1 00:00:00,160 --> 00:00:02,639 Hello, everyone. This is Jacob Emerson with Becker's 2 00:00:02,639 --> 00:00:04,639 Health Care. Thanks so much for tuning in 3 00:00:04,639 --> 00:00:06,960 to the Becker's Health Care podcast, where today 4 00:00:06,960 --> 00:00:09,779 we're gonna be talking about navigating network compliance 5 00:00:10,080 --> 00:00:12,500 and the top trends, value, and outcomes. 6 00:00:12,904 --> 00:00:15,464 So joining me for today's discussion is Gianni 7 00:00:15,464 --> 00:00:17,864 Aiello, who is the vice president of product 8 00:00:17,864 --> 00:00:20,184 at Verifiable. Gianni, thanks so much for taking 9 00:00:20,184 --> 00:00:21,304 the time to be with me on the 10 00:00:21,304 --> 00:00:22,204 podcast today. 11 00:00:22,744 --> 00:00:24,585 Yeah. Thank you, Jake. Absolute pleasure to be 12 00:00:24,585 --> 00:00:26,445 here. Excited for the conversation today. 13 00:00:27,079 --> 00:00:29,480 Likewise, Gianni. And before we dive into that, 14 00:00:29,720 --> 00:00:30,920 can you tell us a little bit more 15 00:00:30,920 --> 00:00:33,079 about yourself in terms of the the work 16 00:00:33,079 --> 00:00:34,060 you do at Verifiable 17 00:00:34,600 --> 00:00:36,760 and the role that the company plays within 18 00:00:36,760 --> 00:00:37,820 our health care system? 19 00:00:38,600 --> 00:00:40,674 Yeah. Sure. So, for the audience here, my 20 00:00:40,674 --> 00:00:42,195 my name is Jenny Hagan. I'm VP of 21 00:00:42,195 --> 00:00:42,695 ProductVerifiable, 22 00:00:43,394 --> 00:00:45,314 and I've been at the company now just 23 00:00:45,314 --> 00:00:46,534 over 18 months. 24 00:00:46,994 --> 00:00:48,674 But over the past 15 years, I've been 25 00:00:48,674 --> 00:00:51,015 a product leader at various different technology companies, 26 00:00:51,634 --> 00:00:54,594 including identity security and AI based voice to 27 00:00:54,594 --> 00:00:55,414 text solutions, 28 00:00:56,010 --> 00:00:58,270 both of which that served health care customers. 29 00:00:58,329 --> 00:01:01,049 So have a pretty extensive background in in 30 00:01:01,049 --> 00:01:02,429 serving health care organizations. 31 00:01:03,289 --> 00:01:04,030 At Verifiable, 32 00:01:04,810 --> 00:01:06,810 my role sort of centers around advanced our 33 00:01:06,810 --> 00:01:07,310 mission 34 00:01:07,609 --> 00:01:09,930 to become the autonomous system of record verified 35 00:01:09,930 --> 00:01:10,829 provider credentials. 36 00:01:11,484 --> 00:01:12,704 We really wanna streamline 37 00:01:13,084 --> 00:01:14,765 the often as as I think most people 38 00:01:14,765 --> 00:01:16,385 can understand the complex and 39 00:01:16,765 --> 00:01:19,405 sometimes resource intensive process in health care around 40 00:01:19,405 --> 00:01:19,905 credentialing, 41 00:01:20,604 --> 00:01:23,004 and we really want to divert those that 42 00:01:23,004 --> 00:01:24,765 that resource back to patient care. So we're 43 00:01:24,924 --> 00:01:26,545 that's sort of our primary mission. 44 00:01:27,130 --> 00:01:28,170 I'll sort of end with, like, we we 45 00:01:28,170 --> 00:01:30,569 believe that partitioning facility credentialing and monitoring shouldn't 46 00:01:30,569 --> 00:01:31,630 take weeks or months. 47 00:01:32,170 --> 00:01:33,609 It can be done in hours or even 48 00:01:33,609 --> 00:01:34,109 minutes. 49 00:01:34,569 --> 00:01:36,890 And, I think achieving that is is going 50 00:01:36,890 --> 00:01:39,689 to be about embracing technology, but also rethinking 51 00:01:39,689 --> 00:01:40,969 the way about the way way in which 52 00:01:40,969 --> 00:01:42,984 we go about doing some work. So, yeah, 53 00:01:42,984 --> 00:01:44,265 that's a little bit about me and and 54 00:01:44,265 --> 00:01:45,244 our mission at Verifiable. 55 00:01:45,625 --> 00:01:47,944 Fantastic. Well, appreciate you filling us in there, 56 00:01:47,944 --> 00:01:51,405 Gianni. And as you know, compliance is crucial 57 00:01:51,545 --> 00:01:52,284 in maintaining 58 00:01:52,665 --> 00:01:54,765 trust with patients and organizational 59 00:01:55,064 --> 00:01:55,564 integrity. 60 00:01:56,109 --> 00:01:57,950 So to get us started, can you explain 61 00:01:57,950 --> 00:02:00,829 the core components of a successful network compliance 62 00:02:00,829 --> 00:02:01,329 program 63 00:02:01,789 --> 00:02:03,869 and the trends that you're seeing today across 64 00:02:03,869 --> 00:02:04,530 the landscape? 65 00:02:05,789 --> 00:02:07,969 Yeah. So there's sort of a varied perspective 66 00:02:08,189 --> 00:02:09,009 in the market 67 00:02:09,310 --> 00:02:11,854 around, like, what does what is needed for 68 00:02:11,854 --> 00:02:14,014 compliance. There's a lot of different elements to 69 00:02:14,014 --> 00:02:16,735 it. I'm I I obviously, given our focus 70 00:02:16,735 --> 00:02:18,115 is very credentialing centric, 71 00:02:18,895 --> 00:02:20,814 I'll I'll lean that way, but there are 72 00:02:20,814 --> 00:02:22,115 things that are very adjacent 73 00:02:22,495 --> 00:02:25,074 to compliance around things like network adequacy 74 00:02:25,729 --> 00:02:26,549 as an example, 75 00:02:26,849 --> 00:02:29,509 and, this the timing delivery of claims reimbursement 76 00:02:29,569 --> 00:02:31,329 that are that are part of a a 77 00:02:31,329 --> 00:02:31,829 compliance 78 00:02:32,129 --> 00:02:33,189 solution as well. 79 00:02:33,489 --> 00:02:35,250 But I'm gonna talk about sort of the 80 00:02:35,250 --> 00:02:37,409 the high level fundamentals that I think that 81 00:02:37,409 --> 00:02:40,675 make, a good compliance program irrespective of, like, 82 00:02:40,675 --> 00:02:42,675 the core mission of or the the use 83 00:02:42,675 --> 00:02:44,194 case that you might be solving within the 84 00:02:44,194 --> 00:02:45,014 scope of compliance. 85 00:02:45,635 --> 00:02:47,314 So I would say that the first step 86 00:02:47,314 --> 00:02:49,335 is really about data sharing and onboarding. 87 00:02:49,635 --> 00:02:51,474 There's always a step around how data is 88 00:02:51,474 --> 00:02:52,615 being shared between 89 00:02:53,060 --> 00:02:55,000 a provider organization and a payer organization, 90 00:02:55,459 --> 00:02:57,479 and that's often an area of friction. 91 00:02:57,780 --> 00:02:59,539 Rosters are a good example of, like, a 92 00:02:59,539 --> 00:03:01,400 data point or a a a format 93 00:03:01,699 --> 00:03:03,879 of data that's exchanged between organizations, 94 00:03:04,659 --> 00:03:07,444 and and having that exchange be as frictionless 95 00:03:07,664 --> 00:03:09,205 as possible is gonna be critical. 96 00:03:10,144 --> 00:03:12,805 The second step is, unsurprisingly, process automation. 97 00:03:13,264 --> 00:03:15,745 There is a lot of still manual activity 98 00:03:15,745 --> 00:03:17,205 that goes on in the process 99 00:03:17,664 --> 00:03:18,965 to exchange information, 100 00:03:19,344 --> 00:03:21,125 to validate and verify information, 101 00:03:21,750 --> 00:03:24,569 and then ultimately make decisions on that information. 102 00:03:25,189 --> 00:03:27,110 And so we believe that, you know, there 103 00:03:27,110 --> 00:03:29,430 there are some really compelling ways to to 104 00:03:29,430 --> 00:03:31,770 really better manage that that process, 105 00:03:32,310 --> 00:03:33,830 and and we think that customers need to 106 00:03:33,990 --> 00:03:36,344 sorry. Organizations need to drive towards that. 107 00:03:36,905 --> 00:03:38,344 And the first step is, like, an efficient 108 00:03:38,344 --> 00:03:40,104 and streamlined this is more specific to our 109 00:03:40,104 --> 00:03:41,645 world, like, credentialing process. 110 00:03:41,944 --> 00:03:43,224 We really do think that's sort of a 111 00:03:43,224 --> 00:03:45,405 starting point in the journey around compliance, 112 00:03:45,865 --> 00:03:47,564 around practitioners and facilities. 113 00:03:48,185 --> 00:03:50,745 Without having a credentialed facility or practitioner, you 114 00:03:50,745 --> 00:03:52,319 can't really get onto the other sections 115 00:03:53,520 --> 00:03:56,159 of compliance. And so having good packet creation, 116 00:03:56,159 --> 00:03:58,640 a focus committee review that focuses on risky 117 00:03:58,640 --> 00:03:59,379 cases versus 118 00:03:59,680 --> 00:04:01,620 everything that's coming through the organization 119 00:04:02,319 --> 00:04:03,460 is very important. 120 00:04:04,640 --> 00:04:06,159 And 2 more steps. The 4th step would 121 00:04:06,159 --> 00:04:09,265 be just provide them facility risk management. Like, 122 00:04:09,265 --> 00:04:10,564 okay. You've done credentialing, 123 00:04:11,425 --> 00:04:13,025 but that isn't where it ends. Right? A 124 00:04:13,025 --> 00:04:14,645 compliance program is an ongoing 125 00:04:15,585 --> 00:04:17,345 it's a program for a reason. It it 126 00:04:17,345 --> 00:04:19,764 needs ongoing monitoring. It needs ongoing management. 127 00:04:20,240 --> 00:04:21,519 So how do we make it so that 128 00:04:21,519 --> 00:04:22,660 as things change, 129 00:04:23,120 --> 00:04:25,459 practitioners change, facilities change, 130 00:04:25,839 --> 00:04:27,839 how are those risks being serviced in a 131 00:04:27,839 --> 00:04:28,339 way 132 00:04:28,720 --> 00:04:30,019 that makes the distribution 133 00:04:30,720 --> 00:04:32,019 much more straightforward and 134 00:04:32,894 --> 00:04:36,095 ultimately reduces down any potential liability concerns that 135 00:04:36,095 --> 00:04:37,954 might come from an issue that arises. 136 00:04:39,134 --> 00:04:40,814 And then last and certainly not least is 137 00:04:40,814 --> 00:04:42,814 just then then there is a a a 138 00:04:42,814 --> 00:04:45,214 network effect. Once this data is there, once 139 00:04:45,214 --> 00:04:45,875 it's available, 140 00:04:46,319 --> 00:04:48,639 how it can be distributed into other parts 141 00:04:48,639 --> 00:04:50,639 of the process, and sometimes it's not even 142 00:04:50,639 --> 00:04:52,420 compliance related processes, honestly. 143 00:04:52,879 --> 00:04:54,339 It could be something like just 144 00:04:54,879 --> 00:04:57,460 when do you unlock a specific provider 145 00:04:58,080 --> 00:05:00,944 from being available to for for claims reimbursement 146 00:05:00,944 --> 00:05:03,125 as part of an insurance plan. Like, 147 00:05:03,664 --> 00:05:05,504 the compliance program should be the arbor of 148 00:05:05,504 --> 00:05:06,245 that decision, 149 00:05:06,625 --> 00:05:08,485 and making sure that the system is interchangeable 150 00:05:08,544 --> 00:05:10,784 and quick to to allow that downstream system 151 00:05:10,784 --> 00:05:12,404 to to consume that context 152 00:05:12,784 --> 00:05:14,830 is really critical. So that's sort of the 153 00:05:14,830 --> 00:05:16,910 5 steps that we see, that are really 154 00:05:16,910 --> 00:05:19,089 important to a successful compliance program. 155 00:05:19,709 --> 00:05:22,029 Understood. And I appreciate you sharing those 5 156 00:05:22,029 --> 00:05:24,830 steps with us, Gianni. To follow-up with you, 157 00:05:24,830 --> 00:05:26,990 based on your experience and based off what 158 00:05:26,990 --> 00:05:27,490 verifiable 159 00:05:27,790 --> 00:05:30,574 is seen, ultimately, what's keeping payer organizations 160 00:05:30,954 --> 00:05:33,134 from effective network compliance? 161 00:05:33,514 --> 00:05:35,115 What are some of the barriers that that 162 00:05:35,115 --> 00:05:35,854 they're facing? 163 00:05:36,794 --> 00:05:38,394 Yeah. So I think there are there's gonna 164 00:05:38,394 --> 00:05:39,435 be a bit of a theme in some 165 00:05:39,435 --> 00:05:41,514 of my, like, my my thoughts here, I 166 00:05:41,514 --> 00:05:43,694 think. I think there's, like, an organizational 167 00:05:44,660 --> 00:05:46,279 reality, like, a business relationship 168 00:05:46,899 --> 00:05:48,980 thing or barrier, and then there's a technology 169 00:05:48,980 --> 00:05:50,180 barrier, and I'll talk about them both a 170 00:05:50,180 --> 00:05:50,919 little differently. 171 00:05:51,220 --> 00:05:53,300 So when it comes to the sort of 172 00:05:53,300 --> 00:05:56,019 the organizational barrier, you know, we are finding 173 00:05:56,019 --> 00:05:58,464 that there is a lack of efficient data 174 00:05:58,464 --> 00:05:59,365 sharing and collaboration 175 00:05:59,745 --> 00:06:01,764 between providers and payers in the industry. 176 00:06:02,305 --> 00:06:05,365 The relationship between these stakeholders often feels siloed 177 00:06:05,904 --> 00:06:07,365 with significant walls 178 00:06:07,824 --> 00:06:09,665 that need to be broken down, honestly. Like, 179 00:06:09,665 --> 00:06:10,964 it's it's a real problem. 180 00:06:11,389 --> 00:06:14,029 And without that partnership and streamlined process, compliance 181 00:06:14,029 --> 00:06:14,529 becomes 182 00:06:15,149 --> 00:06:17,169 really burdensome for everyone involved. 183 00:06:17,629 --> 00:06:19,310 Like, a major issue is the absence of 184 00:06:19,310 --> 00:06:22,189 an agreed upon standard for data exchange. Providers 185 00:06:22,189 --> 00:06:23,730 are often required to navigate, 186 00:06:24,110 --> 00:06:27,475 like, unique payer specific requirements for sharing information. 187 00:06:28,175 --> 00:06:30,574 Those requirements vary not because of, like, any 188 00:06:30,574 --> 00:06:32,194 meaningful difference in policy, 189 00:06:32,654 --> 00:06:35,214 but due to each payer's interpretation of those, 190 00:06:35,694 --> 00:06:37,074 those tasks and rules. 191 00:06:37,639 --> 00:06:40,379 So these differences aren't helping sort of anyone 192 00:06:40,839 --> 00:06:43,560 from an insurance perspective, like, drive differentiation. This 193 00:06:43,560 --> 00:06:45,980 is not like a a reason why organizations 194 00:06:46,199 --> 00:06:46,939 are differentiating. 195 00:06:47,560 --> 00:06:49,000 And so we really do need to break 196 00:06:49,000 --> 00:06:49,980 down that barrier 197 00:06:50,404 --> 00:06:51,845 because, you know, we do see we speak 198 00:06:51,845 --> 00:06:54,025 with we we fortunately serve both sides, 199 00:06:54,564 --> 00:06:56,165 and providers are having to deal with, like, 200 00:06:56,165 --> 00:06:59,465 15 different roster templates for different insurance companies. 201 00:06:59,925 --> 00:07:02,004 And they're having to provide different information, which 202 00:07:02,004 --> 00:07:04,245 means that data can sometimes get out of 203 00:07:04,245 --> 00:07:06,769 sync and and or different. And then on 204 00:07:06,769 --> 00:07:08,529 the on the insurance side, that means they 205 00:07:08,529 --> 00:07:10,849 also have to understand that the product the 206 00:07:10,849 --> 00:07:14,069 provider might be presenting information in incomplete formats. 207 00:07:14,529 --> 00:07:16,370 So that's one area. It's not really about 208 00:07:16,370 --> 00:07:18,545 technology. It's about, like, agreeing upon a set 209 00:07:18,545 --> 00:07:20,225 of principles, and I know that this is 210 00:07:20,225 --> 00:07:21,824 probably not this has been talked about for 211 00:07:21,824 --> 00:07:22,324 years. 212 00:07:22,705 --> 00:07:25,345 But and, honestly, until this gets resolved, this 213 00:07:25,345 --> 00:07:26,944 is gonna continue to be a real big 214 00:07:26,944 --> 00:07:28,324 challenge for a lot of organizations. 215 00:07:29,264 --> 00:07:30,645 We need some collective, 216 00:07:31,660 --> 00:07:33,660 decision making to to really break down that 217 00:07:33,660 --> 00:07:35,819 wall. I did wanna pull out that, like, 218 00:07:35,819 --> 00:07:37,979 we do also see that there is a 219 00:07:37,979 --> 00:07:40,300 real need on the technology side to just 220 00:07:40,300 --> 00:07:42,779 embrace more digitization. Like, I'm not we can 221 00:07:42,860 --> 00:07:44,379 we'll talk I'm sure we'll talk about that 222 00:07:44,379 --> 00:07:47,535 in in as we continue here. But, obviously, 223 00:07:47,835 --> 00:07:50,555 the more you can leverage Ditto assets and 224 00:07:50,555 --> 00:07:51,935 you can leverage more, 225 00:07:52,395 --> 00:07:54,955 electronic communications is going to drive much more 226 00:07:54,955 --> 00:07:56,714 efficiency here. And that's not just a statement 227 00:07:56,714 --> 00:07:59,355 of insurance and provider organizations. That's also the 228 00:07:59,355 --> 00:08:01,410 government and others that are the arborists of 229 00:08:01,410 --> 00:08:03,670 this information. And so we have to modernize 230 00:08:03,730 --> 00:08:05,649 in a lot of areas the technology stacks 231 00:08:05,649 --> 00:08:07,189 so we can become more efficient. 232 00:08:08,129 --> 00:08:09,569 Absolutely. And let me let me go back 233 00:08:09,569 --> 00:08:11,810 to your first point there, Gianni, about data 234 00:08:11,810 --> 00:08:12,310 privacy 235 00:08:12,610 --> 00:08:14,689 because we're we're constantly seeing the health care 236 00:08:14,689 --> 00:08:17,935 industry, both payers and providers, have to constantly 237 00:08:17,995 --> 00:08:21,035 deal with evolving laws and and regulations in 238 00:08:21,035 --> 00:08:21,774 this space. 239 00:08:22,235 --> 00:08:24,394 So how would you say that payers should 240 00:08:24,394 --> 00:08:27,855 be evolving their compliance programs with those evolving 241 00:08:27,915 --> 00:08:28,415 regulations? 242 00:08:29,210 --> 00:08:30,810 And then to follow-up with your second point, 243 00:08:30,810 --> 00:08:32,670 what's the role that digital transformation 244 00:08:33,210 --> 00:08:34,429 can play in that? 245 00:08:36,009 --> 00:08:38,590 Yeah. You know, evolving data proxy laws 246 00:08:39,049 --> 00:08:41,290 and regulations, I've I've I've been in another 247 00:08:41,290 --> 00:08:43,710 set sector, which is more about identity regulations. 248 00:08:43,769 --> 00:08:45,825 And so it's always an ever changing, 249 00:08:46,605 --> 00:08:47,745 benchmark. Right? 250 00:08:48,445 --> 00:08:49,965 But I think when it comes to digital 251 00:08:49,965 --> 00:08:52,605 transformation and compliance programs, you know, a digital 252 00:08:52,605 --> 00:08:53,985 footprint allows organizations 253 00:08:54,365 --> 00:08:57,004 to easily track where data resides and how 254 00:08:57,004 --> 00:08:59,404 it's stored and who is who has access 255 00:08:59,404 --> 00:08:59,940 to it. 256 00:09:00,500 --> 00:09:03,460 This level of visibility is almost impossible to 257 00:09:03,460 --> 00:09:05,700 achieve in a lot of the manual physical 258 00:09:05,700 --> 00:09:08,360 data management processes that sometimes still exist today, 259 00:09:08,740 --> 00:09:11,320 in particular where there's exchange between different services 260 00:09:11,379 --> 00:09:13,960 organizations around credentialing and managing these processes. 261 00:09:14,684 --> 00:09:17,004 So, like, with the right technologies, payers can 262 00:09:17,004 --> 00:09:17,985 control access, 263 00:09:18,605 --> 00:09:21,164 enforce robust security measures, and and most importantly, 264 00:09:21,164 --> 00:09:23,965 maintain sort of a detailed audit trail to 265 00:09:23,965 --> 00:09:26,384 track who is who is accessing or modifying 266 00:09:27,245 --> 00:09:30,449 this sensitive private data, right, which is ultimately 267 00:09:30,449 --> 00:09:32,389 where where the regulations are all moving. 268 00:09:32,690 --> 00:09:34,769 This transparency is not only helps in mitigating 269 00:09:34,769 --> 00:09:37,169 risk, but also ensures compliance and evolving regulatory 270 00:09:37,169 --> 00:09:39,329 framework. So if you have this benchmark and 271 00:09:39,329 --> 00:09:40,070 this foundation, 272 00:09:40,449 --> 00:09:42,529 it becomes much more straightforward for you to 273 00:09:42,529 --> 00:09:45,434 adjust as as the benchmarks change. 274 00:09:46,695 --> 00:09:48,774 You know, at Verifiable, we take this step 275 00:09:48,774 --> 00:09:50,695 further by providing sort of a deep audit 276 00:09:50,695 --> 00:09:51,995 trail across our platform. 277 00:09:52,375 --> 00:09:54,534 These trails sort of track every instance of 278 00:09:54,534 --> 00:09:56,534 data manipulation or access who have made the 279 00:09:56,534 --> 00:09:57,034 change, 280 00:09:57,654 --> 00:10:00,040 what was altered and when it occurred, And 281 00:10:00,040 --> 00:10:02,040 that sort of is the information that you 282 00:10:02,040 --> 00:10:03,980 need to be able to present in reports 283 00:10:04,519 --> 00:10:06,759 to anybody that is gonna be reviewing your 284 00:10:06,759 --> 00:10:07,259 privacy, 285 00:10:08,040 --> 00:10:10,920 regulations or or policies internally to make sure 286 00:10:10,920 --> 00:10:12,440 that you're you're keeping in line with those 287 00:10:12,440 --> 00:10:14,759 things and you don't expose yourself to additional 288 00:10:14,759 --> 00:10:15,105 risk. 289 00:10:15,824 --> 00:10:18,544 We also align with various accreditation bodies like 290 00:10:18,544 --> 00:10:19,044 NCQA 291 00:10:19,745 --> 00:10:22,004 around their expectations around handling, 292 00:10:22,784 --> 00:10:24,865 as well as joint commission and others to 293 00:10:24,865 --> 00:10:26,384 make sure that we're sort of meeting their 294 00:10:26,384 --> 00:10:28,464 minimum bar as well around the tracking of 295 00:10:28,464 --> 00:10:29,605 information as well. 296 00:10:30,289 --> 00:10:32,789 So, Johnny, let's talk about the ROI piece 297 00:10:32,850 --> 00:10:35,169 of all this. Obviously, it's it's important to 298 00:10:35,169 --> 00:10:38,149 create buy in on on new digital transformation 299 00:10:38,529 --> 00:10:39,029 projects. 300 00:10:39,809 --> 00:10:41,409 Can you share some examples for us in 301 00:10:41,409 --> 00:10:44,070 terms of short term and long term KPIs 302 00:10:44,209 --> 00:10:47,915 that you and Verifiable consider critical for a 303 00:10:47,915 --> 00:10:50,254 successful network compliance program. 304 00:10:50,634 --> 00:10:53,115 Ultimately, how can the leaders listening in right 305 00:10:53,115 --> 00:10:55,615 now measure their success in this space? 306 00:10:56,634 --> 00:10:58,235 Yeah. Obviously, we we we deal with a 307 00:10:58,235 --> 00:10:59,295 lot of different customers 308 00:11:00,410 --> 00:11:03,149 and organizations with actually varying different needs. 309 00:11:03,529 --> 00:11:05,950 But there are some sort of consistent perspectives 310 00:11:06,009 --> 00:11:07,850 here that we we do see irrespective of 311 00:11:07,850 --> 00:11:10,110 use case. And so in the short term, 312 00:11:10,410 --> 00:11:12,410 I think the most immediate ROI does tend 313 00:11:12,410 --> 00:11:14,804 to came come from an I don't think 314 00:11:14,804 --> 00:11:17,144 it's a surprise sort of efficiency gains internally. 315 00:11:17,764 --> 00:11:19,925 For example, our platform is incredibly efficient at 316 00:11:19,925 --> 00:11:22,485 performing primary source verifications and completing them in 317 00:11:22,485 --> 00:11:22,985 seconds. 318 00:11:23,605 --> 00:11:26,165 That translates to significant time and cost savings 319 00:11:26,165 --> 00:11:27,225 for internal teams 320 00:11:27,600 --> 00:11:29,759 that allows to freeze them from a lot 321 00:11:29,759 --> 00:11:31,279 of the repetitive tasks that they have to 322 00:11:31,279 --> 00:11:34,240 do there. It also improves the organization's risk 323 00:11:34,240 --> 00:11:37,200 posture because many customers were, you know, conducting 324 00:11:37,200 --> 00:11:38,100 as many as 325 00:11:38,879 --> 00:11:41,514 weren't even conducting certain verifications on Like, they 326 00:11:41,514 --> 00:11:43,355 were just didn't have the capacity to do 327 00:11:43,355 --> 00:11:45,294 it. So that leaves them exposed, 328 00:11:46,475 --> 00:11:48,095 when it comes down to, 329 00:11:48,634 --> 00:11:50,394 how they measure. Risk is always a more 330 00:11:50,394 --> 00:11:52,634 challenging ROI to measure. It tends to be 331 00:11:52,634 --> 00:11:54,659 like, what is the potential liability risk, which 332 00:11:54,819 --> 00:11:56,259 honestly, based on some of the cases that 333 00:11:56,259 --> 00:11:57,860 are out there, we're talking 1,000,000 and 1,000,000 334 00:11:57,860 --> 00:11:59,000 of dollars of potential 335 00:11:59,379 --> 00:12:02,740 liability risk. But there is real tangible efficiency 336 00:12:02,740 --> 00:12:04,659 gains that you can build an ROI model 337 00:12:04,659 --> 00:12:06,279 around in just internally 338 00:12:06,659 --> 00:12:08,684 around your team and how much more efficient 339 00:12:08,684 --> 00:12:11,324 you can be with certain digital transformation automation 340 00:12:11,324 --> 00:12:12,304 being put in place. 341 00:12:13,084 --> 00:12:14,144 In the long term, 342 00:12:14,684 --> 00:12:16,625 I think ROI is often seen 343 00:12:17,004 --> 00:12:19,264 in in sort of the speed and fluidity 344 00:12:19,485 --> 00:12:21,985 fluidity of data availability across the organization. 345 00:12:22,700 --> 00:12:24,940 So one of the inherent challenges is when 346 00:12:24,940 --> 00:12:26,460 you have sort of a bunch of disparate 347 00:12:26,460 --> 00:12:29,120 silos of data, you become much more inefficient 348 00:12:29,340 --> 00:12:30,399 in being able to 349 00:12:31,259 --> 00:12:33,519 flow through different scenarios and use cases, 350 00:12:34,379 --> 00:12:36,460 across the organization, and that creates sort of 351 00:12:36,460 --> 00:12:37,575 a rip ripple effect. 352 00:12:38,695 --> 00:12:40,695 We do see that these improvements lead to 353 00:12:40,695 --> 00:12:43,095 better you know, if if you solve the 354 00:12:43,095 --> 00:12:45,095 fluidity of data and how it can also 355 00:12:45,095 --> 00:12:46,794 be exchanged, so if you have a centralized 356 00:12:46,855 --> 00:12:49,014 data store where data is being shared across 357 00:12:49,014 --> 00:12:49,754 the organization 358 00:12:50,455 --> 00:12:51,915 and and it's and it's accurate, 359 00:12:52,820 --> 00:12:55,059 it leads to better member sentiment and stronger 360 00:12:55,059 --> 00:12:57,139 network adequacy, which you can measure. So you 361 00:12:57,139 --> 00:12:58,519 can actually tie 362 00:12:58,899 --> 00:13:02,040 member sentiment around things like your provider directory 363 00:13:02,660 --> 00:13:05,220 or the outcomes that you're driving from network 364 00:13:05,220 --> 00:13:05,720 adequacy 365 00:13:07,105 --> 00:13:07,684 to the 366 00:13:08,065 --> 00:13:10,784 improved efficiency of the collection of provider and 367 00:13:10,784 --> 00:13:13,345 facility information in a centralized store. And so 368 00:13:13,345 --> 00:13:14,944 we think that's another interest in our AI 369 00:13:14,944 --> 00:13:17,345 model that's a little bit more centered around 370 00:13:17,345 --> 00:13:18,245 the the member 371 00:13:18,625 --> 00:13:20,065 that is a more of a longer term 372 00:13:20,065 --> 00:13:21,504 play that once you get to a solid 373 00:13:21,504 --> 00:13:23,589 base, you can start to showcase the the 374 00:13:23,589 --> 00:13:26,070 tangible impact you're having there. So I think 375 00:13:26,070 --> 00:13:27,589 those are the sort of the primary areas 376 00:13:27,589 --> 00:13:29,830 I'd say. Efficiency gauge is obviously risk posture 377 00:13:29,830 --> 00:13:32,230 are the 2 short term. Speed and fluidity 378 00:13:32,230 --> 00:13:33,909 of data and and drive it towards member 379 00:13:33,909 --> 00:13:35,750 sentiment and network adequacy would be the more 380 00:13:35,750 --> 00:13:36,809 longer term place. 381 00:13:37,495 --> 00:13:39,894 Understood. And clearly still a lot of ongoing 382 00:13:39,894 --> 00:13:43,035 challenges in terms of network compliance success. 383 00:13:43,415 --> 00:13:45,175 But in that vein, Gianni, if you were 384 00:13:45,175 --> 00:13:47,415 looking ahead into your crystal balls as we 385 00:13:47,415 --> 00:13:48,715 enter a new year, 386 00:13:49,095 --> 00:13:50,695 what's one thing that you want health care 387 00:13:50,695 --> 00:13:53,159 leaders to be prepared for? And can you 388 00:13:53,159 --> 00:13:55,159 share some of the best practices that you've 389 00:13:55,159 --> 00:13:57,980 observed in your work with health care organizations 390 00:13:58,200 --> 00:13:59,100 all over the country? 391 00:14:00,279 --> 00:14:02,940 Yeah. I'm gonna I'm gonna probably, talk about 392 00:14:03,000 --> 00:14:04,379 2 things versus 1, 393 00:14:04,840 --> 00:14:06,360 cheat a little bit, because I do think 394 00:14:06,360 --> 00:14:07,985 that they're sort of I I've sort of 395 00:14:07,985 --> 00:14:09,365 touched it a little bit throughout, 396 00:14:09,745 --> 00:14:11,264 to to answer some of the other questions, 397 00:14:11,264 --> 00:14:12,225 but I think there are sort of 2 398 00:14:12,225 --> 00:14:14,384 areas to think about, honestly. 1 is sort 399 00:14:14,384 --> 00:14:17,184 of, like, leadership and organizational approach and some 400 00:14:17,184 --> 00:14:19,585 of the things that we observe with partners 401 00:14:19,585 --> 00:14:21,664 and organizations that we're working with and and 402 00:14:21,664 --> 00:14:24,000 and seeing success with. And then there's sort 403 00:14:24,000 --> 00:14:24,740 of the technology 404 00:14:25,919 --> 00:14:27,919 lens that I'm sure is sort of given 405 00:14:27,919 --> 00:14:30,000 my role and and what I represent would 406 00:14:30,000 --> 00:14:31,679 be what people would expect me to answer 407 00:14:31,679 --> 00:14:33,279 on. So I'll start with the leadership and 408 00:14:33,279 --> 00:14:35,059 then land on the technology. So 409 00:14:35,375 --> 00:14:37,534 I I think leaders who are achieving meaningful 410 00:14:37,534 --> 00:14:39,294 wins are those who sort of embrace the 411 00:14:39,294 --> 00:14:40,674 reality of digital transformation 412 00:14:41,454 --> 00:14:42,995 as an iterative journey 413 00:14:43,454 --> 00:14:45,154 rather than a one and done overhaul. 414 00:14:45,615 --> 00:14:46,815 We find that success 415 00:14:47,134 --> 00:14:49,534 the the most successful companies are focusing on 416 00:14:49,534 --> 00:14:52,470 incremental improvements in specific areas and coming back 417 00:14:52,470 --> 00:14:54,629 to sort of my 5 steps. Right? We 418 00:14:54,629 --> 00:14:56,490 have a number of customers that are, like, 419 00:14:56,629 --> 00:14:59,529 very focused on, for example, either the credentialing 420 00:14:59,670 --> 00:15:00,490 packet creation 421 00:15:01,110 --> 00:15:03,590 or the risk posture management on the compliance 422 00:15:03,590 --> 00:15:05,845 side, so the monitoring portion of it. And 423 00:15:05,845 --> 00:15:07,764 they they're they're very focused on that and 424 00:15:07,764 --> 00:15:09,225 getting that into a better place, 425 00:15:10,164 --> 00:15:12,585 as step 1, and and showing results 426 00:15:13,044 --> 00:15:13,945 as an example. 427 00:15:14,325 --> 00:15:15,065 And so 428 00:15:15,524 --> 00:15:16,644 I mean, that's a really, 429 00:15:17,205 --> 00:15:18,884 a critical thing, and we've seen that there 430 00:15:18,884 --> 00:15:21,379 are customers that are in contrast to the 431 00:15:21,459 --> 00:15:24,200 embark on on a more monolithic project approach, 432 00:15:24,899 --> 00:15:27,539 where they're attempting to completely reimagine the process 433 00:15:27,539 --> 00:15:28,360 in one go 434 00:15:28,740 --> 00:15:32,100 and often face significant changes or they tend 435 00:15:32,100 --> 00:15:34,574 to fail, honestly, to meet their goals. We've 436 00:15:34,574 --> 00:15:37,074 seen the approach work firsthand with 1 customer 437 00:15:37,294 --> 00:15:39,314 that I I unfortunately, I can't I can't 438 00:15:39,454 --> 00:15:41,314 state, but they're a very well known, 439 00:15:41,694 --> 00:15:43,774 insurance company, and they sort of become a 440 00:15:43,774 --> 00:15:46,110 beacon for this iterative methodology, and the result 441 00:15:46,110 --> 00:15:48,190 speaks to themselves. I think they've seen massive 442 00:15:48,190 --> 00:15:49,649 improvements in team morale 443 00:15:49,950 --> 00:15:52,209 across their compliance credentialing teams. 444 00:15:52,509 --> 00:15:55,309 They've seen measurable improvements in their key performance 445 00:15:55,309 --> 00:15:57,970 indicators and their focus areas, and they've ultimately 446 00:15:58,190 --> 00:15:58,690 seen, 447 00:15:59,345 --> 00:16:01,184 operational success as well. They've been able to 448 00:16:01,184 --> 00:16:03,105 achieve quicker time to value, and and they 449 00:16:03,105 --> 00:16:06,065 were able to realize their ROI model that 450 00:16:06,065 --> 00:16:07,904 presented the budget to go and do what 451 00:16:07,904 --> 00:16:09,584 they did. So and they did it through 452 00:16:09,584 --> 00:16:11,264 not trying to do everything, and and I 453 00:16:11,264 --> 00:16:13,339 think that's a really important thing 454 00:16:13,799 --> 00:16:16,360 that surprisingly still isn't always embraced, which is 455 00:16:16,360 --> 00:16:18,120 why I bring it up. Like, the amount 456 00:16:18,120 --> 00:16:19,720 of times we deal with customers that are 457 00:16:19,720 --> 00:16:21,980 trying to just reinvent the entire process 458 00:16:22,360 --> 00:16:25,240 from scratch, and FAO is sort of it's 459 00:16:25,240 --> 00:16:26,860 surprising that it still occurs. 460 00:16:27,644 --> 00:16:30,365 On the technology side, I think well, honestly, 461 00:16:30,365 --> 00:16:31,964 I'm not someone that I'm not the type 462 00:16:31,964 --> 00:16:34,125 of product leader that gets excited about technology 463 00:16:34,125 --> 00:16:35,824 for for for its own sake. 464 00:16:36,284 --> 00:16:38,044 I do think it's impossible to ignore the 465 00:16:38,044 --> 00:16:39,584 impact of automation and AI 466 00:16:40,149 --> 00:16:41,909 and what it will have in how you 467 00:16:41,909 --> 00:16:43,929 go about doing network compliance. 468 00:16:44,470 --> 00:16:47,690 In particular around credentialing, it it will change, 469 00:16:48,470 --> 00:16:50,710 how work is done. And I think leaders 470 00:16:50,710 --> 00:16:52,629 who embrace these tools are better positioned to 471 00:16:52,629 --> 00:16:53,850 drive meaningful results. 472 00:16:54,934 --> 00:16:56,934 And a network compliance involves many manual and 473 00:16:56,934 --> 00:16:58,934 time consuming tasks that don't really add a 474 00:16:58,934 --> 00:17:02,054 ton of, like, man like, don't require a 475 00:17:02,054 --> 00:17:04,375 lot of, like, critical understanding of things. I 476 00:17:04,375 --> 00:17:06,454 I, you know, for example, I I can 477 00:17:06,454 --> 00:17:08,570 perform these tasks not only more cost effectively, 478 00:17:08,570 --> 00:17:11,309 but often with higher accuracy than traditional approaches. 479 00:17:12,009 --> 00:17:13,850 And and we're seeing that, like, you know, 480 00:17:13,850 --> 00:17:16,490 at Verifiable, we're particularly excited about the potential 481 00:17:16,490 --> 00:17:17,850 of AI to address 2 sort of critical 482 00:17:17,850 --> 00:17:20,750 areas. 1 is in the data onboarding process 483 00:17:21,234 --> 00:17:23,554 where I can help highlight required data based 484 00:17:23,554 --> 00:17:26,034 on provider types. So whether it's an MD 485 00:17:26,034 --> 00:17:27,954 that's being credentialed in MP or RN, we 486 00:17:27,954 --> 00:17:29,634 can do a much better job leveraging AI 487 00:17:29,634 --> 00:17:31,714 and to and calling out gaps or areas 488 00:17:31,714 --> 00:17:33,575 that we think need to be adjusted 489 00:17:33,890 --> 00:17:35,809 based on our understanding of the datasets that 490 00:17:35,809 --> 00:17:37,269 are out there and being more proactive. 491 00:17:37,650 --> 00:17:39,269 And that's something that's just 492 00:17:39,809 --> 00:17:41,029 not meaningfully 493 00:17:41,490 --> 00:17:43,730 valuable in comparison to a production specialist that 494 00:17:43,730 --> 00:17:45,990 needs to evaluate the entirety of the information 495 00:17:46,505 --> 00:17:48,744 and make critical decisions around how information is 496 00:17:48,744 --> 00:17:49,805 presented to the committee. 497 00:17:50,585 --> 00:17:52,445 Another example would be, like, 498 00:17:52,825 --> 00:17:54,985 AI holds promise in in the reviewing of 499 00:17:54,985 --> 00:17:55,884 adverse actions, 500 00:17:56,265 --> 00:17:57,545 that are associated to, 501 00:17:58,970 --> 00:18:00,809 a credentialing process. So when there is a 502 00:18:00,809 --> 00:18:02,990 discrimination or something that occurs during 503 00:18:03,289 --> 00:18:05,930 normal business work hours, how does AI generate 504 00:18:05,930 --> 00:18:08,329 summaries and highlight key points so that the 505 00:18:08,329 --> 00:18:10,490 committee can be more efficient and the decision 506 00:18:10,490 --> 00:18:10,990 makers 507 00:18:11,529 --> 00:18:13,849 are more effective in that decision making versus 508 00:18:13,849 --> 00:18:16,605 having to go through a lot of additional 509 00:18:16,605 --> 00:18:18,845 details around things that sometimes is not necessary 510 00:18:18,845 --> 00:18:20,605 to the through the context of the decision 511 00:18:20,605 --> 00:18:22,605 being made. So I think they're the 2 512 00:18:22,605 --> 00:18:24,365 sort of big areas that I'm really excited 513 00:18:24,365 --> 00:18:26,365 about and areas that I'm I I hope 514 00:18:26,365 --> 00:18:28,660 leaders embrace because I think that's gonna lead 515 00:18:28,660 --> 00:18:30,420 to to the best results for them over 516 00:18:30,420 --> 00:18:31,880 the next, couple of years. 517 00:18:32,259 --> 00:18:34,180 Wonderful. Well, it's a lot of great advice 518 00:18:34,180 --> 00:18:36,180 and I think a great place to leave 519 00:18:36,180 --> 00:18:38,660 things. So, Gianni, thank you so much for 520 00:18:38,660 --> 00:18:40,420 taking the time to sit down with us 521 00:18:40,420 --> 00:18:42,440 and for sharing your insights with our listeners. 522 00:18:42,525 --> 00:18:43,505 We truly appreciate 523 00:18:44,045 --> 00:18:45,664 it. Yes. Thank you, Jacob. Pleasure. 524 00:18:46,045 --> 00:18:48,705 I'd also like to thank Verifiable for sponsoring 525 00:18:48,845 --> 00:18:50,765 today's episode. You can tune in to more 526 00:18:50,765 --> 00:18:53,664 podcasts from Becker's Healthcare by visiting our podcast 527 00:18:53,724 --> 00:18:54,865 page at beckershospitalreview.com.