and secondary goals of your purchase. If you want to clean up the provider directory, ensure you request latest billing addresses, and NPIs or other keys you can use to sync with your existing directory.
Aligning your operational data means that your forecasting, prospecting, marketing and sales activities will all come from the same source of truth, helping the entire commercialization organization drink from the same well, improving not only communication, but the outcomes.
Today, the predominant challenge for most businesses isn’t a lack of data—but choosing which numbers to focus on.
2. Internal data improvement through mining your purchased data
How is your internal data looking? If your company is like the vast majority of MedTech companies, your provider directory is out of date and your sales reps complain about using Salesforce.com to fix it. They've got a point. You're paying them to sell, not for data entry.
Luckily, your already-purchased data can be useful in fixing your provider directory and your ERP. Ensure that your vendor has a process in place to clean up physician and organization / practice addresses. This is a time-intensive and technically challenging effort that best-of-breed healthcare analytics vendors do as a matter of course -- and one that you will surely want to leverage as you begin your data cleansing efforts.
One of our customers, a major cardiovascular device manufacturer, was able to achieve a 99.2% match rate on their Salesforce.com data, and now have a process in place to keep their provider data current.
3. Engaging meaningfully with stakeholders through marketing to sales hand-off
You have a great product, and its clinical capabilities are clear. You bought data to help you learn about the right physicians to contact, based on their utilization, the types of patients they treat, and how they care for their patients. For most of us, this work is done by a handful of people inside the sales operations or marketing organization. But the value of the work should resonate throughout the entire commercialization team. Except it rarely does. Why?
Scaling a commercial execution strategy from an executive presentation to an entire team aligned on a core set of goals is as much a psychological challenge as it is an organizational one. Taking your analytics out of the ivory tower and equipping your sales team with actionable, useful and impactful sales tools that will aide them in their activities takes an entirely different set of skills and tools than the tools needed to do the analysis in the first place.
Typically, on the order of 65% of marketing content is never used by the sales team. Which means that 2/3 of the investment in this marketing content is wasted—the ROI on content that never gets used is zero.
The top organizations who succeed in growing their sales organizations focus on the hand-off between marketing and sales. What good is content if it's never used? Your marketing content should be personalized, contextual and meaningful in driving the RIGHT sales conversations. If your content is a generic brochure or product details, you're missing entirely the hook through which your sales team can get more meaningful interactions.
Our customers report that customized collateral for each prospect and target has yielded more, better conversations, and has helped them tell a more compelling story, resulting in more wins.
4. Merging multiple data sources together to surface insights
One of the biggest opportunities, and challenges, in purchasing healthcare data is merging it with other data sources to create a more comprehensive picture of the healthcare system, specifically around the utilization of treatments in your disease states.
The opportunity is obvious! What if you could take a great claims dataset, merge it with the newest physician address data, then merge it with physician affiliation linking and get a completely accurate view of the various entry-points into the thousands of hospitals and healthcare systems in the US.
Therein lies the challenge. First, these datasets are often keyed with different IDs, or sometimes with no IDs at all. Address and affiliation datasets change as practices are bought and sold, physicians move and hospitals change ownership. How do you keep on top of all of these changes, and just as importantly, how do you deliver these changes to your sales team?
Ensure, when you buy data that the discrete providers and organizations are keyed in an industry standard way -- NPIs or even CMS Provider Numbers. Ensure that your claims data contains not only the institution where a service was performed, but also the physicians who performed the service. Demand that the data you get shows all the affiliations for a given physician, and how those have changed over time. And most importantly, demand that this data is updated with each purchase.
As you can see, there are a lot of details to consider when thinking about a data purchase. Don't let an expensive asset become an anchor around your neck. Consider a data vendor that not only has the data you seek, but also a platform to deliver these capabilities to you in one package. The days of emailed CSVs are numbered. Demand more comprehensive approaches to healthcare analytics from your vendors that go beyond raw data and help you scale your marketing, sales and operations strategy to your entire organization.
Part of an ongoing series of practical tips for evolving beyond the "milkman" commercial model in medtech*
Medical device companies face significant headwinds with increased competition resulting in heightened scrutiny over price, preference and availability.
One way medical device commercial teams stand out from the competition is to prove to your healthcare providers that you are a valued business partner who understands and cares about their business… you aren't just there to drop off more inventory and provide a free lunch!
Savvy commercial teams are partnering with providers to help them sustain and grow their own practices.
Building and maintaining patient referral networks is a key driver in the growth and vitality of any healthcare provider's business. Hospitals, free-standing centers and medical practices all face intense competition in their markets to attract and retain patients. While some efforts are focused marketing directly to patients, it's important to market, educate and nurture physicians throughout the community.
Help your prospects and accounts develop a market development strategy.
The following four quadrants summarizes a useful framework to help patient marketing or physician liaison teams prioritizes relationships in their community. The matrix capaures the intersection of physician performance and fit along with relative market share of that relationship.
The physician outreach quadrant represents a new way to visualize and segment referral relationships in any given market. Using referral data from an analytics provider like Carevoyance, divide the market into different quadrants to capture different outreach strategies.
With all physician outreach, remember some of the following best practices, sourced from folks executing similar market development activities.
While it's useful to measure activities (i.e. number of meetings, etch), also measure each category's performance and ROI over time.
*Check out BCG's excellent research on the imperative for medtech commercial teams to evolve their business model.
While healthcare data is becoming more available by the day, the challenges inherent in working with these data are increasing in number and complexity. Since most available healthcare data is derived from financial reporting and accounting systems (EHRs, by design, are billing systems, and most third-party healthcare data comes from the 'switches' that connect providers with payers to facilitate payment), the data structure, field availability and ease of analysis are all skewed toward financial reporting purposes not so much toward extracting other business value
Healthcare data structure, field availability, and ease of analysis are skewed towards financial reporting purposes.
That said, it's not all bleak. As you overcome these 5 challenges to effectively using healthcare claims data, you'll start realizing the inherent value in the data. With the right team and approach, backed by quality processes and good tools, this data can be marshaled to inform marketing campaigns, align teams to sales opportunities and reach your commercialization objectives.
Here are the top 5 challenges in using healthcare data for business growth:
1. Data formats vary from source to source, and even from a single data vendor
In late 2017, CMS (Centers for Medicare & Medicaid Services) announced that their Limited Dataset files will change data format. New fields will be added, and some fields will be changed. CMS is now on version K of their data dictionary, meaning this is the 11th iteration of the data format! These data changes are small individually, but compound quickly, once you take into account the number of affected data sources and downstream processes.
At Carevoyance, we keep up with data availability changes, new datasets and updates to existing data sources, and have automated systems to intake, process and normalize this data, delivering standard data views across all available sources. It's literally our job to make sure that you don't have to think about how versions K & J of the Inpatient LDS data consolidate!
2. There are many ontologies that are inherent in the data, and keeping them up to date is painful
An ontology is a description of the concepts and relationships that can exist in the data. In healthcare there are at least a dozen different ontologies that describe diagnoses (ICD9 and ICD10), procedures performed (CPT, ICD9 and ICD10, APC, DRG), provider specialties (NUCC Taxonomies) and many others. These ontologies change at least annually, and sometimes are replaced by altogether different sets of codes (in October 2015, ICD9 was replaced by ICD10, an entirely new and completely incompatible set of codes). Keeping up with ontology changes, and mapping the various ontologies in each data source is time consuming and error prone.
We built a data engine with healthcare in mind. Our analytics & search engines, import pipelines and all other data and application tools are ontology aware, and we keep up on the changing landscape of ontologies, mapping specific versions of ontologies to when the data was created. Our built-in support for ontologies means that you don't have to continually update your processes as these ontologies change.
Upward of 75k physicians changed employment from private practice to employed between 2014 and 2016. Keep track of these physicians.
3. Physicians change employment regularly, facilities change ownership and that's not in the data
Billing and claims data, by definition, is taken at a moment in time. A physician who practiced at The Toledo Hospital in 2016 may have gone to Henry Ford Hospital in 2017. If you rely on your claims data to tell you where physicians are, your sales efforts will suffer, as your field sales reps will be knocking on wrong doors. According to a recent AMA study, physician practice ownership dipped to 47.1%, down from 53.2%. in 2014. That means that upward of 75k physicians changed employment status between 2014 and 2016.
In order to help our customers maintain their own provider directories, we built what we refer to as our SingleSource DB, our own provider directory, that contains data on over 1.2 million physicians in the US. For SingleSource DB we source physician and facility data from state, federal and non-government sources. Once that data is sourced, the hard work of consolidating that data starts. As you can imagine, each state and federal agency has their own identifiers for each physician and facility, so keeping them in sync is a major function of our system. Once the data is co-mingled, now comes the work of standardizing schema and data elements between more than 50 disparate data sources. Not to bore you with details, but keeping a consistent provider directory is at least 2 FTEs a year.
We help our customers clean up their provider directories by connecting their systems of record (Salesforce, SAP, other CRMs and ERP systems) to the SingleSource DB, so that whenever a change appears for any current or target physician in Carevoyance, that change is propagated to our customers' systems of record, automatically.
Maintaining an up-to-date provider directory for a medical technology company takes is at least 2 FTEs a year.
4. Keeping up with location data, and attributing location to physicians and facilities is a huge effort
Once you have your provider data all configured, you still have to find affiliations between providers and their facilities, have to find locations of their practices, assign these locations to cities, counties, states, Hospital Referral Regions, MSAs, and ensure that as physicians move, that location data stays consistent.
Did you know that USPS does not maintain an up-to-date list of ZIP codes, and where those ZIP codes actually are in the world? What about matching Census data to ZIP code data, so you could use the fantastic wealth of information that Census collects to understand the healthcare market. What about using publicly available research, based on Hospital Referral Regions and Hospital Service Areas to align your salesforce to the opportunity? You must have a solid provider directory in place before you even begin to think about location data.
We maintain our own in-house data system that's expressly designed to keep up-to-date location and other geospatial data. This system serves as our system of record for geospatial zip code data, census and healthcare-specific locations. Using this system, we can precisely geotag physicians, practices and facilities, and run all manner of location-based aggregations on this data. We call it geo-spatial intelligence.
Our hope is by using Carevoyance, our customers can focus on the business value of data, instead of the operational and capital cost of maintaining it.
5. Automating processes to keep up with data updates, changes and new data
Once you have an up-to-date provider directory, location data, claims data warehouse ontology mappings from data to real-world concepts, everything suddenly changes. Maybe a new dataset comes out, or maybe an ontology changes versions, or something mundane, like physician data updates or ZIP code updates, and all your data janitorial work now is obsolete, and needs to be updated, or worse, re-done. This is one of the leading causes of data frustration in medical technology businesses. The data work is never done, and it only gets more difficult, more detail-oriented and has to be done at a faster rate. In order to get these challenges under control, automated systems must be in place, and no system can be bottlenecked by an individual.
We've been building data systems for decades. Our founders come from technical backgrounds, building data-driven healthcare products and high-availability, low latency networking hardware. Performance, as applied to healthcare, is in our blood. That's why we built Carevoyance; we saw a clear need to maintain these systems of record for all the medical technology companies that are downing in data, spend hundreds of thousands annually on efforts that are not scalable, not repeatable and that don't have longevity. Our hope is by using Carevoyance, our customers can focus on the business value of data, instead of the operational and capital cost of maintaining it.
If you think you have a business challenge that we can solve with our industry-leading data platform, please reach out and say hello!
Research and plan
Depending on your relationship with their hospital and their access, you may be able to leverage the hospital's own data. Alternatively leverage public claims files to approximate the following attributes to inform the market development strategy.
Define competitive advantage
When you approach the market you need to be confident that a product or service you are offering that is of interest to prospective referring physicians.
Get commitment from internal stakeholders
The big question here is to consider who is going to get the word out and approach the referral sources. Building awareness in a market requires a commitment across departments to not only win new referral relationship but to keep and grow those referrals.
Consistency is key in building and sustaining the relationship. The hospital should be willing to assign dedicated field representatives to serve as a consistent resources when developing new business. This person will book meetings and build the relationship alongside physician liaisons. As new relationships develop, you'll want to ensure the referring provider has a responsive point of contact who can provide feedback on results, ensure patient outcomes are communicated and help resolve any care coordination issues.
Carevoyance offers a set of tools to enable commercial teams to identify, engage and convert the right physicians and facilities. Our data and analytics is the driver of many effective market development programs. Reach out to discuss how we can help you partner with your hospital clients or prospects.
We've all seen the billboards, lining the highways in our cities, advertising the wait times in the ER. A not so subtle reminder that (potentially) expedient service is available during your next medical emergency.
Hospitals and health system often try to extend the success they have had with driving a message to consumers to advertise their other specialty service lines... robotic surgery, colonoscopies, cardiovascular care, join replacement. While hospitals may be targeting to potential patients, they are equally trying to reinforce a message to community doctors who may refer patients to their facilities and specialists for advanced care.
But is billboard advertising the way to go given the costs and benefits? Yearly costs for the billboard are $10,000-$15,000 per billboard in a mid-sized city. Not to mention thousands of dollars in design and materials for each billboard. This type of advertising is notoriously hard to measure efficacy. How many new customers did the hospital draw in due to the outreach?
Imagine a more targeted, intelligent and focused approach to marketing to physicians. Other types of advertisers and marekters have access
1. Target the right doctors. Leverage utilization data to focus on physicians with the appropriate patient population.
2. Prioritize outreach based on pre-existing relationships, affiliations, geography or a host of other factors.
3. Leverage existing sales networks. Match up your sales reps based on territory or experience with accounts.
4. Design your content. Create engaging information to share with your prospects to build rapport and establish a relationship.
5. Measure outcomes. Select metrics that signal engagement so you know whether