Provider Target List — Concept Review

00 Persona Context Who is using this screen and how ▼

Tracks
eCKM + CKM

Ops Model
Hybrid

GTM
Device-led (B2B2C)

Storyline
"Fill the RPM Gap"

Company Profile (Research)

Company

Withings Medical Group

Medical entity of Withings (French health-tech, ~$100M+ rev). Makes FDA-cleared connected devices: BPM, scales, ECG, sleep trackers.

Core Product	Connected blood pressure cuffs (BPM Connect/Pro), Body smart scales, ScanWatch ECG. RPM-ready with clinical dashboard.
Clinical Workforce	Minimal own clinical staff. Partners with provider practices who prescribe devices and bill RPM.
Revenue Model	Device sales + RPM platform SaaS. Provider bills CPT 99453-99458; Withings earns device margin + platform PMPM.
Medicare History	Devices used in RPM programs. ACCESS Model is new territory — applying as eCKM/CKM participant.

1Access Segmentation

Segment	A Consumer Growth Brand
Mindset	Growth-first Marketer
Friction Point	Has consumer device distribution but no Medicare provider network. Provider adoption IS the go-to-market.

Target List Strategy

Withings needs to find providers who see large hypertension/CKD patient populations and have no existing RPM billing. These providers have patients who need monitoring but haven't adopted any RPM solution — Withings devices fill that gap.

ACO participation is a bonus signal: ACOs have quality incentives that RPM supports, making the business case easier for the provider.

High concentration % matters — a provider whose practice is 40% hypertension will care about an eCKM/RPM solution far more than one at 5%.

The Opportunity Signal

Providers with high target bene counts and zero RPM billing are the highest-value targets. They have the patients, the clinical need, and no incumbent vendor. Withings just needs to show up with devices and a billing-ready platform.

How They'd Use This Screen

Filter: Specialty = Internal Medicine, Family Practice, Cardiology. RPM = 0.
Sort: Target Benes descending.
Revenue input: $360/yr (eCKM rate).
Export: Top 50 providers → hand to sales team for outreach.

Tracks
eCKM + CKM

Ops Model
Hybrid

GTM
Provider Network

Storyline
"Scale Through Partners"

Company Profile (Research)

Company

Story Health Partners

Virtual care management platform for cardiology and CKD. Already delivers CCM/RPM programs — needs to scale patient volume.

Core Product	Virtual cardiology care management platform. RN/NP-staffed clinical team handles CCM, RPM monitoring, and medication management.
Clinical Workforce	Employed clinical team (RNs, NPs, pharmacists). Can staff up — needs patient volume to justify it.
Revenue Model	Shared savings with provider partners or direct CCM/RPM billing. ACCESS adds track-based PMPM revenue.
Medicare History	Active CCM/RPM billing through partner providers. ACCESS Model would add a new revenue stream on the same patient base.

Target List Strategy

Story Health has the clinical infrastructure but not enough provider partners feeding patients into their programs. They need to find high-volume providers who are already oriented toward care management — existing CCM billing signals compatibility.

ACO participation is critical: ACOs have shared savings incentives that align perfectly with Story Health's model. They want to become the care management arm for ACO-participating practices.

The Partnership Signal

Providers already billing CCM with high patient volumes in ACOs = ideal partners. They understand care management, have infrastructure, and are incentivized to improve outcomes. Story Health plugs in as their virtual care management vendor.

How They'd Use This Screen

Filter: ACO = Yes. Care Mgmt = CCM > 0.
Sort: Target Benes descending.
Revenue input: $420/yr (CKM rate).
Export: All ACO-affiliated providers → map to ACO organizations for enterprise sales.

01 Provider Analysis Chicago Metro — eCKM Track — 1,847 providers

Providers iProvider Count. Number of unique NPIs matching current filters. Shown as "filtered / total" to indicate you're viewing a subset.

Total = all providers in the pre-computed dataset for this market definition.

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of 1,847 total

Target Benes Reachable iTarget Beneficiaries Reachable. Sum of target beneficiaries across all filtered providers. Note: a single beneficiary may see multiple providers, so this is NOT unique patients — it's total provider-patient touchpoints.

This tells you: "through these providers, you can reach this many patient relationships."

Source: SUM of bene_count (visit relationship) from V1 cohort panel.

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across filtered providers

Avg Concentration iAverage Target Concentration. Mean of (Target Benes / Total Panel) across filtered providers. Tells you how relevant your target population is to these providers' practices.

Higher = these providers disproportionately serve your target market. Lower = your target patients are a small slice of their practice.

Calculation: AVG(target_benes / total_panel_bene_count) across filtered rows.

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target / total panel

Revenue Potential iTotal Revenue Potential. Sum of (Target Benes x Avg Revenue/Patient) across filtered providers.

This is a ceiling estimate — assumes every target beneficiary enrolls through these providers. Actual yield depends on conversion rate, competition, and patient willingness.

Calculation: SUM(target_benes) x revenue_input. Uses the $/yr value from the revenue input field.

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at $360/patient/yr

% with Care Mgmt iCare Management Prevalence. Percentage of filtered providers who bill for ANY care management service (CCM, RPM, RTM, PCM, or AWV).

High % = mature care management market, more competition but also more infrastructure.
Low % = early-stage market for care management adoption.

Source: Providers where any of ccm/rpm/rtm/pcm/awv bene counts > 0.

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billing any CCM/RPM/RTM

Showing 1–25 of 342 providers

Per page

1 of 14

Provider Name	Specialty	Total Panel iTotal Panel Size. Total unique Medicare beneficiaries seen by this provider (all conditions, not just target cohort). Indicates the provider's overall practice scale. Source: V2 overall panel — `total_panel_bene_count`.	Target Benes ▼ iTarget Beneficiaries. Beneficiaries from YOUR defined target market who visited this provider. This is the overlap between your market and this provider's panel. Higher = more of your target patients flow through this provider = higher-value channel target. Source: V1 cohort panel — `bene_count` where `relationship_type = 'visit'`.	Conc % iTarget Concentration. What percentage of this provider's total panel is from your target market. High concentration (30%+) = your target population is a significant part of their practice. They have strong incentive to adopt solutions for this population. Low concentration (<5%) = your patients are a rounding error in their practice. Harder sell. Calculation: target_benes / total_panel * 100	Fit iFit Score (1–5). How well this provider matches the active persona's strategy. Select a persona via the filter bar to activate. Higher = better match. 4–5 green · 3 amber · 1–2 red Withings (device vendor): • 5 = No RPM + ACO + AWV (empty field, fully receptive) • 4 = No RPM + ACO or AWV signal • 3 = No RPM only • 2 = RPM suppressed (unknown) • 1 = RPM active (incumbent in place) Story Health (care mgmt): • 5 = CCM + ACO + RPM (full care mgmt partner) • 4 = CCM + ACO (ideal partner) • 3 = CCM only (oriented, no ACO) • 2 = ACO only (aligned, no CM infra) • 1 = Neither (cold lead)	ACO iACO Participation. ACO name and program type (SSP or REACH) if the provider is aligned to a Medicare shared savings entity. Blank if not in any ACO. SSP (Shared Savings Program): Traditional Medicare ACO — provider shares savings when total costs come in below benchmark. REACH (Realizing Equity, Access, and Community Health): Higher-risk model with prospective capitation and stronger financial stakes. ACO providers have organizational-level incentives to improve outcomes and reduce unnecessary utilization — making them more receptive to care management solutions. Source: V1 provider profile — SSP provider files + REACH entity rosters (Layer 9 foundation table).	CCM iCCM — Chronic Care Management. Nationwide bene count billed by this provider for CCM (CPT 99490, 99491). NOT cohort-scoped — this is a property of the provider's practice. High CCM = provider has care management infrastructure and billing workflows in place. Zero CCM = no chronic care management program. Interpretation depends on your strategy: • If you're a CCM vendor: Zero = opportunity, High = competitor • If you're seeking partners: High = compatible infrastructure	RPM iRPM — Remote Patient Monitoring. Nationwide bene count billed for RPM (CPT 99453-99458). NOT cohort-scoped. For device vendors (like Withings): Zero RPM = no incumbent vendor = highest-value target. For care management platforms: RPM > 0 = provider already monitors patients remotely = compatible.	RTM iRTM — Remote Therapeutic Monitoring. Nationwide bene count billed for RTM (CPT 98975-98981). NOT cohort-scoped. RTM monitors non-physiologic data — medication adherence, pain levels, functional status, symptoms. It complements RPM (which monitors physiologic vitals like BP and weight). Common in musculoskeletal, behavioral health, and chronic pain programs. Relevant for ACCESS MSK and BH track participants. RTM adoption is lower than RPM; providers billing RTM are early adopters of non-device monitoring technology.	PCM iPCM — Principal Care Management. Nationwide bene count billed for PCM (CPT 99424-99427). NOT cohort-scoped. PCM is similar to CCM but scoped to a single high-risk condition (vs. CCM's multi-condition requirement). A provider can bill PCM for a patient with severe heart failure, for example, without needing a second chronic condition. PCM signals a provider who is actively managing complex, single-condition patients — highly relevant for ACCESS track targeting where condition specificity matters. PCM billing is relatively rare; it was only established in 2020 and adoption is still growing.	AWV iAWV — Annual Wellness Visits. Nationwide bene count receiving AWVs from this provider. A leading indicator of preventive care orientation. High AWV + low RPM = provider does preventive care but hasn't adopted monitoring. Warm lead for RPM vendors. AWV is the most common care management touchpoint — many providers do AWVs but nothing else.	Rev Potential iRevenue Potential. Estimated annual revenue if all target beneficiaries at this provider enrolled. Calculation: target_benes x avg_revenue_per_patient (from input field). This is a ceiling — actual yield depends on conversion rate. Use as a relative ranking signal, not an absolute forecast.

02 Column Specifications Field definitions for developers ▼

COL-01 Provider Identity Fields

Core provider identification from Medicare claims data.

provider_name = display_name (from V1 referral network enrichment)
npi = performing_npi (10-digit National Provider Identifier)
specialty = cms_specialty_name (mode of prvdr_spclty across claims)
state = provider_state (derived from provider_zip, primary practice location)
tin = tin (Tax Identification Number — not displayed in v1, available for export)
tin_name = tin_name (organization name — not displayed in v1, available for export)

Patient-facing filter: The dataset is pre-filtered to patient-facing providers only (is_patient_facing = TRUE). Non-patient-facing specialties (Anesthesiology, Pathology, Radiology, Lab) are excluded. This is set at export time, not a user filter.

COL-02 Total Panel

total_panel = total_panel_bene_count (from V2 overall panel)

Definition: Count of unique Medicare beneficiaries who had at least one
visit claim with this provider during the measurement period.
ALL beneficiaries, not filtered to target cohort.

Measurement period: Calendar year or trailing 12 months
(matches the CCW export run parameters)

COL-03 Target Beneficiaries

target_benes = bene_count WHERE relationship_type = 'visit' (from V1 cohort panel)

Definition: Count of beneficiaries from the defined target market
(market definition criteria applied upstream) who had at least one
visit claim with this provider.

Only "visit" relationships are counted — not referred_to or referred_from.
A visit = the performing_npi on the claim directly saw the patient.

Note: A beneficiary who sees multiple providers appears in EACH
provider's target_benes count. Summing across providers overcounts
unique beneficiaries — the hero metric notes this.

COL-04 Concentration %

concentration_pct = target_benes / total_panel * 100

Interpretation:
40%+ = High — target population is a major part of this provider's practice
15-39% = Moderate — meaningful overlap
5-14% = Low — target patients are a small segment
<5% = Minimal — incidental overlap

This is the "how much they'd care" signal. A cardiologist with 500
hypertension patients out of 600 total (83%) is a very different
conversation than an internist with 50 out of 2,000 (2.5%).

COL-05 ACO Participation

aco_display = CASE
WHEN in_ssp AND in_reach THEN ssp_aco_name + " (SSP+REACH)"
WHEN in_ssp THEN ssp_aco_name + " (SSP)"
WHEN in_reach THEN reach_entity_name + " (REACH)"
ELSE "—"
END

Source: V1 provider profile — prvdr_aco foundation table (Layer 9)
SSP: vbc_ssp_provider_{year} filtered to prvdr_aco_year = {year}
REACH: cmds_apm71_provider entities active after cutoff date

A provider in BOTH SSP and REACH appears with the SSP name (primary).
Full ACO details available in export (aco_num, entity_id).

COL-06 Care Management Columns (CCM, RPM, RTM, PCM, AWV)

ccm_benes = ccm_bene_count (nationwide, from prvdr_care_mgmt foundation, Layer 8)
rpm_benes = rpm_bene_count
rtm_benes = rtm_bene_count
pcm_benes = pcm_bene_count
awv_benes = awv_bene_count

IMPORTANT: These are NATIONWIDE counts, not cohort-scoped.
A provider billing RPM for 500 patients nationally has RPM infrastructure
regardless of how many are in your specific target cohort.

This is by design — care mgmt billing is a property of the PROVIDER's
practice, not a property of your market. It answers "does this provider
have care management infrastructure?" not "are they doing care mgmt
for your specific patients?"

CCW suppression: counts < 11 are suppressed (set to NULL/—) per CMS rules.

CCM (99490, 99491): Chronic Care Management — 20+ min/month care coordination
RPM (99453-99458): Remote Patient Monitoring — device-based vital sign tracking
RTM (98975-98981): Remote Therapeutic Monitoring — non-physiologic data (adherence, symptoms)
PCM (99424-99427): Principal Care Management — single high-risk condition
AWV (G0438, G0439): Annual Wellness Visit — preventive care touchpoint

COL-07 Revenue Potential

revenue_potential = target_benes * avg_revenue_per_patient

avg_revenue_per_patient = user input (default $360 for eCKM)

This is a ceiling estimate — assumes 100% conversion of target benes
through this provider. Actual yield = target_benes * conversion_rate
* avg_revenue_per_patient, where conversion_rate is unknown at this stage.

Used for RELATIVE ranking, not absolute forecasting.

COL-08 Median Distance

median_distance = median of haversine distances between provider's
primary practice ZIP centroid and each patient's home ZIP centroid

Primary practice ZIP = ZIP with highest bene_count for this NPI
(provider may practice at multiple locations)

Source: V2 overall panel — adj_dist_by_npi_zip from 1Sage operational tables

Units: miles, rounded to 1 decimal
NULL if insufficient data

COL-09 Care Management Interpretation Guide

The same columns mean different things depending on the vendor's business model:

Pattern	Signal for RPM Vendor (e.g., Withings)	Signal for Care Mgmt Platform (e.g., Story Health)
High RPM + High Target Benes	Competitor — incumbent RPM vendor in place	Compatible — provider has monitoring infrastructure
Zero RPM + High Target Benes	Top Target — no RPM vendor, high need	Mixed — big panel but no monitoring culture yet
High CCM + ACO	Good fit — care mgmt culture, may adopt devices	Ideal partner — existing infrastructure + aligned incentives
AWV only + High Panel	Warm lead — preventive orientation, no monitoring yet	Growth opportunity — could expand from wellness visits to full care mgmt
No Care Mgmt + Small Panel	Low priority	Low priority

03 Data Model Pre-computed dataset from CCW export ▼

This screen consumes a single flat dataset produced upstream by the CCW export pipeline. The dataset joins fields from multiple provider profile views (V1, V2) computed in the vinci segmentation engine. No live queries — everything is client-side filtering on a pre-loaded dataset.

Market Definition

Target criteria submitted
Geography, tracks, conditions
Defines the patient cohort

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CCW Pipeline

Bene spine built (patient list)
Referral network discovered
Provider profiles computed (V1+V2)
ACO + care mgmt enrichment

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Export & Approval

CCW suppression applied (<11)
Export reviewed and approved
~2+ day turnaround

→

This Screen

Loads exported flat file
Client-side filter/sort/export
Revenue calculated in browser

V1 Cohort Panel (per target market)

One row per NPI. Providers who touched the target beneficiary cohort via visit claims.

Field	Type	Description
`npi`	string(10)	National Provider Identifier
`display_name`	string	Provider name from claims
`cms_specialty_name`	string	Medicare specialty (mode from claims)
`provider_zip`	string(5)	Primary practice ZIP (max bene count location)
`tin`, `tin_name`	string	Tax ID and organization name
`bene_count`	int	Target benes (visit relationship only)
`claim_count`, `total_allowed`	int, decimal	Claims and total allowed charges
`ccm_bene_count` ... `awv_bene_count`	int (nullable)	14 care mgmt categories (nationwide). NULL if suppressed (<11)
`in_ssp`, `in_reach`, `in_any_aco`	boolean	ACO participation flags
`ssp_aco_num`, `ssp_aco_name`	string (nullable)	SSP ACO identifier and name
`reach_entity_id`	string (nullable)	REACH entity identifier

V2 Overall Panel (same NPIs as V1)

Extends V1 with full book-of-business metrics. Row count must equal V1.

Field	Type	Description
`total_panel_bene_count`	int	Total unique benes (all conditions)
`pct_panel_in_cohort`	decimal	V1 bene_count / total_panel_bene_count
`median_distance`	decimal	Median patient travel distance (miles)
`top_spclty_description`	string	Top specialty by bene volume

Derived Browser-Calculated Fields

Field	Calculation
`concentration_pct`	`target_benes / total_panel * 100`
`revenue_potential`	`target_benes * user_input_revenue`
Hero: providers count	COUNT of rows matching current filters
Hero: total target benes	SUM(target_benes) across filtered rows
Hero: avg concentration	AVG(concentration_pct) across filtered rows
Hero: revenue potential	SUM(revenue_potential) across filtered rows
Hero: % with care mgmt	COUNT(has_any_cm) / COUNT(*) across filtered rows

04 Data & Workflow How provider data flows into this screen ▼

Plan vs. Grow Context

This screen appears in both modules. The provider dataset is the same — the module determines what else is available.

Plan Module

Static target list. No customer patient data. Used for market analysis, outreach planning, and building the initial provider targeting strategy.

Available: Filter, sort, export, revenue modeling
Not available: Penetration metrics, conversion tracking

Grow Module (Future)

Same target list as base layer, plus customer data overlay. Customer has uploaded their patient roster — the screen shows penetration metrics: how many target benes at each provider have been acquired.

Adds: Acquired count, conversion %, penetration heatmap
Enables: "Best/worst providers", "remaining opportunity", progress monitoring

Data Pipeline

Step	System	Output	Timing
1. Market definition	1Access Plan	Target criteria (geography, tracks, conditions)	User-initiated
2. Cohort build	CCW / Vinci	Bene spine (target patient list)	Hours
3. Referral network	CCW / Vinci	NPI-level visit/referral edges	Hours
4. Provider profile V1	CCW / Vinci	Cohort panel + care mgmt + ACO	Hours
5. Provider profile V2	CCW / Vinci	Overall panel + distance + specialty	Hours
6. Suppression + export	CCW	Flat file (CSV/Parquet), counts <11 suppressed	2+ days (approval)
7. Load into 1Access	1Access	Dataset available for this screen	Minutes

Delivery: CSV Export

The export button generates a CSV of the current filtered/sorted view. Includes all visible columns plus NPI and TIN (always included for downstream CRM matching).

Column	Always Included	Notes
NPI	Yes	Primary key for provider matching
TIN + TIN Name	Yes	For organization-level CRM matching
All visible columns	Yes	Reflects current sort order
Provider ZIP	Yes	For geographic analysis in external tools
Revenue Potential	Yes	Calculated with current $/patient input

Refresh Cadence

Provider datasets are point-in-time snapshots from the CCW export. Not live-connected.

Data Element	Refresh Driver	Frequency
Target bene counts	New market definition run	On-demand (re-run costs time)
Care mgmt billing	CMS claims data refresh	Quarterly (claims lag ~3 months)
ACO participation	CMS program files	Annually (SSP), semi-annually (REACH)
Provider identity	NPPES updates	Monthly