1 00:00:00,160 --> 00:00:02,899 Evernorth brings the power of wonder and relentless 2 00:00:02,960 --> 00:00:05,919 innovation to create world class pharmacy care and 3 00:00:05,919 --> 00:00:09,199 benefit solutions. Our connected health services make the 4 00:00:09,199 --> 00:00:12,080 treatment, prediction, and prevention of health care's most 5 00:00:12,080 --> 00:00:13,139 complex conditions 6 00:00:13,605 --> 00:00:16,344 easier and more accessible as we drive organizations 7 00:00:16,725 --> 00:00:19,524 and people forward. Ever North Home Based Care 8 00:00:19,524 --> 00:00:22,004 provides value based care that helps patients with 9 00:00:22,004 --> 00:00:23,384 multiple chronic conditions 10 00:00:23,765 --> 00:00:26,085 and social determinant of health barriers get the 11 00:00:26,085 --> 00:00:28,884 care they need and the personalized experience they 12 00:00:28,884 --> 00:00:31,660 deserve. We serve patients who struggle to navigate 13 00:00:31,660 --> 00:00:34,060 the health care system by bringing high quality 14 00:00:34,060 --> 00:00:34,560 primary 15 00:00:34,939 --> 00:00:37,739 and preventative care services to the home. By 16 00:00:37,739 --> 00:00:40,700 providing clinical care and support services that provide 17 00:00:40,700 --> 00:00:44,105 whole person care, we improve health equity, access, 18 00:00:44,105 --> 00:00:46,605 and outcomes for the populations we serve. 19 00:00:47,865 --> 00:00:49,865 This is Gracelyn Keller with the Becker's Healthcare 20 00:00:49,865 --> 00:00:51,885 Podcast, and we are live with the 2024 21 00:00:52,185 --> 00:00:53,405 payer issues roundtable. 22 00:00:53,865 --> 00:00:55,725 I am joined right now by Mitchell Gordorkin, 23 00:00:55,945 --> 00:00:58,549 who is the VP of business development at 24 00:00:58,549 --> 00:01:01,350 Certify. So, Mitchell, thanks for being here. Let's 25 00:01:01,350 --> 00:01:03,909 start our conversation off today by briefly introducing 26 00:01:03,909 --> 00:01:06,229 yourself and talking about your current role at 27 00:01:06,229 --> 00:01:08,310 your organization. Sure. Thanks. Well, first of all, 28 00:01:08,310 --> 00:01:09,829 thanks so much for having me. It's, it's 29 00:01:09,829 --> 00:01:11,590 an honor to be on, and, love the 30 00:01:11,590 --> 00:01:13,290 conference. We come here every year. 31 00:01:13,885 --> 00:01:15,325 So like you said, my name is Mitchell 32 00:01:15,325 --> 00:01:17,724 Gerdogan. I'm the vice president of of business 33 00:01:17,724 --> 00:01:18,864 development at Certify, 34 00:01:19,405 --> 00:01:22,305 an API first provider network management platform. 35 00:01:22,844 --> 00:01:25,724 We are a provider data infrastructure directly plugged 36 00:01:25,724 --> 00:01:26,944 into primary sources. 37 00:01:27,420 --> 00:01:29,739 Returning thousands of provider data points in real 38 00:01:29,739 --> 00:01:30,239 time. 39 00:01:30,620 --> 00:01:32,299 What that does is that enables us to 40 00:01:32,299 --> 00:01:35,180 modernize the entire provider life cycle from initial 41 00:01:35,180 --> 00:01:36,640 onboarding through credentialing, 42 00:01:36,939 --> 00:01:39,840 enrollment, ongoing monitoring, and roster management. 43 00:01:40,295 --> 00:01:42,775 And perhaps even more importantly, we store every 44 00:01:42,775 --> 00:01:45,734 single data point using entire provider journey in 45 00:01:45,734 --> 00:01:47,275 a centralized provider database 46 00:01:47,734 --> 00:01:50,134 at the atomic level. Those data points can 47 00:01:50,134 --> 00:01:52,534 be easily updated from other systems or reused 48 00:01:52,534 --> 00:01:54,795 across the health plan's downstream network operations 49 00:01:55,210 --> 00:01:57,790 to power accurate directories or claims payments. 50 00:01:58,409 --> 00:02:00,010 All of this is in a pursuit of 51 00:02:00,010 --> 00:02:01,790 our mission to lay the provider infrastructure 52 00:02:02,250 --> 00:02:04,409 upon which the next generation of provider data 53 00:02:04,409 --> 00:02:06,650 products can be built and our vision of 54 00:02:06,650 --> 00:02:10,189 1 API, 1 provider ID, frictionless provider data. 55 00:02:11,245 --> 00:02:13,644 Wonderful. Thank you for being here, and let's 56 00:02:13,644 --> 00:02:16,364 start our conversation off with engagement. So at 57 00:02:16,364 --> 00:02:18,525 an industry level, how would you describe the 58 00:02:18,525 --> 00:02:21,905 biggest barriers to effectively serving and engaging members? 59 00:02:21,965 --> 00:02:22,944 And what opportunities 60 00:02:23,245 --> 00:02:25,185 do you see for large scale improvements, 61 00:02:25,669 --> 00:02:26,870 and how are you applying this in your 62 00:02:26,870 --> 00:02:27,610 current strategy? 63 00:02:27,909 --> 00:02:29,430 Yeah. I think it's a great question. In 64 00:02:29,430 --> 00:02:31,370 in our industry, the biggest barrier, 65 00:02:31,750 --> 00:02:33,849 to effectively serving and engaging members 66 00:02:34,229 --> 00:02:36,709 really starts with the providers and reducing the 67 00:02:36,709 --> 00:02:38,409 administrative burden on providers 68 00:02:38,764 --> 00:02:41,185 to maintain up to date data, which ultimately 69 00:02:41,324 --> 00:02:42,705 feeds health plan directories, 70 00:02:43,004 --> 00:02:45,025 claim processes, and member experiences. 71 00:02:45,884 --> 00:02:48,284 Today, on average, a provider must engage with 72 00:02:48,284 --> 00:02:50,844 10 different systems to accurately update their data 73 00:02:50,844 --> 00:02:52,625 across multiple different health plans. 74 00:02:53,000 --> 00:02:54,840 That means every time they have to update 75 00:02:54,840 --> 00:02:56,620 an address or contact information, 76 00:02:57,000 --> 00:02:58,520 they have to go to 10 different places 77 00:02:58,520 --> 00:02:59,659 to update that information. 78 00:03:00,199 --> 00:03:01,979 The burden on them leads to noncompliance, 79 00:03:02,439 --> 00:03:03,340 stale datasets, 80 00:03:04,039 --> 00:03:07,159 that immediately become inconsistent and inaccurate across health 81 00:03:07,159 --> 00:03:07,900 plan directories. 82 00:03:08,355 --> 00:03:10,754 And due to the inefficiency, the error rates, 83 00:03:10,754 --> 00:03:13,075 and the rework, the admin spend by payers 84 00:03:13,075 --> 00:03:16,055 and health care organizations currently represents 30% 85 00:03:16,355 --> 00:03:18,455 of excess US health care spending. 86 00:03:18,995 --> 00:03:20,754 That cost ends up being borne by the 87 00:03:20,754 --> 00:03:21,254 members. 88 00:03:21,770 --> 00:03:24,090 And moreover, more than half of US providers 89 00:03:24,090 --> 00:03:26,409 report delays in patient care due to inaccurate 90 00:03:26,409 --> 00:03:28,569 provider data. So in addition to those higher 91 00:03:28,569 --> 00:03:31,629 costs, the patient experiences themselves are suffering tremendously. 92 00:03:32,490 --> 00:03:34,569 From our perspective, the work to maintain accurate 93 00:03:34,569 --> 00:03:36,830 provider data starts at the time of credentialing. 94 00:03:37,235 --> 00:03:39,074 It's the first interaction a provider has with 95 00:03:39,074 --> 00:03:40,455 a health plan, and oftentimes, 96 00:03:40,995 --> 00:03:43,395 we hear that credentialing just is not an 97 00:03:43,395 --> 00:03:44,615 asset to our company. 98 00:03:44,995 --> 00:03:46,754 And we understand that. And to some extent, 99 00:03:46,754 --> 00:03:47,814 that may be true. 100 00:03:48,275 --> 00:03:50,034 However, the provider data that a health plan 101 00:03:50,034 --> 00:03:52,710 receives during the credentialing process is robust and 102 00:03:52,710 --> 00:03:54,629 is certainly an asset that can be and 103 00:03:54,629 --> 00:03:56,650 should be used across a health plan's organization. 104 00:03:57,430 --> 00:04:00,009 When collected, ingested, and stored correctly, 105 00:04:00,310 --> 00:04:03,210 that data becomes immensely valuable in feeding streamlined, 106 00:04:03,349 --> 00:04:04,969 efficient downstream processes 107 00:04:05,395 --> 00:04:07,634 and reducing the ongoing burden on providers to 108 00:04:07,634 --> 00:04:09,655 maintain just that small piece of dataset. 109 00:04:10,275 --> 00:04:12,995 In Certify, we're laser focused on reducing provider 110 00:04:12,995 --> 00:04:15,395 burden by asking the provider for only the 111 00:04:15,395 --> 00:04:18,035 information we can't get from primary sources during 112 00:04:18,035 --> 00:04:19,095 the onboarding process. 113 00:04:19,730 --> 00:04:22,389 Through our open APIs, we enable peak interoperability 114 00:04:22,689 --> 00:04:25,170 with other provider data systems. We can ingest 115 00:04:25,170 --> 00:04:27,889 full rosters or just atomic level updates from 116 00:04:27,889 --> 00:04:30,449 providers, provider groups, or health systems in any 117 00:04:30,449 --> 00:04:30,949 format. 118 00:04:31,384 --> 00:04:33,064 And the data updates on our back end 119 00:04:33,064 --> 00:04:35,865 directly stored cleanly and centrally to be used 120 00:04:35,865 --> 00:04:37,964 in any downstream provider data processes. 121 00:04:38,425 --> 00:04:40,425 Our thesis is that if we ask providers 122 00:04:40,425 --> 00:04:42,584 for less data in less places, we can 123 00:04:42,584 --> 00:04:44,664 get them onboarded with less friction, get them 124 00:04:44,664 --> 00:04:47,050 into the network, help them maintain the accuracy 125 00:04:47,050 --> 00:04:48,750 of that data, and, essentially, 126 00:04:49,290 --> 00:04:51,689 increase access to quality care for the patients 127 00:04:51,689 --> 00:04:52,509 that need it. 128 00:04:53,689 --> 00:04:55,550 And shifting gears to leadership, 129 00:04:55,850 --> 00:04:58,430 keeping pace in today's dynamic health care leaders, 130 00:04:58,785 --> 00:05:00,004 landscape is challenging. 131 00:05:00,465 --> 00:05:01,904 So what is a piece of advice you'd 132 00:05:01,904 --> 00:05:03,925 share with peer leaders to grow their businesses 133 00:05:04,064 --> 00:05:06,384 while keeping members top of mind? Yeah. I 134 00:05:06,384 --> 00:05:08,785 would just encourage healthcare leaders to pressure test 135 00:05:08,785 --> 00:05:11,444 and future proof their existing systems and processes. 136 00:05:12,180 --> 00:05:14,580 Ask yourself critically if you're just trying to 137 00:05:14,580 --> 00:05:16,439 accomplish a point in time function, 138 00:05:16,819 --> 00:05:18,500 or if you're setting yourself up for long 139 00:05:18,500 --> 00:05:19,720 term growth and success. 140 00:05:20,100 --> 00:05:21,139 You know, we hear it all the time 141 00:05:21,139 --> 00:05:23,540 that the seven worst words in healthcare are, 142 00:05:23,540 --> 00:05:25,485 that's the way we've always done it. And 143 00:05:25,485 --> 00:05:26,925 my advice to health care leaders is to 144 00:05:26,925 --> 00:05:29,245 look at your 5 year provider data goals. 145 00:05:29,245 --> 00:05:31,824 Ask yourself, are you laying a modernized infrastructure 146 00:05:31,884 --> 00:05:34,285 today to help set your providers up and 147 00:05:34,285 --> 00:05:36,285 to set your organization up for your goals 148 00:05:36,285 --> 00:05:38,759 of tomorrow? And are you improving the provider 149 00:05:38,759 --> 00:05:41,879 experience, which ultimately improves the member experience and 150 00:05:41,879 --> 00:05:42,699 patient outcomes? 151 00:05:43,079 --> 00:05:45,079 Your provider network is one of your greatest 152 00:05:45,079 --> 00:05:46,219 assets of the organization. 153 00:05:46,839 --> 00:05:48,680 And are you making the right investments today 154 00:05:48,680 --> 00:05:50,279 to enable that network to meet the right 155 00:05:50,279 --> 00:05:52,439 members at the right place at the right 156 00:05:52,439 --> 00:05:52,904 time? 157 00:05:54,105 --> 00:05:57,384 And shifting gears again here, let's talk about 158 00:05:57,384 --> 00:06:00,185 technology, for example, since that is something that 159 00:06:00,185 --> 00:06:02,345 is obviously playing a huge role in the 160 00:06:02,345 --> 00:06:05,319 landscape today. So what role is that playing 161 00:06:05,319 --> 00:06:07,879 in your organization's growth strategies, and can you 162 00:06:07,879 --> 00:06:10,120 share examples of that? Yeah. Sure. So, I 163 00:06:10,120 --> 00:06:12,759 mean, technology is the core and the foundation 164 00:06:12,759 --> 00:06:14,300 of everything we do here at Certify. 165 00:06:14,680 --> 00:06:16,439 And as I mentioned earlier, our mission is 166 00:06:16,439 --> 00:06:18,759 to lay the infrastructure upon which the next 167 00:06:18,759 --> 00:06:20,894 generation of provided data products can be built. 168 00:06:21,055 --> 00:06:22,894 So it's not just technology for us. It's 169 00:06:22,894 --> 00:06:25,454 also how are we enabling other organizations to 170 00:06:25,454 --> 00:06:25,954 leverage, 171 00:06:26,414 --> 00:06:29,454 their own technology and improving their own workflows 172 00:06:29,454 --> 00:06:30,194 and processes. 173 00:06:30,974 --> 00:06:32,910 But to us, that means 4 key pillars. 174 00:06:33,149 --> 00:06:34,750 It means that we are a data first 175 00:06:34,750 --> 00:06:35,250 organization. 176 00:06:35,550 --> 00:06:37,790 Real time visibility into provider data at the 177 00:06:37,790 --> 00:06:40,189 atomic level is the core of everything that 178 00:06:40,189 --> 00:06:42,589 we do. And because we store that data 179 00:06:42,589 --> 00:06:45,649 discreetly and atomically, that makes us highly flexible. 180 00:06:45,944 --> 00:06:47,704 With just one line of code, we can 181 00:06:47,704 --> 00:06:50,264 configure our workflows to meet your organization's specific 182 00:06:50,264 --> 00:06:51,404 policies and procedures. 183 00:06:51,865 --> 00:06:53,464 And because that data is stored in a 184 00:06:53,464 --> 00:06:56,024 centralized data model, it feeds all of our 185 00:06:56,024 --> 00:06:59,250 modularized products and services from initial intake through 186 00:06:59,250 --> 00:06:59,750 credentialing, 187 00:07:00,370 --> 00:07:01,269 network enrollment, 188 00:07:01,569 --> 00:07:03,189 monitoring, and roster management. 189 00:07:03,649 --> 00:07:05,410 It can also feed any sort of claims 190 00:07:05,410 --> 00:07:08,129 processes or directory processes, which leads us to 191 00:07:08,129 --> 00:07:10,769 the 4th pillar that every single data point 192 00:07:10,769 --> 00:07:12,230 is available via APIs. 193 00:07:12,644 --> 00:07:14,644 Use whichever data points you need, whenever you 194 00:07:14,644 --> 00:07:16,324 need them, wherever you need them, send it 195 00:07:16,324 --> 00:07:18,324 to whichever data system you need upon any 196 00:07:18,324 --> 00:07:19,305 underlying trigger. 197 00:07:19,845 --> 00:07:21,125 It's not just the core of what we 198 00:07:21,125 --> 00:07:23,365 do, though. You know, it really enables our 199 00:07:23,365 --> 00:07:25,524 customers to grow into new markets, our health 200 00:07:25,524 --> 00:07:27,524 plans are in health systems to open new 201 00:07:27,524 --> 00:07:28,024 markets, 202 00:07:28,360 --> 00:07:31,319 to onboard new providers, to increase access, and 203 00:07:31,319 --> 00:07:31,819 ultimately, 204 00:07:32,279 --> 00:07:34,540 improve access to care and serve their members. 205 00:07:35,960 --> 00:07:38,840 And in an ever evolving regulatory environment, what 206 00:07:38,840 --> 00:07:41,259 tools and key strategies have helped your organization 207 00:07:41,400 --> 00:07:44,404 improve quality and clinical outcomes for members while 208 00:07:44,404 --> 00:07:45,305 staying compliant? 209 00:07:46,004 --> 00:07:47,764 Yeah. I think it's a great question. We 210 00:07:47,764 --> 00:07:50,345 are constantly in a in an evolving regulatory 211 00:07:50,485 --> 00:07:50,985 environment. 212 00:07:51,444 --> 00:07:53,845 Compliance regulations are changing, and and we live 213 00:07:53,845 --> 00:07:56,740 in a an amazing country with 52 individual 214 00:07:56,879 --> 00:07:59,539 jurisdictions, including Washington, DC and Puerto 215 00:08:00,000 --> 00:08:01,600 Rico. Each of them has its own unique 216 00:08:01,600 --> 00:08:04,560 primary data sources for upwards of 40 to 217 00:08:04,560 --> 00:08:06,879 50 different license types. They each have their 218 00:08:06,879 --> 00:08:09,300 own compliance rules, verification requirements. 219 00:08:09,904 --> 00:08:12,644 They vary by provider type, line of business. 220 00:08:13,104 --> 00:08:13,925 You know, historically, 221 00:08:14,704 --> 00:08:17,604 one small compliance change meant new job aids, 222 00:08:17,664 --> 00:08:18,404 new trainings, 223 00:08:18,944 --> 00:08:21,985 significant change management processes, which ultimately led to 224 00:08:21,985 --> 00:08:24,544 error prone processes, onboarding providers that may be 225 00:08:24,544 --> 00:08:25,044 noncompliant 226 00:08:25,500 --> 00:08:27,420 or not being able to main direct maintain 227 00:08:27,420 --> 00:08:30,000 directories, with the most up to date, legislature. 228 00:08:31,339 --> 00:08:33,019 For us, it's just one line of code 229 00:08:33,019 --> 00:08:35,440 to adjust one or any number of rules, 230 00:08:35,899 --> 00:08:38,379 or new compliance regulations spanning across those state 231 00:08:38,379 --> 00:08:40,620 lines, across those provider types, or across those 232 00:08:40,620 --> 00:08:41,120 networks. 233 00:08:41,644 --> 00:08:44,285 Because every single data point or action or 234 00:08:44,285 --> 00:08:46,524 event is logged on our back end, we 235 00:08:46,524 --> 00:08:49,165 can run programmatic scripts to ensure that workflows 236 00:08:49,165 --> 00:08:51,825 and datasets comply with the regulations and regulators 237 00:08:52,205 --> 00:08:54,764 of each individual jurisdiction, license type, or line 238 00:08:54,764 --> 00:08:57,920 of business, ensuring that providers are onboarded with 239 00:08:57,920 --> 00:09:00,320 peak quality and compliance, and they maintain that 240 00:09:00,320 --> 00:09:02,399 way throughout the life cycle of their engagement 241 00:09:02,399 --> 00:09:03,940 with the health plan or the system. 242 00:09:04,639 --> 00:09:07,120 Well, Mitchell, as we wrap our conversation up, 243 00:09:07,120 --> 00:09:08,720 are there any parting words you'd like to 244 00:09:08,720 --> 00:09:10,100 share on the podcast today? 245 00:09:10,504 --> 00:09:12,024 Yeah. I would just say that, you know, 246 00:09:12,024 --> 00:09:13,625 here at the conference, one of the big 247 00:09:13,625 --> 00:09:15,705 themes is how do we take a a 248 00:09:15,705 --> 00:09:17,884 data first approach to be able to improve 249 00:09:18,024 --> 00:09:20,524 access to care, improve outcomes for our members? 250 00:09:20,985 --> 00:09:23,730 It's really encouraging to see, the emphasis and 251 00:09:23,730 --> 00:09:25,570 the focus of data in today's healthcare and 252 00:09:25,570 --> 00:09:26,629 regulatory environment. 253 00:09:27,009 --> 00:09:27,670 I oftentimes 254 00:09:28,690 --> 00:09:32,370 compare health tech today to where FinTech was 255 00:09:32,370 --> 00:09:34,309 maybe 10 or even 20 years ago, 256 00:09:34,610 --> 00:09:37,590 you know, access to your financial data was 257 00:09:37,649 --> 00:09:38,149 historically 258 00:09:38,715 --> 00:09:40,955 you know, protected and siloed. And of course, 259 00:09:40,955 --> 00:09:43,215 it still is dealt with the highest security. 260 00:09:43,835 --> 00:09:46,335 But now it's actionable, it's accessible, it's transparent, 261 00:09:46,394 --> 00:09:48,654 and you have a big boom of different, 262 00:09:48,795 --> 00:09:51,434 you know, financial apps or financial platforms that 263 00:09:51,434 --> 00:09:53,134 can be built on top of that data. 264 00:09:53,319 --> 00:09:55,319 And I would just encourage everyone to think 265 00:09:55,319 --> 00:09:57,159 about health tech in the same way today 266 00:09:57,159 --> 00:09:59,959 where, you know, access to data access to 267 00:09:59,959 --> 00:10:02,199 analytics can really help us drive decision making 268 00:10:02,199 --> 00:10:02,699 processes, 269 00:10:03,079 --> 00:10:04,139 not just for providers, 270 00:10:04,519 --> 00:10:07,194 but patient outcomes as well. And so it's 271 00:10:07,194 --> 00:10:08,714 been really exciting to see all of that. 272 00:10:08,714 --> 00:10:09,834 It's been really exciting to see all the 273 00:10:09,834 --> 00:10:11,294 great leaders here at the conference. 274 00:10:11,674 --> 00:10:12,954 And, yeah, we're looking forward to a great 275 00:10:12,954 --> 00:10:15,355 time. Wonderful. Well, thank you for joining me 276 00:10:15,355 --> 00:10:17,454 today. Again, we are live at the 2024 277 00:10:17,754 --> 00:10:18,975 payer issues roundtable. 278 00:10:19,754 --> 00:10:20,495 Thank you.