Sample: Market Report & Launch Plan
See a sample of our combined market report and launch plan.
A strategic credentialing and revenue roadmap for Davis OT, a pediatric occupational therapy practice in metro Detroit.
Prepared by pie Health
Executive Overview
Provider
Darla Davis
Practice Name
Davis OT
Practice Type
Pediatric Occupational Therapy (Solo Practice)
Region
Metro Detroit, MI
Business Status
EIN, NPI-1, NPI-2, CAQH, Articles of Organization complete
Credentialing Focus
BCBSM/BCN, Medicaid MCOs, Priority Health, Aetna, UnitedHealthcare
Total pie Health Investment
$2,650
Monthly Revenue at Capacity
$8,900
Break-Even Month
Month 5
1. Introduction & Strategic Rationale
Davis OT is a new pediatric occupational therapy practice launching in Metro Detroit. The provider, Darla Davis, OTR/L, brings both clinical expertise and community insight to this underserved yet high-potential market. This report outlines a payer-informed, credentialing-backed growth plan designed to reach $97,000 in annual revenue within 12 months.
We call it a launch plan because it reflects acceleration — from zero to full panel — powered by strategy, data, and support from pie Health.
2. Market Opportunity in Metro Detroit
Key Regional Facts
Population: 4.3+ million residents
Pediatric Need: High Medicaid eligibility in Detroit proper; mixed commercial coverage in suburbs
Top Employers: Ford, GM, Henry Ford Health, Trinity Health, Detroit Public Schools
Payer Environment: Dominated by BCBSM/BCN, with significant roles played by Medicaid MCOs, Priority Health, Aetna, and UHC
Ford, GM, Stellantis
Automotive
BCBSM, Aetna, UHC
Henry Ford Health, Trinity, DMC
Healthcare
BCBSM, Priority
University of Michigan, DPS
Education
BCBSM, Priority
City of Detroit
Government
BCBSM, BCN, HAP
3. Methodology & Payer Mix Rationale
The projected payer mix was built using local data, payor market share reports, and firsthand insights from the provider and regional trends:
BCBSM/BCN
30%
Michigan's largest commercial insurer; “super popular” locally
Medicaid MCOs
30%
Essential for low-income families; key for pediatric referrals
Priority Health
20%
Strong regional share in Southeast MI
Aetna
15%
Commercial and Medicaid MCO presence
UnitedHealthcare
5%
Smaller but steady role in OT reimbursement
Pediatric OTs typically see higher Medicaid representation due to family income thresholds and early intervention funding sources.
4. Billing & Reimbursement Assumptions
Revenue modeling uses CPT 97530 (Therapeutic Activities – 15 minutes) as the primary billing code across all payer types. Reimbursement rates were benchmarked by payor and adjusted for regionally conservative assumptions:
97530
Therapeutic Activities
$57–$80 depending on payer
5. Revenue Forecast: Full Capacity
BCBSM/BCN
30%
36
$80
$2,880
$34,560
Priority Health
20%
24
$70
$1,680
$20,160
Aetna
15%
18
$65
$1,170
$14,040
Medicaid MCOs
30%
36
$57
$2,052
$24,624
UnitedHealthcare
5%
6
$60
$360
$4,320
Total
100%
120
—
$8,142
$97,704
6. Credentialing Plan with pie Health
Discovery & Eligibility Check
$375
Confirm payor participation & requirements
Provider Setup
$50
Gather documents, CAQH, NPI
Group Enrollment (if needed)
$150
Setup for billing via NPI-2
Payor Applications (5×)
$875
Each includes follow-up to effective date
One-Time Total
$1,450
Ongoing Maintenance
$100/mo
Support, directory maintenance, revalidation
Annual Total
$2,650
Includes credentialing + 12 months of maintenance
7. Revenue Ramp-Up & Patient Growth Timeline
This chart illustrates Davis OT’s projected monthly revenue and patient sessions over the first year.
This visual marks the expected month each major payer becomes effective, beginning with BCBSM in Month 3. It reflects the staggered credentialing process and provides a simple reference for when reimbursements are anticipated to begin from each insurer.
8. Timeline Narrative
Phase 1: Credentialing
1–2
All applications submitted
$0 revenue
→ First Approval
3
BCBSM starts
$1,200
→ Add Priority
4
Start building referrals
$1,900
→ Medicaid Live
5
School referrals begin
$3,000
→ Add Aetna
6
Word-of-mouth grows
$3,800
Phase 2: Growth
7–8
Network established
$4,900–$5,700
Phase 3: Maturity
9–12
Near/full capacity
Up to $8,900/month
9. Pediatric OT-Specific Market Insights
Family referrals drive growth — parent word-of-mouth is essential
Schools and early intervention programs generate high-volume referrals
Fall (Sept–Nov) is peak referral season due to school IEPs
Summer can be mixed — some drop off, others intensify treatment
Home visits are a strategic differentiator against clinic-based competition
10. Risks & Mitigation Strategies
Credentialing delays
Cash flow issues
Private-pay sessions in early months
Slower-than-expected referrals
Growth delay
Invest in early intervention contacts
Competition from hospital systems
Referral scarcity
Differentiate via home visits and responsiveness
Seasonal drop-offs
Lost revenue
Frontload evaluation outreach in fall
11. Summary Recommendations
Begin credentialing immediately with BCBSM and Medicaid MCOs
Consider early marketing to schools, EI programs, and parent groups
Track payor approval dates and patient volume closely
Use home-visit option to build niche loyalty
Meet monthly with pie Health to review payer progress
Appendix: Sources & References
Regional & Market Research
[3] Economy of Metropolitan Detroit — https://en.wikipedia.org/wiki/Economy_of_metropolitan_Detroit [4] City of Detroit Benefit Booklet — https://detroitmi.gov/... [5] Top 25 Health Insurance Companies – PeopleKeep — https://www.peoplekeep.com/blog/top-25-health-insurance-companies-in-the-u.s [6] Employee Benefits Summary (MI) – MployerAdvisor — https://mployeradvisor.com/state-benefit-guides/... [7] Detroit Chamber Workforce Data — https://www.detroitchamber.com/... [8] Major Employers in Michigan – The Michigan Life — https://themichiganlife.org/... [9] Detroit Regional Partnership Employer List — https://www.detroitregionalpartnership.com/... [10] Perplexity Research Summary — Used to build revenue ramp-up and payer mix [11] Crain’s Detroit Business Data — https://www.crainsdetroit.com [12] Blossom Children’s Center – OT Billing Guidance — https://blossomchildrenscenter.com/occupational-therapy/
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