Bringing a new product or service to the healthcare market is rarely as simple as identifying a need and finding organizations willing to buy. After all, the healthcare landscape is vast, fragmented, and constantly changing, thanks to everything from economic disruption and new technologies to how patient populations vary across regions.
This uncertainty means clear visibility into the healthcare market is absolutely critical. Before you launch a new product or expand into a new territory, you need to understand where demand exists, who the biggest competitors are, and how your business can differentiate itself and get into the hands of the patients or providers that need it.
One way to bring that picture into focus? Medical claims data.
Claims capture detailed information about diagnoses, procedures, providers, facilities, and other healthcare activities. These signals are valuable puzzle pieces you can use to find opportunities, prioritize prospects, and build more informed go-to-market (GTM) strategies.
Watch our webinar "Demystifying Claims," with Solutions Engineering Director Aaron Cohen for an in-depth discussion of claims data or read on for highlights from the webinar and tips for developing more effective GTM strategies.
What are medical claims?
At its most basic level, a medical claim is a bill submitted by a healthcare provider to an insurance company or other payor for reimbursement. Each claim contains standardized codes describing the care delivered during a patient encounter, including diagnoses, procedures, devices, pharmaceuticals, and other billable services.
But treating claims as nothing more than billing records overlooks what makes them so valuable for commercial strategy.
Collectively, medical claims are signals of real healthcare activity. Aaron Cohen says claims data can help answer some of the most important questions about a market:
- Who is delivering care? Provider identifiers can help connect activity to individual clinicians, facilities, and organizations.
- What care is being delivered? Procedure and billing codes show the services, treatments, supplies, or other billable activities associated with an encounter.
- Why is care being delivered? Diagnosis codes provide insight into the conditions and patient populations driving healthcare utilization.
- Where is care happening? Place-of-service and facility information can reveal whether activity is taking place in hospitals, physician offices, ambulatory settings, or other sites of care.
- When is care happening? Dates of service make it possible to analyze changes in healthcare activity over time.
Definitive Healthcare draws upon claims from multiple sources, including the Centers for Medicare and Medicaid Services (CMS) standard analytic files, which provides information on services rendered to Medicare beneficiaries at facilities like hospitals and nursing homes.
Claims alone, however, don't always provide the complete picture. A list of procedures can tell you that activity is happening, but it may not tell you how the providers delivering that care are connected, who owns a facility, which health system influences purchasing decisions, or which organizations represent distinct opportunities. As Aaron puts it:
"The real power of claims data comes when you marry it to reference data. That way, you can link how patients are moving through healthcare and the type of activity they're experiencing with organizations and providers to get as complete a picture as you can find."
That’s why we created the Atlas Dataset. Our solutions combine Medicare claims data with medical and prescription claims we’ve collected from thousands of public, private, and proprietary sources, giving leaders access to billions of de-identified claims spanning the healthcare industry. But the Atlas Dataset delivers even more insights by layering in reference and affiliation data and other intelligence. That additional context can turn individual records of care into a clearer picture of the relationships, behaviors, and trends shaping a market.
Using claims to understand your total addressable market (TAM)
Determining the size of your opportunity is one of the most important questions you need to answer during the early stages of GTM strategy development. Medical claims data can help you find your TAM by giving you insight into the diagnoses, procedures, and utilization patterns associated with your solution.
In Definitive Healthcare’s View Product Suite, claims can be searched using elements such as diagnosis, procedure, billing, physician, geography, and place of service to understand activity across the market.
For a software company, that might mean looking at organizations managing high volumes of a particular patient population or procedure. A staffing company could examine which markets are experiencing growing activity in specialties that require hard-to-fill clinical roles. Or a medical supplier might evaluate procedure volumes across different facilities or sites of care.
These numbers serve as good starting estimates for determining your TAM, but you may want to narrow down your focus, segment your target market, or leverage estimations to account for known missingness in the data. Fortunately, our solutions feature powerful filtering tools, so you can create audience segments based on facility type and size, provider specialty, geographic location, and more.
For a deeper dive, read our guide to calculating your total addressable market.
Find and prioritize the right providers
Of course, knowing that demand exists is only the beginning. Your GTM teams still need to determine where that demand is concentrated, and which organizations deserve their attention.
Within the View Product Suite, you can use the same customized search and filtering criteria you used to find your TAM to also generate a list of providers and facilities tailored to your solutions needs. Depending on your goals, you might identify organizations based on patient populations, practitioner specialties, procedure volumes, technology installations, or other signals of potential need.
Every facility has a comprehensive profile offering valuable insights at-a-glance. You can review financial performance, HCAHPS scores and quality information, clinical metrics like average length of stay or readmission rate, common therapy areas, affiliated organizations within the facility’s network, technology installations, a list of executive contacts, and so much more.
Together, these insights can help you move beyond a broad list of potential buyers and prioritize the accounts that best match your ideal customer profile, market strategy, and value proposition.
Additionally, the referral overview gives you a detailed breakdown of other referring physicians within a given provider’s market. This not only helps you identify related physicians within the same network or geographic area but also helps you trace referral patterns throughout a certain area, potentially expanding the reach of your sales engagement opportunities.
Turn healthcare activity into market intelligence
A successful GTM strategy depends on having clarity and context into the market you’re entering. Medical claims enhance that strategy with a solid, data-driven foundation. They show where healthcare activity is happening, who is delivering care, which patient needs are driving utilization, and how those patterns are changing.
For a deeper introduction to medical claims and how to leverage claims data in Definitive Healthcare’s solutions, check out our webinar “Demystifying Claims.” The webinar discusses how organizations can apply claims data to market sizing, segmentation, targeting, competitive analysis, and more. Anyone who operates within healthcare can benefit from understanding claims data.
While claims data are a good way to see healthcare activity, you can extract even more value from your data by combining your insights with reference and affiliations data. This gives you even deeper visibility into how healthcare professionals and organizations are connected across the industry. You’ll be able to understand the relationships, operational interactions, and trends between providers and practitioners.
Ready to see how claims data can sharpen your go-to-market strategy? Book a demo with Definitive Healthcare.
You might also be interested in...
