Claims-Based Predictive Targeting Marketing Implementation

A specialty point-of-care healthcare organization serving 6M members across 365 clients historically operated with a one-size-fits-all marketing model. Outreach was broad and undifferentiated, with no claims-based targeting or predictive intelligence.

Becky was brought in as Consultant – Program Lead to design and launch a net-new, claims-based predictive targeting program capable of identifying members likely to undergo surgery and reaching them at the right stage of their journey. The program launched in May 2024 with a single client (11K members) and has since expanded to 2M eligible lives, with approximately 550K members actively tagged for surgical marketing campaigns.

Design and operationalize a predictive, claims-driven marketing engine that could:

• Identify members likely to pursue surgery using predictive claims modeling.
• Predict proximity to surgery and probable procedure category.
• Deliver automated, compliant outreach across email and print.
• Measure lift across engagement, consult, and surgery conversion rates.

The program required cross-functional orchestration across marketing, product, engineering, analytics, legal, customer success, and external data partners.

Healthcare claims data is difficult to operationalize. It is often stale, fragmented, and constrained by privacy and compliance requirements. To make the model viable, claims data had to be refreshed weekly and contractually authorized for marketing use.

Clients were required to grant autonomy for standardized messaging with zero customization — an uncommon arrangement in healthcare. Messaging had to avoid sounding invasive while protecting PHI. The entire system had to be automated end-to-end to prevent significant headcount expansion.

The initiative required alignment across eight internal teams, an executive steering committee, and an external data partner. This was an operating model shift, not a campaign launch.

Becky designed and led the program end-to-end, beginning with executive alignment on the business case for claims-based targeting and defining the governance structure required to support it. She established the executive steering model, communication cadence, and decision rights necessary to move quickly in a regulated environment. She partnered with Product and Analytics to determine which surgical categories to prioritize based on revenue models, procedure timelines, and operational readiness. Working directly with data scientists, she helped shape the predictive framework that identified likelihood of surgery, proximity to surgery, and probable procedure type. Becky developed the client selection and rating matrix to identify pilot candidates and future rollout targets. She led negotiations around contract addendums granting authority to use claims data and standardized messaging—an uncommon level of autonomy in a healthcare setting.

On the operational side, she designed the full campaign architecture: defining cadences for each surgical path, overseeing content strategy for email and print, and ensuring messaging balanced relevance with privacy sensitivity. She coordinated engineering and an external data partner to build a scalable ingestion pipeline, tagging framework, and automation layer capable of weekly refresh without additional headcount.

The result was a data-partner-agnostic system designed for scale, capable of onboarding new clients and data sources without re-architecting the model.

Using matched comparison clients to control for pre-program engagement levels, the lift analysis demonstrated:

• +44.5% engagement rate lift vs. non-TMO clients
• +22.0% consult conversion lift
• +17.0% full-funnel surgery conversion lift

The program delivered a 2.4% revenue lift.

What began as a single-client pilot is now a scalable predictive marketing engine serving millions of eligible members. The program remains operational in largely its original structure, demonstrating durability and sustained business impact.