1 00:00:00,119 --> 00:00:02,674 Hello, everyone. This is Erica Spice Mason with 2 00:00:02,674 --> 00:00:04,211 the Becker Health care podcast. 3 00:00:04,589 --> 00:00:05,946 Thank you so much for tuning in. 4 00:00:06,665 --> 00:00:08,261 I'm thrilled to have the chance to sit 5 00:00:08,261 --> 00:00:10,374 down today with Par, Sas, 6 00:00:10,753 --> 00:00:13,310 the senior Director of product management for Health 7 00:00:13,310 --> 00:00:13,550 edge. 8 00:00:14,269 --> 00:00:16,927 Today, we're going to dive into operational efficiency 9 00:00:16,986 --> 00:00:20,031 and provider data management for Health plans. Part, 10 00:00:20,190 --> 00:00:22,177 it's a pleasure to have you on the 11 00:00:22,177 --> 00:00:24,799 podcast today, just to give our listeners a 12 00:00:24,799 --> 00:00:26,786 little bit more context. I was wondering if 13 00:00:26,786 --> 00:00:28,551 you wanted to share a little bit more 14 00:00:28,551 --> 00:00:30,782 about yourself, your role, your organization, 15 00:00:31,420 --> 00:00:32,934 whatever feels top of mind for you. 16 00:00:34,129 --> 00:00:36,918 Thank you, everyone. It's a great pleasure to 17 00:00:36,918 --> 00:00:37,396 be here. 18 00:00:38,046 --> 00:00:38,364 And 19 00:00:39,077 --> 00:00:41,139 I've been bit heritage for, 20 00:00:41,694 --> 00:00:43,915 little over 9 years, and I've probably worked 21 00:00:43,915 --> 00:00:45,104 in the bigger space. 22 00:00:45,833 --> 00:00:47,738 During my time here at Health. I've actually 23 00:00:47,738 --> 00:00:48,453 worked on 24 00:00:49,088 --> 00:00:51,073 launching multiple products. And 1 of, 25 00:00:51,866 --> 00:00:52,978 my most exciting 26 00:00:53,549 --> 00:00:56,510 product launch is the development of our new 27 00:00:56,510 --> 00:00:57,869 provider data management platform, 28 00:00:58,750 --> 00:01:01,310 we've taken it from concept to reality. 29 00:01:02,441 --> 00:01:04,660 Thank you for having me on, ma'am. Actually 30 00:01:04,660 --> 00:01:07,435 looking forward to sharing more about our provided 31 00:01:07,435 --> 00:01:08,941 data management product and the, 32 00:01:10,149 --> 00:01:12,567 impact we aim to make in the health 33 00:01:12,786 --> 00:01:13,026 industry. 34 00:01:13,905 --> 00:01:17,420 No. Wonderful. Thanks, Par, and we're excited to 35 00:01:17,420 --> 00:01:19,512 have you here. Especially to shed some light 36 00:01:19,512 --> 00:01:22,466 on a topic that I think every member 37 00:01:22,466 --> 00:01:24,701 of the healthcare C suite is interested right 38 00:01:24,701 --> 00:01:27,655 now, and that's driving operational efficiency. 39 00:01:28,466 --> 00:01:30,370 We know this is a key driver in 40 00:01:30,370 --> 00:01:33,941 many payer organizations, growth and innovation strategies in 41 00:01:33,941 --> 00:01:34,734 20 24. 42 00:01:35,464 --> 00:01:37,449 So considering all of this, can you share 43 00:01:37,449 --> 00:01:40,411 with us the role of provider data management 44 00:01:40,467 --> 00:01:40,706 here? 45 00:01:42,771 --> 00:01:43,247 Absolutely. 46 00:01:44,136 --> 00:01:45,485 When it comes to the, 47 00:01:46,200 --> 00:01:46,835 provider data, 48 00:01:47,391 --> 00:01:50,963 operational efficiency, it does play, a very crucial 49 00:01:50,963 --> 00:01:52,313 role within health plans. 50 00:01:53,122 --> 00:01:55,827 The first thing to understand is that, the 51 00:01:55,827 --> 00:01:56,725 provider data 52 00:01:57,100 --> 00:01:59,407 in itself is is very white. 53 00:01:59,978 --> 00:02:03,258 And it becomes all the more important for 54 00:02:03,711 --> 00:02:06,673 organizations to actually manage. They have provider data 55 00:02:06,729 --> 00:02:07,944 across different 56 00:02:08,317 --> 00:02:08,794 platforms forms. 57 00:02:09,683 --> 00:02:10,319 Let's see that, 58 00:02:11,034 --> 00:02:14,157 accurate and up to date provider data is 59 00:02:14,214 --> 00:02:17,155 essential for streamlining all of the business operations. 60 00:02:17,728 --> 00:02:19,563 And when it comes to the health plans, 61 00:02:19,802 --> 00:02:24,109 they heavily rely on provider information so that 62 00:02:24,109 --> 00:02:26,284 they can reduce their claims processing 63 00:02:26,661 --> 00:02:27,161 and 64 00:02:27,473 --> 00:02:28,188 payment errors, 65 00:02:28,823 --> 00:02:31,865 which could actually lead to a much faster 66 00:02:32,000 --> 00:02:32,818 and accurate 67 00:02:33,430 --> 00:02:33,827 reimbursement. 68 00:02:34,621 --> 00:02:37,128 This not only save time, but it also 69 00:02:37,427 --> 00:02:37,927 improves 70 00:02:38,466 --> 00:02:39,984 relationships for the health plans, 71 00:02:40,703 --> 00:02:42,801 with their, provider community 72 00:02:44,224 --> 00:02:47,182 provided data management also helps in, enhancing 73 00:02:48,109 --> 00:02:48,505 experience. 74 00:02:49,060 --> 00:02:52,811 Members rely heavily on the provider directories that 75 00:02:53,050 --> 00:02:54,506 the health plan publish 76 00:02:54,962 --> 00:02:56,657 on their websites to 77 00:02:57,034 --> 00:03:00,322 locate and identify the in network providers 78 00:03:01,032 --> 00:03:04,059 for accessing care. And it is all the 79 00:03:04,059 --> 00:03:07,405 more important that these directories need to be 80 00:03:07,405 --> 00:03:09,237 accurate and current so that, 81 00:03:10,448 --> 00:03:13,718 the Hilton can essentially improve on their member 82 00:03:13,718 --> 00:03:14,218 satisfaction 83 00:03:14,914 --> 00:03:18,844 and reduce the burden on, the customer service 84 00:03:18,902 --> 00:03:19,402 team 85 00:03:20,749 --> 00:03:23,534 Provided data, management is also very important when 86 00:03:23,534 --> 00:03:24,511 it comes to 87 00:03:24,966 --> 00:03:25,603 decision making. 88 00:03:26,239 --> 00:03:28,649 You know, health plans rely on accurate 89 00:03:29,199 --> 00:03:29,699 provider 90 00:03:30,080 --> 00:03:32,259 information to make very important 91 00:03:32,719 --> 00:03:33,219 decisions 92 00:03:33,520 --> 00:03:35,919 such as, their network work, analysis, 93 00:03:36,892 --> 00:03:39,302 identifying potential caps in coverage 94 00:03:39,678 --> 00:03:42,066 and making sure that, they can make a 95 00:03:42,066 --> 00:03:43,601 little more informed 96 00:03:44,057 --> 00:03:47,564 decision, as they expand and optimize, the network 97 00:03:47,564 --> 00:03:49,150 web. And all of this 98 00:03:49,705 --> 00:03:50,975 essentially leads to, 99 00:03:52,024 --> 00:03:54,818 improved access in care for their members, 100 00:03:55,297 --> 00:03:57,532 and it can also create a much more, 101 00:03:58,170 --> 00:03:58,889 cooperative competitive, 102 00:03:59,527 --> 00:04:00,565 provider network, 103 00:04:01,536 --> 00:04:04,026 moreover now, you know, provider 104 00:04:04,401 --> 00:04:07,528 data is also becoming all the more vital 105 00:04:08,301 --> 00:04:10,504 for compliance and health plans 106 00:04:10,862 --> 00:04:13,590 must meet these regulatory needs 107 00:04:14,124 --> 00:04:16,669 related to provided information, which means that, 108 00:04:17,719 --> 00:04:20,196 they need to ensure that at any given 109 00:04:20,196 --> 00:04:20,436 point, 110 00:04:21,235 --> 00:04:22,215 their provider 111 00:04:22,753 --> 00:04:25,231 updates, make it into the system and are 112 00:04:25,231 --> 00:04:26,210 available for 113 00:04:26,524 --> 00:04:28,677 members so that they can avoid any, 114 00:04:29,475 --> 00:04:30,294 potential fines 115 00:04:30,751 --> 00:04:31,149 and 116 00:04:31,947 --> 00:04:32,186 entities. 117 00:04:33,063 --> 00:04:35,990 It's also all the word important to understand 118 00:04:36,109 --> 00:04:39,931 that the nature of the provider data, it's 119 00:04:39,931 --> 00:04:42,559 extremely dynamic. You have a lot of updates 120 00:04:42,559 --> 00:04:44,391 that keep coming in from the, 121 00:04:45,441 --> 00:04:46,818 credentialing systems or 122 00:04:47,194 --> 00:04:48,172 affiliation or 123 00:04:48,548 --> 00:04:48,787 locations. 124 00:04:49,744 --> 00:04:53,010 And, essentially, this needs a very robust data 125 00:04:53,010 --> 00:04:54,125 management process, 126 00:04:55,018 --> 00:04:58,691 real time updates, and issuing data verification processes 127 00:04:58,691 --> 00:05:01,884 are gonna be essential in order to make 128 00:05:01,884 --> 00:05:04,061 sure that the health plans can 129 00:05:04,612 --> 00:05:05,908 Curate and has, 130 00:05:06,283 --> 00:05:09,466 a more accurate and actionable provider data. 131 00:05:10,580 --> 00:05:11,137 Would see that, 132 00:05:12,186 --> 00:05:12,686 Operational 133 00:05:13,061 --> 00:05:17,116 efficiency enhancing it is definitely driving growth. It 134 00:05:17,116 --> 00:05:19,899 also foster a lot of innovation for the 135 00:05:19,899 --> 00:05:20,399 payer 136 00:05:20,773 --> 00:05:20,932 organization. 137 00:05:21,584 --> 00:05:21,744 And, 138 00:05:22,462 --> 00:05:23,600 essentially by prioritizing 139 00:05:24,057 --> 00:05:28,227 this, it ultimately leads to an improved patient 140 00:05:28,286 --> 00:05:28,525 outcome, 141 00:05:29,259 --> 00:05:30,398 a much better 142 00:05:30,937 --> 00:05:33,174 relationship between the providers and the health plans 143 00:05:33,174 --> 00:05:33,674 and 144 00:05:34,053 --> 00:05:36,050 overall and operational success. 145 00:05:37,815 --> 00:05:41,148 Par. I really appreciate how you outlined all 146 00:05:41,148 --> 00:05:44,029 of these areas that contribute to 147 00:05:44,578 --> 00:05:45,078 efficiency 148 00:05:45,854 --> 00:05:48,267 related to provider data management. So I heard 149 00:05:48,804 --> 00:05:49,304 compliance 150 00:05:49,681 --> 00:05:52,174 decision making, member experience and satisfaction, 151 00:05:53,123 --> 00:05:54,714 faster and accurate reimbursement. 152 00:05:55,111 --> 00:05:55,906 There's a lot of, 153 00:05:56,861 --> 00:05:59,326 impact that it sounds like provider data management 154 00:05:59,326 --> 00:06:01,734 has on the organization as a whole. So 155 00:06:01,791 --> 00:06:03,874 really appreciate how you explained all of those 156 00:06:03,874 --> 00:06:04,352 areas. 157 00:06:05,307 --> 00:06:07,297 And so I think that leads me to 158 00:06:07,297 --> 00:06:08,332 my next question, 159 00:06:08,730 --> 00:06:11,436 you know, considering the influence that provider data 160 00:06:11,436 --> 00:06:13,200 management has on all of these areas. 161 00:06:13,913 --> 00:06:16,157 What are you seeing as common pain points 162 00:06:16,291 --> 00:06:18,906 for health plans when it comes to data 163 00:06:18,906 --> 00:06:19,619 management here, 164 00:06:20,348 --> 00:06:22,576 And also, are there pain points that you're 165 00:06:22,576 --> 00:06:25,917 seeing commonly for Pd tools and platforms as 166 00:06:25,917 --> 00:06:26,155 well. 167 00:06:27,365 --> 00:06:30,964 Yeah. Absolutely. 1 of the, common pain pinpoint 168 00:06:30,964 --> 00:06:31,285 that, 169 00:06:31,845 --> 00:06:34,485 health plans face when it comes to the 170 00:06:34,485 --> 00:06:35,625 provided data management 171 00:06:36,100 --> 00:06:37,220 in itself is, 172 00:06:38,020 --> 00:06:38,759 the data 173 00:06:39,220 --> 00:06:41,879 accuracy. Now ensuring that, you know, the provider 174 00:06:42,020 --> 00:06:43,834 information is current and is 175 00:06:44,513 --> 00:06:44,752 collect, 176 00:06:45,790 --> 00:06:47,147 is a constant challenge, 177 00:06:47,706 --> 00:06:51,160 given the the frequent changes in provider networks 178 00:06:51,298 --> 00:06:54,670 or contract details, or credentialing statuses. 179 00:06:55,389 --> 00:06:56,449 Now inaccurate 180 00:06:56,990 --> 00:07:00,430 data can actually lead to issues on the 181 00:07:00,430 --> 00:07:00,930 downstream 182 00:07:01,710 --> 00:07:04,113 side of the business which is, like, you 183 00:07:04,113 --> 00:07:07,604 know, claims being appended, or being processed with 184 00:07:07,604 --> 00:07:08,001 errors, 185 00:07:08,715 --> 00:07:11,149 payment delays and compliance, which 186 00:07:11,988 --> 00:07:13,287 another significant 187 00:07:13,746 --> 00:07:17,341 pain point is around the the integration. Now 188 00:07:17,341 --> 00:07:20,306 health plans often has data coming in from 189 00:07:20,306 --> 00:07:21,442 multiple sources 190 00:07:21,897 --> 00:07:22,294 and 191 00:07:22,930 --> 00:07:25,498 integrating this data into a single 192 00:07:25,952 --> 00:07:29,145 cohesive system, the can actually be very complex. 193 00:07:29,622 --> 00:07:32,400 And lack of having an integration can actually 194 00:07:32,400 --> 00:07:32,956 result in, 195 00:07:33,670 --> 00:07:35,893 data silos, making it difficult, 196 00:07:36,865 --> 00:07:37,845 to get a comprehensive 197 00:07:38,224 --> 00:07:41,345 view of the provider data that is being 198 00:07:41,345 --> 00:07:42,944 floated around within the, 199 00:07:43,745 --> 00:07:45,504 ecosystem of the health plan. 200 00:07:46,398 --> 00:07:49,272 In fact, health plans struggle when it comes 201 00:07:49,272 --> 00:07:51,368 to the heterogeneous state of formats 202 00:07:51,746 --> 00:07:54,700 that are provided by hospitals and other entities. 203 00:07:55,595 --> 00:07:57,774 These updates can actually come in in various 204 00:07:57,834 --> 00:07:58,314 formats. 205 00:07:59,435 --> 00:08:01,274 Especially, it could be structured or it could 206 00:08:01,274 --> 00:08:04,966 be also on structured. And this creates a 207 00:08:04,966 --> 00:08:08,002 lot of burden on the health plan to 208 00:08:08,002 --> 00:08:12,579 actually consume combined and analyze the information effectively 209 00:08:12,635 --> 00:08:15,414 coming in from all these different sources. 210 00:08:15,890 --> 00:08:18,455 This in fact adds complexity to their 211 00:08:18,908 --> 00:08:23,248 administrative tasks in maintaining and updating the provider 212 00:08:23,385 --> 00:08:27,132 data, which I think already is considerably complex 213 00:08:27,132 --> 00:08:27,712 in us 214 00:08:28,103 --> 00:08:30,647 And many health plans rely on 215 00:08:31,760 --> 00:08:34,781 outdated systems. There there maybe sometimes homegrown growth 216 00:08:34,781 --> 00:08:35,258 platforms. 217 00:08:36,308 --> 00:08:39,519 Or also, you know, tend to manually process, 218 00:08:39,976 --> 00:08:41,092 all of these updates, 219 00:08:41,890 --> 00:08:44,840 which can end up being extremely time consuming, 220 00:08:45,254 --> 00:08:46,855 and Error prone, 221 00:08:48,294 --> 00:08:51,095 the accuracy and the completeness of the provider 222 00:08:51,095 --> 00:08:52,534 data in itself is, 223 00:08:53,828 --> 00:08:55,285 becomes a very complex 224 00:08:55,822 --> 00:08:56,061 operation. 225 00:08:56,699 --> 00:08:59,991 And it can actually lead to errors in 226 00:09:00,129 --> 00:09:01,644 patient care, billing, 227 00:09:02,202 --> 00:09:04,947 and overall poor decision making 228 00:09:05,401 --> 00:09:06,514 process in itself. 229 00:09:07,230 --> 00:09:07,730 Pd, 230 00:09:08,343 --> 00:09:11,286 with the Pd platform, we are trying to 231 00:09:11,286 --> 00:09:14,164 make sure that, you know, we emphasized in 232 00:09:14,164 --> 00:09:17,346 addressing all these key areas where of, the 233 00:09:17,346 --> 00:09:17,744 platform, 234 00:09:18,634 --> 00:09:21,612 focuses a lot and heavily on the data 235 00:09:21,991 --> 00:09:23,290 accuracy, seamless 236 00:09:23,749 --> 00:09:26,546 integration be it an upstream source that is 237 00:09:26,546 --> 00:09:28,877 sending data or it could be a put 238 00:09:28,877 --> 00:09:29,696 your downstream 239 00:09:30,153 --> 00:09:31,929 business system that means 240 00:09:32,306 --> 00:09:35,256 provider data real time, and also adds in 241 00:09:35,256 --> 00:09:36,930 a lot more efficiency, 242 00:09:37,344 --> 00:09:40,675 and automation so that the overall business process 243 00:09:40,675 --> 00:09:44,299 can become administration can be much more efficient 244 00:09:44,578 --> 00:09:47,044 and to also support the comprehensive needs. 245 00:09:48,396 --> 00:09:50,942 Yeah. Thanks so much again, Par with you 246 00:09:50,942 --> 00:09:53,746 for... For sharing all these insights. And it 247 00:09:53,746 --> 00:09:56,160 sounds like there's a lot of room for 248 00:09:56,218 --> 00:09:56,718 improvements 249 00:09:57,095 --> 00:10:00,147 in Pd platforms as you were just noting 250 00:10:00,619 --> 00:10:03,412 And considering all of the challenges that you 251 00:10:03,412 --> 00:10:07,003 outlined, especially that piece on... That piece about 252 00:10:07,003 --> 00:10:08,495 making sure that data is act... 253 00:10:09,092 --> 00:10:11,265 It sounds like a constant challenge. So 254 00:10:11,801 --> 00:10:13,872 is this what led Health edge to decide 255 00:10:13,872 --> 00:10:15,705 to develop a Pd tool? I I'd love 256 00:10:15,705 --> 00:10:17,059 to know a little bit more of the 257 00:10:17,059 --> 00:10:19,223 backstory and hear how the tool came to 258 00:10:19,223 --> 00:10:22,006 be and also what differentiates it from others? 259 00:10:23,198 --> 00:10:23,675 Absolutely. 260 00:10:24,311 --> 00:10:27,594 We decided to build the provider data management 261 00:10:28,544 --> 00:10:32,384 system because we recognized a critical need in 262 00:10:32,384 --> 00:10:35,445 the health care industry for a more accurate 263 00:10:35,745 --> 00:10:36,464 efficient and 264 00:10:37,279 --> 00:10:37,779 reliable 265 00:10:38,399 --> 00:10:41,059 provider data. In fact, there were several factors 266 00:10:41,120 --> 00:10:42,559 that drove into this, 267 00:10:43,039 --> 00:10:44,259 decision making for us 268 00:10:44,970 --> 00:10:47,514 we observed that, many of the health plans, 269 00:10:47,912 --> 00:10:51,171 including several of our customers were struggling with, 270 00:10:51,886 --> 00:10:53,556 the accuracy and the completeness. 271 00:10:54,128 --> 00:10:55,321 Of, step provider data. 272 00:10:56,117 --> 00:10:56,356 And, 273 00:10:57,311 --> 00:11:00,813 inaccurate or outdated provider information can actually lead 274 00:11:00,813 --> 00:11:02,802 to significant issues such as, 275 00:11:03,613 --> 00:11:06,476 you know, errors in claim processing, delays and 276 00:11:06,476 --> 00:11:06,874 payments, 277 00:11:07,828 --> 00:11:11,510 dissatisfaction within the members and the provider community 278 00:11:11,567 --> 00:11:13,590 itself, We saw an opportunity 279 00:11:14,359 --> 00:11:16,978 for us to address these pain points by 280 00:11:16,978 --> 00:11:20,151 creating a solution that interest data, 281 00:11:20,882 --> 00:11:21,940 accuracy and reliability. 282 00:11:23,034 --> 00:11:26,641 Secondly, the health care landscape in itself is 283 00:11:26,778 --> 00:11:27,278 evolving 284 00:11:28,306 --> 00:11:31,167 with increasing demands of, real time data and 285 00:11:31,167 --> 00:11:31,667 seamless 286 00:11:32,041 --> 00:11:33,790 integration across various systems, 287 00:11:34,744 --> 00:11:37,304 the health plans also received provided a, dates 288 00:11:37,304 --> 00:11:41,085 in various formats, structured unstructured. And it poses 289 00:11:41,144 --> 00:11:44,764 a challenge constantly and trying to consolidate and 290 00:11:44,825 --> 00:11:45,785 analyze this information, 291 00:11:46,679 --> 00:11:47,078 efficiently. 292 00:11:47,797 --> 00:11:50,854 Our solution. Now, the Pd platform is designed 293 00:11:51,073 --> 00:11:53,790 to handle these heterogeneous platforms. In fact, they 294 00:11:53,790 --> 00:11:56,678 use our generated Ai low code no code 295 00:11:56,678 --> 00:11:57,077 platform, 296 00:11:57,795 --> 00:11:58,114 which 297 00:11:58,673 --> 00:12:01,545 provides a much more streamlined and cohesive approach, 298 00:12:02,515 --> 00:12:04,583 for the provider data management itself. 299 00:12:05,776 --> 00:12:06,730 Also, given that, 300 00:12:07,446 --> 00:12:10,284 the provider data is very dynamic in nature 301 00:12:10,644 --> 00:12:12,742 including, you know, a lot of frequent changes 302 00:12:13,361 --> 00:12:15,119 across various upstream systems. 303 00:12:15,918 --> 00:12:16,717 This requires, 304 00:12:17,277 --> 00:12:19,295 a much more robust and an 305 00:12:19,608 --> 00:12:21,115 active management process. 306 00:12:21,828 --> 00:12:24,603 And, Health nuts have homegrown grown systems, 307 00:12:25,713 --> 00:12:28,745 and traditional methods active that are outdated, and, 308 00:12:29,381 --> 00:12:30,756 they cannot keep up 309 00:12:31,210 --> 00:12:32,324 with these changes, 310 00:12:32,721 --> 00:12:34,550 which essentially leads to a lot of, 311 00:12:35,504 --> 00:12:36,936 inefficiencies and errors. 312 00:12:37,906 --> 00:12:41,012 By developing a modern provider data, management platform, 313 00:12:41,172 --> 00:12:43,322 we aimed to create a system, 314 00:12:44,118 --> 00:12:45,791 capable of handling these, 315 00:12:46,283 --> 00:12:49,384 dynamic updates real time and ensuring that the 316 00:12:49,384 --> 00:12:52,190 health plans always have access to the boost 317 00:12:52,326 --> 00:12:53,996 current and accurate data. 318 00:12:54,567 --> 00:12:58,170 We also recognize recognized the importance of fig 319 00:12:58,227 --> 00:13:00,772 and compliance in the healthcare industry. 320 00:13:01,423 --> 00:13:03,491 And, health plans must adhere to, 321 00:13:04,128 --> 00:13:08,128 various state and federal regulations regarding provider information 322 00:13:08,359 --> 00:13:11,136 our solution is actually designed to support 323 00:13:12,247 --> 00:13:14,469 you know, the compliance need reducing the risks 324 00:13:14,469 --> 00:13:16,239 of any fines and penalties, 325 00:13:16,850 --> 00:13:19,643 our while making sure that, the health times 326 00:13:19,643 --> 00:13:21,968 actually meet all the regulatory 327 00:13:22,500 --> 00:13:23,952 requirements that are needed 328 00:13:25,298 --> 00:13:28,251 I would say health edge, overall objective has 329 00:13:28,251 --> 00:13:31,785 always been to enhance operational efficiency 330 00:13:32,163 --> 00:13:34,915 and improve health. Experience and foster 331 00:13:35,294 --> 00:13:37,695 innovation within the payer community. 332 00:13:38,415 --> 00:13:40,915 And, here we are, and I think Pd 333 00:13:41,455 --> 00:13:42,915 checks all of those criteria. 334 00:13:43,308 --> 00:13:44,102 It fits right in. 335 00:13:46,008 --> 00:13:47,779 Yeah. It's great to hear privacy, 336 00:13:48,153 --> 00:13:50,877 and I know we've talked so much about 337 00:13:51,488 --> 00:13:52,362 how some of... 338 00:13:53,014 --> 00:13:53,334 Payers, 339 00:13:54,133 --> 00:13:55,192 perhaps homegrown 340 00:13:55,650 --> 00:13:59,779 Pd systems or legacy Pd systems do present 341 00:14:00,220 --> 00:14:03,340 the risk of outdated or inaccurate provider data. 342 00:14:03,580 --> 00:14:04,080 So 343 00:14:04,540 --> 00:14:07,154 to end our conversation, I wanted to just 344 00:14:07,434 --> 00:14:09,688 go a little deeper on that. Can you 345 00:14:09,747 --> 00:14:13,017 share with our listeners what those risks are 346 00:14:13,017 --> 00:14:15,968 with having outdated or inaccurate provider data? 347 00:14:16,526 --> 00:14:17,026 And 348 00:14:17,339 --> 00:14:19,411 what would you recommend to to leaders who 349 00:14:19,411 --> 00:14:21,903 would really like to mitigate those risks effectively? 350 00:14:23,236 --> 00:14:24,671 Awesome. And good question. 351 00:14:25,243 --> 00:14:25,641 The 352 00:14:26,277 --> 00:14:27,652 potential risks associated 353 00:14:28,027 --> 00:14:28,266 with, 354 00:14:29,061 --> 00:14:32,734 out outdated or inaccurate provider data or very 355 00:14:32,734 --> 00:14:34,878 significant. In fact it of impacts, 356 00:14:35,831 --> 00:14:37,579 various aspects of, 357 00:14:38,135 --> 00:14:39,350 the health care 358 00:14:39,803 --> 00:14:40,254 operations 359 00:14:40,851 --> 00:14:41,486 you know, like, 360 00:14:42,520 --> 00:14:43,871 claims, processing errors. 361 00:14:44,666 --> 00:14:46,812 When you have inaccurate provider data, 362 00:14:47,527 --> 00:14:49,378 this could actually lead to 363 00:14:50,009 --> 00:14:52,330 incorrect claim payments or denials. 364 00:14:52,970 --> 00:14:56,409 And this can actually cause financial losses for 365 00:14:56,409 --> 00:14:58,089 help plans and a lot of, 366 00:14:59,140 --> 00:15:01,846 frustrations within the provider community. 367 00:15:02,881 --> 00:15:06,701 It also adds the administrative, burden within the 368 00:15:06,701 --> 00:15:08,626 provider community by this you know, then they 369 00:15:08,626 --> 00:15:11,255 need to do the necessary outreach in order 370 00:15:11,255 --> 00:15:14,601 to resolve, those issues. The payments can also 371 00:15:14,601 --> 00:15:17,904 be delayed when you have outdated information, sometimes, 372 00:15:18,838 --> 00:15:19,656 you know, the 373 00:15:20,032 --> 00:15:22,502 your your payments are all gonna get delayed. 374 00:15:23,059 --> 00:15:23,537 And 375 00:15:24,015 --> 00:15:26,460 you know, this affects their cash flow 376 00:15:27,378 --> 00:15:29,316 and it can also stream the 377 00:15:29,775 --> 00:15:32,112 relationship and the trust that the providers 378 00:15:32,571 --> 00:15:33,130 will have, 379 00:15:33,864 --> 00:15:36,258 you know, between them and the health plan. 380 00:15:37,615 --> 00:15:41,227 It's also now important that health plans must 381 00:15:41,285 --> 00:15:41,659 comply 382 00:15:42,096 --> 00:15:42,993 with various, 383 00:15:43,685 --> 00:15:44,956 regulatory requirements, 384 00:15:45,988 --> 00:15:47,100 around provider data, 385 00:15:48,450 --> 00:15:51,284 inaccurate provider data and publishing it on the 386 00:15:51,404 --> 00:15:53,945 provider directory can lead to non compliance, 387 00:15:54,819 --> 00:15:55,692 resulting in, 388 00:15:56,487 --> 00:15:56,987 penalties, 389 00:15:57,440 --> 00:16:01,744 fines and overall, the repetition damaged force the 390 00:16:01,744 --> 00:16:04,152 health plan itself. And members, 391 00:16:04,765 --> 00:16:08,604 rely heavily on the provider directory to find 392 00:16:08,660 --> 00:16:11,614 an a network providers to access care. 393 00:16:12,566 --> 00:16:16,081 And inaccurate and outdated information can actually lead 394 00:16:17,009 --> 00:16:18,620 to difficulties and challenges 395 00:16:18,929 --> 00:16:21,235 for finding or locating a provider. 396 00:16:21,712 --> 00:16:23,699 And that can also lead to, you know, 397 00:16:23,858 --> 00:16:24,756 your member 398 00:16:25,131 --> 00:16:26,346 dissatisfaction rates 399 00:16:27,054 --> 00:16:28,881 see that also, you know, 400 00:16:29,676 --> 00:16:32,298 when it comes to accurate provider data, it's 401 00:16:32,298 --> 00:16:33,887 gonna be extremely crucial, 402 00:16:34,940 --> 00:16:37,899 for patients to receive appropriate care. And if 403 00:16:37,899 --> 00:16:39,680 you have an outdated 404 00:16:40,300 --> 00:16:40,940 information out there, 405 00:16:41,915 --> 00:16:44,654 you know, sometimes, this could actually lead to 406 00:16:44,795 --> 00:16:45,295 accidental 407 00:16:45,995 --> 00:16:47,535 of patients to 408 00:16:47,915 --> 00:16:49,215 providers who probably 409 00:16:49,769 --> 00:16:50,667 or either, 410 00:16:51,043 --> 00:16:53,932 you know, no longer working in a particular 411 00:16:54,148 --> 00:16:55,126 location or 412 00:16:55,741 --> 00:16:58,264 are no longer part of your network or 413 00:16:58,384 --> 00:17:00,798 Sometimes if they have an outdated 414 00:17:01,414 --> 00:17:04,443 credentialing, that could also post a challenge. And 415 00:17:04,443 --> 00:17:06,936 all of this, I would say leads to 416 00:17:07,249 --> 00:17:08,127 a lot of, 417 00:17:08,686 --> 00:17:09,186 operational 418 00:17:09,804 --> 00:17:10,304 inefficiencies. 419 00:17:10,921 --> 00:17:11,320 And 420 00:17:11,799 --> 00:17:14,035 usually, health plans end up having a lot 421 00:17:14,035 --> 00:17:14,434 of, 422 00:17:15,152 --> 00:17:15,950 administrative staff, 423 00:17:17,083 --> 00:17:19,876 and resources to correct correct some of these 424 00:17:19,876 --> 00:17:22,212 errors and resolve of these conflicts. 425 00:17:22,670 --> 00:17:25,419 And this is overall, it bumps up the 426 00:17:25,634 --> 00:17:26,610 administrative costs 427 00:17:26,984 --> 00:17:28,652 for, any health plans. 428 00:17:29,366 --> 00:17:32,226 And, I, say that, you know, in order 429 00:17:32,226 --> 00:17:33,043 to mitigate 430 00:17:33,417 --> 00:17:34,393 these just 431 00:17:35,257 --> 00:17:37,399 it's gonna be important that and, you know, 432 00:17:37,558 --> 00:17:40,438 of the health plans considered a few areas 433 00:17:40,493 --> 00:17:41,445 when it comes to, 434 00:17:42,095 --> 00:17:42,809 forward thinking. 435 00:17:43,444 --> 00:17:45,904 You need to have a, a provided data 436 00:17:45,904 --> 00:17:48,150 platform that would essentially help 437 00:17:48,840 --> 00:17:49,792 any health plan, 438 00:17:50,761 --> 00:17:54,500 in implementing a process that word offer regular 439 00:17:54,500 --> 00:17:56,727 and systematic provider updates, 440 00:17:57,695 --> 00:18:00,474 that would ensure that, the provider data remains 441 00:18:00,474 --> 00:18:00,974 accurate 442 00:18:01,427 --> 00:18:02,221 and current. 443 00:18:03,015 --> 00:18:06,294 And these need to have automated feeds 444 00:18:07,085 --> 00:18:09,804 almost you know, real me real time if 445 00:18:09,804 --> 00:18:11,724 possible so that you know and the hill 446 00:18:11,724 --> 00:18:12,704 pads feel confident 447 00:18:13,244 --> 00:18:15,619 that at any given point in time, it's 448 00:18:15,739 --> 00:18:18,772 the most recent data that is made available 449 00:18:18,772 --> 00:18:19,810 for consumption. 450 00:18:20,927 --> 00:18:24,040 As we in bring in provider data, it 451 00:18:24,040 --> 00:18:28,203 is also important that health plans have 452 00:18:28,813 --> 00:18:32,397 a verification process of the provider data, from 453 00:18:32,397 --> 00:18:34,865 multiple sources just so that, you know, you 454 00:18:34,865 --> 00:18:38,446 don't heavily trust on 1 single source when 455 00:18:38,446 --> 00:18:39,981 it comes to maintaining 456 00:18:40,436 --> 00:18:41,493 accuracy and reliability 457 00:18:42,043 --> 00:18:43,554 for your provided information. 458 00:18:44,349 --> 00:18:45,621 You're better off, you know, having, 459 00:18:46,495 --> 00:18:48,086 an added attest station source or, 460 00:18:48,722 --> 00:18:51,201 could be multiple source is that provide your 461 00:18:51,201 --> 00:18:52,869 provider data, and to talk at all, you 462 00:18:52,869 --> 00:18:55,094 have your roster update So it's gonna be 463 00:18:55,094 --> 00:18:56,786 important to have a platform 464 00:18:57,240 --> 00:18:59,822 says that would... That can actually curate data 465 00:18:59,879 --> 00:19:01,708 from all these different sources, 466 00:19:02,185 --> 00:19:03,060 and essentially, 467 00:19:03,855 --> 00:19:06,638 you know, create a golden record of provider 468 00:19:06,638 --> 00:19:07,138 data 469 00:19:07,845 --> 00:19:10,410 that can be consumed for a downstream business 470 00:19:10,465 --> 00:19:10,783 process. 471 00:19:11,657 --> 00:19:14,753 Automation is gonna be extremely key. And the 472 00:19:14,753 --> 00:19:16,421 real time updates is gonna, 473 00:19:16,913 --> 00:19:17,413 significantly 474 00:19:17,869 --> 00:19:19,085 reduce the risk of 475 00:19:19,620 --> 00:19:19,780 inaccuracies. 476 00:19:20,655 --> 00:19:22,646 So it's important that, there is, 477 00:19:23,681 --> 00:19:24,875 automation that is in place, 478 00:19:25,448 --> 00:19:27,921 so that, you can reduce the 479 00:19:28,400 --> 00:19:29,697 manual errors 480 00:19:30,314 --> 00:19:33,185 that could any given point in time when 481 00:19:33,185 --> 00:19:34,780 it comes to provider data. 482 00:19:35,752 --> 00:19:37,903 And also, they're given that, 483 00:19:38,461 --> 00:19:41,192 the provided data can come in in different 484 00:19:41,249 --> 00:19:42,285 forms and shapes, 485 00:19:43,099 --> 00:19:45,356 you know, trying to standardize that 486 00:19:45,735 --> 00:19:47,014 across the board is 487 00:19:47,653 --> 00:19:49,810 I would say, is a challenge that cannot 488 00:19:49,810 --> 00:19:52,478 be resolved, for that, the only way to 489 00:19:52,536 --> 00:19:55,643 overcome that is, by using a platform that 490 00:19:55,643 --> 00:19:57,794 can actually adapt to various, 491 00:19:58,511 --> 00:19:59,945 to know, to all of the data that 492 00:19:59,945 --> 00:20:02,823 is coming in various forms and shapes so 493 00:20:02,823 --> 00:20:04,731 that it can make it into the system 494 00:20:04,731 --> 00:20:06,424 in a timely fashion for 495 00:20:07,117 --> 00:20:09,502 consumption. And overall, I would say that 496 00:20:10,630 --> 00:20:11,503 educating staff 497 00:20:11,900 --> 00:20:15,790 on how important it is to maintain provider 498 00:20:15,790 --> 00:20:18,807 data is going to be extremely crucial so 499 00:20:18,807 --> 00:20:21,526 that if health plan has the opportunity to 500 00:20:21,526 --> 00:20:22,981 set high standards 501 00:20:23,833 --> 00:20:24,549 for the business. 502 00:20:26,060 --> 00:20:26,560 Wonderful. 503 00:20:26,936 --> 00:20:27,436 Par 504 00:20:28,625 --> 00:20:31,184 appreciate all of the insights today. I appreciate... 505 00:20:31,664 --> 00:20:33,285 Especially appreciate what you said about 506 00:20:33,664 --> 00:20:35,184 striving for that. I think he called it 507 00:20:35,184 --> 00:20:37,919 a golden record of provider data, and 508 00:20:38,717 --> 00:20:40,712 all the possibilities we're seeing to achieve that 509 00:20:40,712 --> 00:20:43,106 with technology and automation and 510 00:20:43,664 --> 00:20:45,181 platforms that you described. So... 511 00:20:45,914 --> 00:20:48,307 Thank you again for outlining really how provider 512 00:20:48,307 --> 00:20:50,061 data management is at the intersection of so 513 00:20:50,061 --> 00:20:51,976 many issues that are top of mind for 514 00:20:51,976 --> 00:20:54,129 payer leaders right now. Really enjoyed having you 515 00:20:54,129 --> 00:20:54,847 on the podcast. 516 00:20:55,819 --> 00:20:57,887 You so much. I appreciate the opportunity as 517 00:20:57,887 --> 00:20:58,523 well. Thank you. 518 00:20:59,239 --> 00:21:01,864 Yeah, thank you. And we'd also like to 519 00:21:01,864 --> 00:21:04,910 thank Health Ed. For sponsoring today's podcast episode. 520 00:21:05,548 --> 00:21:07,304 So listeners, if you'd like to tune into 521 00:21:07,304 --> 00:21:09,699 more podcast from Becker health care, please be 522 00:21:09,699 --> 00:21:12,345 sure to visit our podcast page, at becker 523 00:21:12,345 --> 00:21:13,776 hospital review dot com.