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Hi, everyone. This is Erica Spicer Mason with

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Becker's Healthcare. Thank you so much for tuning

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into the Becker's Healthcare podcast series.

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So today, we're going to talk about legacy

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systems versus patient access

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and how to transform payer and provider alliances.

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And joining me for this discussion are two

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leaders from Verifiable.

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We have with us Brooke West, president,

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and Jocelyn Wood, senior solutions consultant.

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Brooke and Jocelyn, thank you so much for

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making time for Becker's today and for coming

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on the podcast.

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Thanks for having us.

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Really happy to have you both. And just

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to kind of give a bit of context

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for our listeners, I wanted to see if

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you could both just share a little bit

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more about yourselves, your work in health care,

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whatever you think would be helpful for our

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listeners to know.

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And, Brooke, how about you can get us

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started with that?

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Sounds good. Thanks for having us, Erica. My

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name is Brooke West, and I'm president of

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Verifiable.

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I've just joined this past December.

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My career arc up until this point has

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always been in software and technology, and it

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was about twelve years ago that I got

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into health care. It it was really quite

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a moment,

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when I began my first role in health

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care as I realized that I was missing

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purpose in my career and didn't know it

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up to that point. And that at that

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point, you know, now I was lucky enough

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to be able to do what I love

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to do, which is drive go to market

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strategies.

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But that this time the result of my

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work could impact a human life.

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It's pretty hard to do anything different from

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there.

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So since then I've been on a career

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world tour of health care experiencing

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roles that address all different sides of health

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care including electronic health records,

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behavioral health, primary care,

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the employer market of healthcare centers of excellence,

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bundled payments.

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And now I'm thrilled to be part of

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the verifiable movement to transform

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the very first domino that falls in healthcare

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which is credentialing.

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Without it, healthcare would not happen full stop.

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Providers simply cannot see patients if they're not

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credentialed.

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And the state of credentialing is in dire

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need of transformation and automation and it's it's

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really the epitome of legacy

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as it's it's incredibly costly, labor intensive,

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you know, all the things.

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So verifiable, we exist to change that and

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get high quality providers seeing patients faster

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at a significantly lower cost to the payer,

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provider, or health system.

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Brooke, what a great overview, and thanks so

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much for that initial framing on credentialing. Really

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interesting. And I know we'll get deeper into

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that as we go through the discussion, but

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really appreciate,

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kind of those high level insights.

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Jocelyn, would you like to go next?

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Hi, Erica.

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I'm Jocelyn Woods, senior solutions consultant here at

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Verifiable. I serve as a subject matter expert

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across credentialing, enrollment, privileging. I work really closely

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with our go to market teams to ensure

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we're meeting the complex needs of this industry.

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I joined Verifiable

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last May with nearly two decades of experience

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in health care. I've had leadership roles across

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national payers and provider groups in health systems.

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I've also sat on both sides of the

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credentialing table, leading CVO operations and managing provider

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relations, overseeing things like contracting.

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This broad lens that I brought to Verifiable

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gives me a deep appreciation for just how

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broken and burdensome the credentialing process has been

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for far too long. Verifiable is a solution

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that I wish that I had as a

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credentialing specialist

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back when I sat in a sea of

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cubicles surrounded by real paper, stamps, and rubber

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fingers. So the opportunity to help bring real

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meaningful change to such a critical piece of

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the health care puzzle made joining this team

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an easy decision for me. I'm proud to

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be part of a company that's reimagining what

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credentialing can and should look like.

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Thanks so much, Jocelyn. And so funny to

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hear you or at least envision that image

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of, a real cubicle with lots of paper

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flying around. It seems like a different lifetime,

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but was not that long ago, I suppose.

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But also appreciate this experience that you're bringing

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from the payer and provider side, and it

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sounds like both sides of credentialing too.

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So with that, let's let's get into this

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idea of payer and provider collaboration. I know

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I kind of teased that at the beginning.

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And it's often seen as a key strategy

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for improving patient access.

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So, Brooke, what are the biggest roadblocks that

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are preventing organizations from expanding their provider networks,

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and how do these changes ultimately affect patient

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access?

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Yeah. What are the biggest roadblocks?

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Legacy systems.

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Legacy systems are the biggest roadblocks.

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They're expensive,

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slow,

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a suboptimal

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provider experience, and they delay patient care.

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There's really not too much positive to say

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here.

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The the growth of partnerships between health plans

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and providers, it's essential.

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I feel like that's obvious saying that out

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loud.

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You know health plans wanna grow their networks

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while maintaining a certain level of quality

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while providers wanna get delegated. But

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there are incredibly long processing times,

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manual errors, sky high administrative costs, and lost

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revenue due to long processing times that can

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really get in the way. All of these

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have negative downstream implications

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on patient outcomes.

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Delayed credentialing timelines lead to longer wait times

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for care.

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You know, the provider experiences are not great.

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The operational costs are high and the revenue

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is delayed

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I e lost. So organizations, they've gotta be

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nimble and action oriented.

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The the lack of performance of legacy systems,

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it really holds them back from every perspective

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and it hinders their ability to scale

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and and remain compliant with all of the

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industry guidelines.

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Yeah. Really good points that you're raising here,

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Brooke. Thank you so much.

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And, Jocelyn, I know Brooke just touched on

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how legacy systems can affect

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really key processes and metrics like wait times

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for patient care and, of course, patient access

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metrics.

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Can you also touch on how legacy systems

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can affect speed and efficiency

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of processes that enable network growth, like credentialing

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and enrollment? And why is this something that

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leaders should think of as something that they

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need to address urgently? It's a great question.

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One of the major roadblocks that health care

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organizations face every day in the space of

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credentialing enrollment is just a sheer volume of

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paperwork and manual process that's still involved.

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Leads to inefficiencies,

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errors, delays, all of which have a ripple

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effect through the entire organization.

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Some specifics, manual data entry. Relying on manual

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data entry can lead to human errors. We're

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all human. Missing information, delayed updates, which all

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results in noncompliance or delayed reimbursements.

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Long credentialing timelines have always, been a barrier.

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They continue to be a barrier. Traditional systems

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often take weeks or even months to process

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provider credentialing and enrollment application.

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This delays the provider from accessing the network.

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This impacts care and delivery as well as

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reimbursement cycles.

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It's also a compliance risk. Keeping up with

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constantly evolving regulations and compliance requirements is another

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major issue. Legacy systems struggle to adapt to

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these changes and guidelines,

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leads to possible fines, penalties, and organizations for

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all who fail to meet these standards.

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Network optimization,

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without automation,

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monitoring and optimizing provider network is a manual,

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time consuming process that's prone to errors. This

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also affects the ability to quickly identify gaps

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in your network coverage and reduce unnecessary administrative

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overload.

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Previously, credentialing and monitoring has been somewhat overlooked.

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New updates to NCQA are going into effect

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on 07/01/2025,

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and they indicate a major shift in priority

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towards achieving specific quality and compliance goals. It's

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essential that today's organizations adapt quickly for providers

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so that they can speed up the time

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to revenue. And for health plans looking to

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scale their networks while ensuring quality access, these

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new regulations are just a small part, I

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think, of what's driving the need for more

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efficient and reliable credentialing processes, but it's a

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really good catalyst for the industry.

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Yeah. Absolutely. And, Jocelyn, I'm just wondering, you

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know,

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if you've seen any organizations

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make intentional improvements to their legacy systems, whether

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that's a new system or an upgrade, something

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along those lines, can you share an example

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of how improvements there have made a measurable

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impact?

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Absolutely.

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Here at Verifiable, we work with both health

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plans and providers of all sizes. But one

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recent example that comes to mind is a

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client of ours, MidiHealth.

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Now their goal was to close the menopause

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care gap by providing

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compliant provider networks nationwide. So after securing their

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series a funding in the fall of twenty

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twenty three, they had intentions to expand clinical

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availability to all 50 states by July 2024.

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But many health relies on nurse practitioners to

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deliver care, which means that they also had

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to hire physicians to fulfill state specific regulations

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surrounding collaborative agreements, all while maintaining affordability for

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their patients which required supporting four of the

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major health plans to provide reimbursable

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care everywhere.

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The level of automation and configurability was verifiable

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on Salesforce. It gave their internal team of

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two everything that they needed to manage their

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compliance process at scale. And what we helped

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them do was achieve 50 state provider coverage,

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serve over 200,000

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patients to date, and shorten their credentialing turnaround

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times to just two days.

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Yeah. I really appreciate you sharing those numbers,

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Jocelyn.

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It was so helpful for our listeners.

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And, you know, I I know that we've

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talked about a lot of challenges here. And,

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Jocelyn, you even just touched on some upcoming

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NCQA changes.

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So what practical steps should leaders be taking

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right now to transform their operations?

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And, Jocelyn, maybe you can get us started

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with that, and then Brooke will kick it

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over to you. Absolutely.

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I think some actionable strategies that organizations can

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implement to become more agile and efficient,

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prior automation, shift from manual paper based process

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to automated solutions, implement systems that automate the

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credentialing enrollment and compliance monitoring process, and in

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turn, it will reduce your timelines, minimize your

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errors, and lower your costs.

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Integrate your systems. Moving to integrated platforms where

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credentialing enrollment provided data linked can streamline operations

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and reduce the need for duplicated data entry.

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This helps ensures that all systems are in

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sync and compliance is being continuously monitored throughout

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the process.

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Start to focus on data analytics.

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Leverage analytics to track performance metrics, identify where

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your bottlenecks are, and improve your decision making.

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For example, monitoring credentialing timelines and identifying areas

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for improvement can lead to more efficient operations.

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Keep up with continuous training and education, ensuring

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that staff are continuously trained on all new

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technology, what are the new what the new

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compliance standards are, and the best practices.

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This is gonna be crucial for making the

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most of your new system.

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You also wanna invest in scalable solutions. So

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choose systems that are scalable, flexible, and capable

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of adapting to new regulations and the and

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growing patient provider networks.

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Yeah. Thank you so much, Jocelyn. So I'm

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hearing automation,

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integrated systems, data analytics.

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Brooke, what else would you add?

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What I would add is that what Jocelyn

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just outlined is really not industry specific.

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It could be applied to almost every industry.

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And quite frankly,

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these changes have happened in almost every other

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industry. So it's a tried and true playbook.

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And it will help providers

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to get in network faster,

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improve patient access,

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you know, while driving efficiency and cost savings

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for payers.

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Yeah. Thanks so much, Brooke. And I've learned

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a lot in our short discussion today, so

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I just wanna thank you so much thank

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you both so much for the insights.

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Before we close, is there anything else that

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maybe we missed or that you'd like to

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add that we haven't covered yet? And, Brooke,

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let's let's stick with you since you just

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so kindly answered the last question.

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Sure.

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What I would say is don't wait.

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Don't wait to make these changes.

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With every day that ticks on with payers

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and legacy systems, they go deeper into the

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hole of inefficiency and unnecessary cost, and it

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will be harder to climb out. And this

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concept of automation, as I just mentioned, it's

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not, you know, it isn't new. And it's

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proven in many many other industries and even

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in pockets of healthcare. So the risk is

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very low,

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with significant upside.

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And with NCQA changes as motivation, I would

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encourage leaders to act now. Incredible upside,

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you know, with cost savings and accelerated revenue

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awaits.

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Yeah. Thanks so much, Brooke. And, Jocelyn, what

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would you say to close us out?

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Yeah. I I would say throughout my time

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in the credentialing space, I've never seen a

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company or a product solve problems with legacy

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systems and processes like Verifiable. Now I know

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I'm biased, but I chose to join this

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company because I think that they're taking the

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right approach to improve the specific part of

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health care. It's so essential for advancing our

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industry.

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On that note, I'd just like to add

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that the Verifiable team is going to be

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at Becker's Healthcare payer issues roundtable event, April

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twenty eighth to twenty ninth in Chicago. So

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please swing by Booth 1023 or stop by

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our happy hour on April 28 from six

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to eight, and discover how Verifiable helps payers

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streamline credentialing, remain audit ready, and improve provider

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network operations.

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Jocelyn, so appreciate the shout out about Becker's

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event coming up soon. So hope to see

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listeners there.

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Thank you both so much again for your

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time and your insights.

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Thank you for having us. Thank you so

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much, Erica. And we'd also like to thank

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our podcast sponsor for today, Verifiable.

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Listeners, please be sure to tune in to

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more podcasts from Becker's Healthcare by visiting our

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podcast page at beckershospitalreview.com.