The Definitive Approach to Healthcare Sales - 101: Codifying the Patient Journey

The ABC’s on DRGs, CPTs, HCPCS, and ICD-10s

A playbook for selling to healthcare providers has some of the same chapters you’d see in any B2B sales playbook. Total addressable market defined? Territories built? Check, and check. The similarities go on.

But still, a sales playbook can’t just be lifted from one sector to another - and this is particularly true in healthcare. In healthcare, the substance behind a data-driven strategy isn’t just hospital demographics and physician specialties (though those are important). Instead, it’s the data that captures the patient journey that drives it all.

That’s captured in claims data – a powerful resource that enables data-driven firms to segment their markets, identify targets, build sales territories, and price products. So why aren’t more people taking advantage? For one, there’s many types of codes (DRGs, CPTs, HCPCS, ICD-10s, the list goes on) and it very quickly starts to feel like an alphabet soup. It’s challenging to know where to start and how to interpret it all.

In this webinar, we’ll help sales, marketers, and other go-to-market planners understand the patient data that influences provider decisions, exploring what the data is and from where it is derived, what insights it enables, and how those insights transform into good commercial decisions, including:               

    • The codes, terms, and language combinations that capture patient journeys and make up the backbone of healthcare data

    • What’s included in medical claims and payor data

    • How to use claims to analyze patients’ records

    • How to apply patient data trends and patterns to differentiate from your competitors

About the Presenters

Casey Eastlack, Senior Data Analyst Manager

Casey Eastlack Headshot

Casey leads a Definitive team of client-facing data analysts. The team takes a consultative approach to data science that prioritizes collaboration and customer success and results in custom reports that deliver actionable and specific insights into healthcare facilities and patients. Before joining Definitive, Casey consulted with Fortune 100 clients as an analyst at MaPS/Millward Brown. She holds a Bachelor of Science (BS) from Boston College.




Ashley Berube, Data Analyst Manager


Ashley brings over six years of experience from the healthcare data and analytics field to her position as a Data Analyst Manager at Definitive Healthcare. She leads a team of client-facing data analysts to deliver on providing actionable insights in custom reports. Before joining Definitive, Ashley was a Senior Decision Support Analyst at HopeHealth. She holds an MBA from Bryant University and a Bachelor of Arts (BA) from Providence College. Ashley is the chair of WE@DHC, the Women’s Empowerment Affinity Group at Definitive Healthcare.

Watch The Replay!

Get a sneak peek into the webinar! Read a preview of the transcript below:

Casey Eastlack (00:01):
Hi everyone, my name is Casey Eastlack.

Ashley Berube (00:04):
And, my name is Ashley Berube.

Casey Eastlack (00:06):
And today we’re going to be talking about codifying the patient journey. But before we start, I have a couple of housekeeping items I wanted cover. So this webinar is being recorded and will be sent out to all registrants. The console is fully customizable so you can kind of drag and drop boxes as you see fit or maximize different windows. We will have a Q&A window, so if you have any questions, feel free to drop them in there. And there will be two survey questions on the console. Please be sure to fill them out before we finish and then we really appreciate your feedback on that. But now, I’ll kind of get started in talking about our webinar.

So in terms of agenda items, we’re first going to talk about types of insurance programs, then we’ll dive deep into the different types of clinical codes. And then we’ll talk about how to find the right clinical code for your use case. Common provider types that are in our data. Examples of reports that we can build based on our claims and our patient data. And then what Definitive has for coverage.

So we’ll first to start out about talking about the different types of US insurance programs. So the first one is Medicare. This is a federal program that’s available to those who are 65-plus, disabled or ESRD, so end stage renal disease. There are four parts to Medicare plus Medigap that’s available, which I’ll cover in a second.

First, we have part A. That is mainly inpatient care, so that covers hospital, sniff care and hospice and [inaudible 00:01:29] care. We also have part B, so that is outpatient, so that covers any durable medical equipment, HHA care. It also covers preventative services like screenings, shots, vaccines, and annual wellness visits.

We also have Medicare Advantage or part C. So this one’s actually offered by private companies. It allows folks to bundle their Medicare plan together so you can bundle your part A, B, and D together for lower cost, in general. It also allows for kind of extra coverage for things like vision, hearing and dental insurance.

And lastly is part D or prescription drug coverage. So this is also run by private insurance companies and it helps cover the costs for prescriptions and can sometimes include vaccinations. And then Medigap, which I talked about earlier, is supplemental insurance that can be purchased to help cover expenses such as copays, co-insurance and deductibles. So the Medicare also has an annual enrollment period, so this year it actually runs from October 15th through December 7th… .