Products & Technology

Harvesting HME Claims and Patient Data

How providers can cultivate new markets, grow their business, and provide better service by tapping into claims and patient data.

plant growingIf marketing is the seed that helps you grow and keep customers, then data is the rich soil that helps grow and cultivate those markets.

With a light-speed increase in the sophistication of technology, the ability to connect and measure digitally, and the digital footprint left behind at the scene of a sale, data has never been so important for growing your business.

The practice of collecting and mining data to support a marketing strategy is typically called data-driven marketing. And although data mining may be commonplace in many businesses, there is plenty of room for improvement. According to CMO, a digital publication from Adobe:

  • 78 percent of marketers say their data-driven marketing is either embedded or strategic
  • 64 percent of marketing executives strongly agree that data-driven marketing is crucial to success
  • 87 percent of marketers consider data their organization’s most underutilized asset


In part, caps, cuts and competitive bidding have pushed HME providers out of their comfort zone and into the wild west of consumer marketing. This game changer forces providers to compete with retail heavyweights, such as Walmart and Walgreens, in-store and online. A recent Forbes article reported that Walmart is in the process of building the world’s biggest private cloud, where it will process 2.5 petabytes of data every hour. “Over 200 streams of internal and external data, including 40 petabytes of recent transactional data, can be modeled, manipulated and visualized,” the article states. To give you an idea of scale, one petabyte equals 1 million gigabytes.

But with that said, it’s about the journey. And the initial steps of introducing even the most basic data collection into a business can produce very good outcomes.

“Patient and claims data is heavily underutilized today,” says Shaw Rietkerk, executive vice president and general manager at Brightree, when asked about HME providers’ business use of data. “Many providers are missing out on valuable information from their operations. Digging into their data can reveal greater visibility into their business to show which areas are performing well and which are not that should be targeted to enhance marketing strategies.

“Included in this data mining strategy is the ability to identify key referral sources,” he continues. “Providers can determine this by looking at data, such as referral volume, how complete the referrals are from a documentation perspective and the amount of the reimbursements. By analyzing such data, providers get a better understanding of their market, who to engage for their marketing strategies and what areas to track for future marketing opportunities.”

According to Wayne Bailey, director of client services of Bonafide Management Services, a look back at the classic four P’s of marketing (product, price, promotion and place) helps point to where providers stand today.

“Most small business owners look at promotion when they get into trouble,” he says. “But the main issue providers need to notice is price. The only room for growth today is maximizing margins, which requires advanced software tracking systems that tie every single item sold directly back to the inventory and making business decisions based on the hard data. I would say that most providers are missing stellar marketing opportunities by not taking advantage of these systems.”

As an example, Bailey pointed out that incontinence products have very low margins, which means all marketing efforts should be focused on Medicaid contracts, where there is the most potential for profits.

“You can only take advantage of this opportunity if you have advanced software systems that help you manage your warehouses and move a high quantity of product efficiently,” he says. “Higher margin items like CPAP or CPAP resupply can be highly profitable, but only if you have the data available to tell you what you are actually stocking and selling. Otherwise, you’re just shooting in the dark, and wasting significant opportunities as a result.”

Lisa Anderson specializes in education and outreach for Universal Software Solutions Inc. She has managed large DME retail stores as well as worked as a DME biller. She says her initial reaction to questions about using patient and claims data for marketing felt like “an ethical betrayal — like we would be dropping the last layer of protection for this vulnerable population if we start targeting them by combing through patient records.”

However, Anderson says she now realizes that data-driven marketing is not different from what is already happening in every other retail market.

“Maybe my initial reaction was the clinician in me reacting from a benevolent place, rather than a savvy retailer,” she explains. “Many of us are still learning that the market has changed, and our thinking has to as well.”

According to Anderson, she has come across estimates stating that over 30 percent of DME revenues will come from non-insurance sales by 2020.

“Providers are beginning to utilize patient and claim data more effectively, but many are still missing opportunities to provide additional products that can enhance the patient experience and maximize business with key referral sources,” says Ryan Ball, director of VGM Market Data. “Many providers have been conditioned over the years to fear direct-to-patient marketing efforts due to Medicare supplier standards, but there is a captive audience waiting to be tapped into. Identifying and focusing sales and marketing efforts on key referral sources is also key to finding new growth opportunities.”


According to Doug Iversen, sales and marketing director for Computers Unlimited/TIMS Software, keeping an eye on the delta between actual product sales and the reimbursement amount is the data that has the most potential for margin growth.

“Patients, like consumers, are generally willing to pay for incremental value,” he notes. “Identify, then stratify, the customers who are willing to spend more than the claim will pay. Quickly identifying the type of consumer who will pay for enhanced products and services will be key because if you don’t offer choices or what they expect, they can go somewhere else quickly.”

Ball says that successful data marketing is based on knowing customers’ preferred mode of communication and specific patient contact information, such as email, phone and address, and patient demographic information, such as date of birth and last date of purchase.

“This should all be part of the patient intake process,” he explains. “As long as you have provided a Medicare-approved product to the patient within the last 18 months, you can freely communicate with that patient about additional products; however, obtaining a specific release from the patient is also a good idea.”

Ball also contends that providers should be tracking their key referral sources, volume trending year over year, and new referral sources captured.

Anderson said providers must tap into the data that is likely already being captured in the providers’ DME software if using a point of sale system along with insurance billing:

  • Like any retailer, DME retailers should identify their top 10 best cash sellers and their top 10 luxury sellers.
  • They should know the insurance items that spike based on the season, know their related cash sale upsells, and know their cash-based upgrade options.
  • They should be aware of what product lines do best in the geographic area where their stores are located.
  • They should understand the age distribution of their patients, as well as the level of insurance coverage for those groups.

“Top 10 best cash sellers should be well stocked, prominently placed, well trained for all employees, and suggested during transactions where they would enhance the experience of the customer,” she says. “The Top 10 luxury sellers are the products that should be unwrapped and accessible on the sales floors, assembled and charged and ready for demo. These luxury items are things that other providers may not carry, often come with beautiful free advertising pieces from the manufacturers, and can set your showrooms apart from the small DME sections in your local pharmacies and grocery stores.

“Just like a retail shopper, DME customers are in your store because they need something,” she continues. “They aren’t just browsing. As more boomers enter our arena, we see that customers are willing to come out of pocket for quality merchandise. We have to be ready to give them the hands on demo that Amazon can’t, and we can’t be shy about it.”

Anderson also suggests taking advantage of a dual marketing campaign with your manufacturers and distributors.

Another strategy to create marketing opportunities is to focus on specific outcome-based data that is compelling to your audience and then determine how best to communicate that information.

“Providers who include outcomes-based data in their marketing campaigns can have a receptive audience in referral sources,” Rietkerk says. “Many referral sources not only like to see such data from providers — they are swayed by that data to use one provider over another. The same is true of patients who look for recommended products or services to improve their health.”

For example, if you work in sleep therapy, it can be beneficial to use data that shows patient compliance, positive reimbursement, complete documentation, your ability to deliver products to your patients quickly, and patient satisfaction documented through scores or survey, because these areas weigh heavily with your audience, he explains. If your data shows positive patient outcomes, that information should be reflected in your marketing strategy as it may lead to attracting more patients.

“How you execute marketing campaigns using this data is nearly as important,” he continues. “Once you identify your target audience, you must determine the most effective ways to reach them. There are a variety of communication channels, such as email, print, phone and face-to-face, which can be the best options to broaden your reach and increase your odds of a successful marketing campaign.”

According to Christina Throndson, director of business development at VGM Forbin, the data that providers collect should have a plan associated to it.

“If we’re supplied with the user’s email address, this should be implemented into our plan,” she says. “The provider plans will be tailored based on what audience you’re speaking to.

“For example, you will want to segment the sleep apnea patients from the mobility patients,” she continues. “The plan should take into consideration the best form of contact for this group. Most of these users engage with the following mediums: email, patient portals/websites and social media. In this example, as a provider, we will want to use those mediums to build a post-sale customer journey that will include the different forms of communication with common behavior the provider has identified as a trend.”

Throndson said the marketing path may include:

  • Email marketing.
  • Social media advertising on platforms such as Facebook and Youtube.
  • Providing valuable information to the user’s needs (for example, how to clean your CPAP with a call out to a CPAP cleaner).
  • Remarketing advertising (not available on mediums such as Google AdWords for prescription products).
  • Search engine advertising to those users who are on related sites or searches.

“You want a plan that makes sense for your users based on what they want and need, keeping in mind ‘what’s in it for them,’” she notes. “If those users don’t see a benefit, it’s not of value to you. You need to catch them in their moment of interest or drive the interest with content that is found to be of great value.”

Throndson also points out that in the process, providers will want to test and pay attention to what works and what doesn’t. While building a plan or path, do not lose track of a realistic goal in the form of measurement that will display success. Providers would love to have thousands of dollars in sales, leads, etc., but you’ll need to stay logical; it may take a month or two for you to form a benchmark to see what those expectations will be before you can set a realistic goal.

“When those measurements are completed via a call, online visit, etc., make sure you have tracking attached to those measurements without having to ask, ‘How did you hear about us?’” she says. “It’s 2018. Most realistic call to actions will have a trackable measurement associated with them. This will require proper setup of campaign-specific landing pages, phone numbers, analytics, etc. And most importantly, they will have to be monitored. Make sure you are watching what works and what doesn’t to know what needs to be adjusted to grow your success.”


As consumers, Anderson pointed out that we’ve become used to probative questions at check out, but in the DME world, providers must be cautious collecting data from patients during a retail transaction.

“What we do is often very personal and private for our customers, and at the end of that transaction the last thing we want is for them to feel like we are willing to violate their privacy to make a buck,” she says.

Anderson suggested that providers collect:

  • Email addresses and text alert permission: Do you want to be reminded of appointments, refills, and documentation needs?
  • When do they like to be contacted? How do they like to be contacted?
  • How would they like to handle repeat business? Do they like coming in or would they rather order via phone, email or text? Do they need reminders when supplies get low?

Finally, there is a lot of data collection precedent so even if you are just starting out, there are many sources to tap for further understanding.
“Walmart knows the ROI on every single item they sell,” Bailey says. “They know the floor space cost not only of the floor but the space on the shelf. The ROI drives all their decisions on what to sell, where to display, etc. Grocery stores, drugstores, and Amazon all know these things as well. They collect personal data in various ways.

“The important thing is that DME providers must recognize that they must stay up to date with these methods of data collection, or they will fall behind and be trampled by retailers who understand the importance of data-driven decisions,” he says. “This is a paradigm shift. The models exist. The software exists. Providers just need to jump on board.”

This article originally appeared in the February 2018 issue of HME Business.

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