How to optimize your sales outreach efforts by analyzing claims data

Healthcare sales teams already know the challenges of long buying cycles and complex ecosystems. What separates top performers is not whether they use data—but how they apply it. Claims data, in particular, has become indispensable for targeting the right prospects in the healthcare space, sizing markets, and outmaneuvering competitors.

Below, we explore ways to leverage claims data, with examples of how Definitive Healthcare’s Atlas All-Payor Claims can accelerate precision targeting and help teams turn data into measurable growth.

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. 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 support this in several ways:

• Physician prioritization: Who is performing the highest volume of relevant procedures? Which providers are showing growth trends that suggest early adoption?
• Facility patterns: Which hospitals or clinics have historically embraced new interventions? Which remain slow adopters?
• Referral networks: Which physicians are at the center of patient flow and can influence broader adoption?

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.

In practice, this is where Definitive Healthcare’s Atlas All-Payer Claims data becomes invaluable. With filters for diagnosis, procedure, geography, physician specialty, and more, sales teams can move from high-level TAM estimates to actionable prospect lists—for instance, identifying interventional cardiologists performing high volumes of TAVR procedures within targeted regions.

3. 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.

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. Three common applications include:

1. Market share tracking: Compare claims volumes associated with your therapy against competing products across regions and specialties.
2. Physician champion identification: Identify providers who are consistently prescribing or performing procedures linked to a competitor’s product. These physicians may be harder to win over—or prime candidates for targeted education.
3. White space discovery: Detect regions or practice settings where competitor presence is low, signaling untapped opportunity.

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

In the healthcare market, insights are the differentiator between reactive and strategic teams. Claims data provides a granular view of patient journeys, treatment patterns, and provider behaviors, enabling teams to precisely target high-value opportunities and build smarter engagement strategies. In a landscape defined by complexity and change, the right data transforms uncertainty into a strategic advantage.

Ready to see how claims intelligence can sharpen your outreach? Start your free trial of Definitive Healthcare and explore the data firsthand.