CareSet Target: Outpatient Therapy Volumes Case Study

Goal: Align sales and marketing resources by identifying the right populations and healthcare providers

Scope: Generate a list of sub-specialist physicians servicing patients with buy & bill medications.  For each physician, detail their panel, inbound flow of referrals, and Brand preferences.  Using 6 years of 100% Medicare outpatient claims, select claims for three Brand therapies.   Therapies 1, 2 and 3 are defined using a combination of HCPCS billing and ICD diagnosis codes.  Search across all Medicare claims, across all settings and sites (ambulatory surgical centers, infusion center, hospital outpatient departments, and private practice/office) where the physician performs administrations.


  • CareSet expanded HCP Targets by 15% with improved 100% Medicare claims coverage nationwide
  • Identified non-traditional specialty HCP’s with relevant populations
  • Claims capture allowed an accurate decile segmentation based on product utilization
  • First time the client had HCP-patient panels segmented by age of diagnosis

Example Comparison of two Physicians:

target therapies

target patient panel size graphic





On left, HCP-level product use along with patient counts for administrations referred and performed.  On the right, we see “patient counts over time” showing Physician B’s practice is growing while Physician A’s patient counts slow.  Remember, these are patient counts of all their Medicare fee-for-service patients!  The improved detail in physician profiles enabled precise segmentation of the physician audience.

15% More Prescribers with better detail:


In the table with Physician A-E, we see Physician A saw 4,518 patients between 2010-2015.  Of those, 26 indicated patients received therapy administered by this physician, yet 848 patients have 3+ year old diagnosis, and 223 are newly diagnosed.  This provider is likely referring the treatments to a partner who we also identify.  Provider B and C receive those referrals and administer one of the specialized medicines in the market basket 485 and 1,534 times in the same 6 year period.

Find populations in need through advancing analytics.  Improve physician relations with better and timely insights.

Ashish Patel

Ashish is co-founder of CareSet Systems. An entrepreneur and healthcare data transparency advocate, Ashish also founded the DocGraph Journal, bringing together the Healthcare Data Science community along with Politico and ProPublica to publish data sets for scientific advancement. Ashish is currently working to decode Medicare Claims data for Pharmaceutical companies, helping analyze provider teaming, and building robust networks.