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This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are live with the 2024
payer issues roundtable.
I am joined right now by Mitchell Gordorkin,
who is the VP of business development at
Certify. So, Mitchell, thanks for being here. Let's
start our conversation off today by briefly introducing
yourself and talking about your current role at
your organization. Sure. Thanks. Well, first of all,
thanks so much for having me. It's, it's
an honor to be on, and, love the
conference. We come here every year.
So like you said, my name is Mitchell
Gerdogan. I'm the vice president of of business
development at Certify,
an API first provider network management platform.
We are a provider data infrastructure directly plugged
into primary sources.
Returning thousands of provider data points in real
time.
What that does is that enables us to
modernize the entire provider life cycle from initial
onboarding through credentialing,
enrollment, ongoing monitoring, and roster management.
And perhaps even more importantly, we store every
single data point using entire provider journey in
a centralized provider database
at the atomic level. Those data points can
be easily updated from other systems or reused
across the health plan's downstream network operations
to power accurate directories or claims payments.
All of this is in a pursuit of
our mission to lay the provider infrastructure
upon which the next generation of provider data
products can be built and our vision of
1 API, 1 provider ID, frictionless provider data.
Wonderful. Thank you for being here, and let's
start our conversation off with engagement. So at
an industry level, how would you describe the
biggest barriers to effectively serving and engaging members?
And what opportunities
do you see for large scale improvements,
and how are you applying this in your
current strategy?
Yeah. I think it's a great question. In
in our industry, the biggest barrier,
to effectively serving and engaging members
really starts with the providers and reducing the
administrative burden on providers
to maintain up to date data, which ultimately
feeds health plan directories,
claim processes, and member experiences.
Today, on average, a provider must engage with
10 different systems to accurately update their data
across multiple different health plans.
That means every time they have to update
an address or contact information,
they have to go to 10 different places
to update that information.
The burden on them leads to noncompliance,
stale datasets,
that immediately become inconsistent and inaccurate across health
plan directories.
And due to the inefficiency, the error rates,
and the rework, the admin spend by payers
and health care organizations currently represents 30%
of excess US health care spending.
That cost ends up being borne by the
members.
And moreover, more than half of US providers
report delays in patient care due to inaccurate
provider data. So in addition to those higher
costs, the patient experiences themselves are suffering tremendously.
From our perspective, the work to maintain accurate
provider data starts at the time of credentialing.
It's the first interaction a provider has with
a health plan, and oftentimes,
we hear that credentialing just is not an
asset to our company.
And we understand that. And to some extent,
that may be true.
However, the provider data that a health plan
receives during the credentialing process is robust and
is certainly an asset that can be and
should be used across a health plan's organization.
When collected, ingested, and stored correctly,
that data becomes immensely valuable in feeding streamlined,
efficient downstream processes
and reducing the ongoing burden on providers to
maintain just that small piece of dataset.
In Certify, we're laser focused on reducing provider
burden by asking the provider for only the
information we can't get from primary sources during
the onboarding process.
Through our open APIs, we enable peak interoperability
with other provider data systems. We can ingest
full rosters or just atomic level updates from
providers, provider groups, or health systems in any
format.
And the data updates on our back end
directly stored cleanly and centrally to be used
in any downstream provider data processes.
Our thesis is that if we ask providers
for less data in less places, we can
get them onboarded with less friction, get them
into the network, help them maintain the accuracy
of that data, and, essentially,
increase access to quality care for the patients
that need it.
And shifting gears to leadership,
keeping pace in today's dynamic health care leaders,
landscape is challenging.
So what is a piece of advice you'd
share with peer leaders to grow their businesses
while keeping members top of mind? Yeah. I
would just encourage healthcare leaders to pressure test
and future proof their existing systems and processes.
Ask yourself critically if you're just trying to
accomplish a point in time function,
or if you're setting yourself up for long
term growth and success.
You know, we hear it all the time
that the seven worst words in healthcare are,
that's the way we've always done it. And
my advice to health care leaders is to
look at your 5 year provider data goals.
Ask yourself, are you laying a modernized infrastructure
today to help set your providers up and
to set your organization up for your goals
of tomorrow? And are you improving the provider
experience, which ultimately improves the member experience and
patient outcomes?
Your provider network is one of your greatest
assets of the organization.
And are you making the right investments today
to enable that network to meet the right
members at the right place at the right
time?
And shifting gears again here, let's talk about
technology, for example, since that is something that
is obviously playing a huge role in the
landscape today. So what role is that playing
in your organization's growth strategies, and can you
share examples of that? Yeah. Sure. So, I
mean, technology is the core and the foundation
of everything we do here at Certify.
And as I mentioned earlier, our mission is
to lay the infrastructure upon which the next
generation of provided data products can be built.
So it's not just technology for us. It's
also how are we enabling other organizations to
leverage,
their own technology and improving their own workflows
and processes.
But to us, that means 4 key pillars.
It means that we are a data first
organization.
Real time visibility into provider data at the
atomic level is the core of everything that
we do. And because we store that data
discreetly and atomically, that makes us highly flexible.
With just one line of code, we can
configure our workflows to meet your organization's specific
policies and procedures.
And because that data is stored in a
centralized data model, it feeds all of our
modularized products and services from initial intake through
credentialing,
network enrollment,
monitoring, and roster management.
It can also feed any sort of claims
processes or directory processes, which leads us to
the 4th pillar that every single data point
is available via APIs.
Use whichever data points you need, whenever you
need them, wherever you need them, send it
to whichever data system you need upon any
underlying trigger.
It's not just the core of what we
do, though. You know, it really enables our
customers to grow into new markets, our health
plans are in health systems to open new
markets,
to onboard new providers, to increase access, and
ultimately,
improve access to care and serve their members.
And in an ever evolving regulatory environment, what
tools and key strategies have helped your organization
improve quality and clinical outcomes for members while
staying compliant?
Yeah. I think it's a great question. We
are constantly in a in an evolving regulatory
environment.
Compliance regulations are changing, and and we live
in a an amazing country with 52 individual
jurisdictions, including Washington, DC and Puerto
Rico. Each of them has its own unique
primary data sources for upwards of 40 to
50 different license types. They each have their
own compliance rules, verification requirements.
They vary by provider type, line of business.
You know, historically,
one small compliance change meant new job aids,
new trainings,
significant change management processes, which ultimately led to
error prone processes, onboarding providers that may be
noncompliant
or not being able to main direct maintain
directories, with the most up to date, legislature.
For us, it's just one line of code
to adjust one or any number of rules,
or new compliance regulations spanning across those state
lines, across those provider types, or across those
networks.
Because every single data point or action or
event is logged on our back end, we
can run programmatic scripts to ensure that workflows
and datasets comply with the regulations and regulators
of each individual jurisdiction, license type, or line
of business, ensuring that providers are onboarded with
peak quality and compliance, and they maintain that
way throughout the life cycle of their engagement
with the health plan or the system.
Well, Mitchell, as we wrap our conversation up,
are there any parting words you'd like to
share on the podcast today?
Yeah. I would just say that, you know,
here at the conference, one of the big
themes is how do we take a a
data first approach to be able to improve
access to care, improve outcomes for our members?
It's really encouraging to see, the emphasis and
the focus of data in today's healthcare and
regulatory environment.
I oftentimes
compare health tech today to where FinTech was
maybe 10 or even 20 years ago,
you know, access to your financial data was
historically
you know, protected and siloed. And of course,
it still is dealt with the highest security.
But now it's actionable, it's accessible, it's transparent,
and you have a big boom of different,
you know, financial apps or financial platforms that
can be built on top of that data.
And I would just encourage everyone to think
about health tech in the same way today
where, you know, access to data access to
analytics can really help us drive decision making
processes,
not just for providers,
but patient outcomes as well. And so it's
been really exciting to see all of that.
It's been really exciting to see all the
great leaders here at the conference.
And, yeah, we're looking forward to a great
time. Wonderful. Well, thank you for joining me
today. Again, we are live at the 2024
payer issues roundtable.
Thank you.