Hi, everyone. This is Erica Spicer Mason with
Becker's Healthcare. Thank you so much for tuning
into the Becker's Healthcare podcast series.
So today, we're going to talk about legacy
systems versus patient access
and how to transform payer and provider alliances.
And joining me for this discussion are two
leaders from Verifiable.
We have with us Brooke West, president,
and Jocelyn Wood, senior solutions consultant.
Brooke and Jocelyn, thank you so much for
making time for Becker's today and for coming
on the podcast.
Thanks for having us.
Really happy to have you both. And just
to kind of give a bit of context
for our listeners, I wanted to see if
you could both just share a little bit
more about yourselves, your work in health care,
whatever you think would be helpful for our
listeners to know.
And, Brooke, how about you can get us
started with that?
Sounds good. Thanks for having us, Erica. My
name is Brooke West, and I'm president of
Verifiable.
I've just joined this past December.
My career arc up until this point has
always been in software and technology, and it
was about twelve years ago that I got
into health care. It it was really quite
a moment,
when I began my first role in health
care as I realized that I was missing
purpose in my career and didn't know it
up to that point. And that at that
point, you know, now I was lucky enough
to be able to do what I love
to do, which is drive go to market
strategies.
But that this time the result of my
work could impact a human life.
It's pretty hard to do anything different from
there.
So since then I've been on a career
world tour of health care experiencing
roles that address all different sides of health
care including electronic health records,
behavioral health, primary care,
the employer market of healthcare centers of excellence,
bundled payments.
And now I'm thrilled to be part of
the verifiable movement to transform
the very first domino that falls in healthcare
which is credentialing.
Without it, healthcare would not happen full stop.
Providers simply cannot see patients if they're not
credentialed.
And the state of credentialing is in dire
need of transformation and automation and it's it's
really the epitome of legacy
as it's it's incredibly costly, labor intensive,
you know, all the things.
So verifiable, we exist to change that and
get high quality providers seeing patients faster
at a significantly lower cost to the payer,
provider, or health system.
Brooke, what a great overview, and thanks so
much for that initial framing on credentialing. Really
interesting. And I know we'll get deeper into
that as we go through the discussion, but
really appreciate,
kind of those high level insights.
Jocelyn, would you like to go next?
Hi, Erica.
I'm Jocelyn Woods, senior solutions consultant here at
Verifiable. I serve as a subject matter expert
across credentialing, enrollment, privileging. I work really closely
with our go to market teams to ensure
we're meeting the complex needs of this industry.
I joined Verifiable
last May with nearly two decades of experience
in health care. I've had leadership roles across
national payers and provider groups in health systems.
I've also sat on both sides of the
credentialing table, leading CVO operations and managing provider
relations, overseeing things like contracting.
This broad lens that I brought to Verifiable
gives me a deep appreciation for just how
broken and burdensome the credentialing process has been
for far too long. Verifiable is a solution
that I wish that I had as a
credentialing specialist
back when I sat in a sea of
cubicles surrounded by real paper, stamps, and rubber
fingers. So the opportunity to help bring real
meaningful change to such a critical piece of
the health care puzzle made joining this team
an easy decision for me. I'm proud to
be part of a company that's reimagining what
credentialing can and should look like.
Thanks so much, Jocelyn. And so funny to
hear you or at least envision that image
of, a real cubicle with lots of paper
flying around. It seems like a different lifetime,
but was not that long ago, I suppose.
But also appreciate this experience that you're bringing
from the payer and provider side, and it
sounds like both sides of credentialing too.
So with that, let's let's get into this
idea of payer and provider collaboration. I know
I kind of teased that at the beginning.
And it's often seen as a key strategy
for improving patient access.
So, Brooke, what are the biggest roadblocks that
are preventing organizations from expanding their provider networks,
and how do these changes ultimately affect patient
access?
Yeah. What are the biggest roadblocks?
Legacy systems.
Legacy systems are the biggest roadblocks.
They're expensive,
slow,
a suboptimal
provider experience, and they delay patient care.
There's really not too much positive to say
here.
The the growth of partnerships between health plans
and providers, it's essential.
I feel like that's obvious saying that out
loud.
You know health plans wanna grow their networks
while maintaining a certain level of quality
while providers wanna get delegated. But
there are incredibly long processing times,
manual errors, sky high administrative costs, and lost
revenue due to long processing times that can
really get in the way. All of these
have negative downstream implications
on patient outcomes.
Delayed credentialing timelines lead to longer wait times
for care.
You know, the provider experiences are not great.
The operational costs are high and the revenue
is delayed
I e lost. So organizations, they've gotta be
nimble and action oriented.
The the lack of performance of legacy systems,
it really holds them back from every perspective
and it hinders their ability to scale
and and remain compliant with all of the
industry guidelines.
Yeah. Really good points that you're raising here,
Brooke. Thank you so much.
And, Jocelyn, I know Brooke just touched on
how legacy systems can affect
really key processes and metrics like wait times
for patient care and, of course, patient access
metrics.
Can you also touch on how legacy systems
can affect speed and efficiency
of processes that enable network growth, like credentialing
and enrollment? And why is this something that
leaders should think of as something that they
need to address urgently? It's a great question.
One of the major roadblocks that health care
organizations face every day in the space of
credentialing enrollment is just a sheer volume of
paperwork and manual process that's still involved.
Leads to inefficiencies,
errors, delays, all of which have a ripple
effect through the entire organization.
Some specifics, manual data entry. Relying on manual
data entry can lead to human errors. We're
all human. Missing information, delayed updates, which all
results in noncompliance or delayed reimbursements.
Long credentialing timelines have always, been a barrier.
They continue to be a barrier. Traditional systems
often take weeks or even months to process
provider credentialing and enrollment application.
This delays the provider from accessing the network.
This impacts care and delivery as well as
reimbursement cycles.
It's also a compliance risk. Keeping up with
constantly evolving regulations and compliance requirements is another
major issue. Legacy systems struggle to adapt to
these changes and guidelines,
leads to possible fines, penalties, and organizations for
all who fail to meet these standards.
Network optimization,
without automation,
monitoring and optimizing provider network is a manual,
time consuming process that's prone to errors. This
also affects the ability to quickly identify gaps
in your network coverage and reduce unnecessary administrative
overload.
Previously, credentialing and monitoring has been somewhat overlooked.
New updates to NCQA are going into effect
on 07/01/2025,
and they indicate a major shift in priority
towards achieving specific quality and compliance goals. It's
essential that today's organizations adapt quickly for providers
so that they can speed up the time
to revenue. And for health plans looking to
scale their networks while ensuring quality access, these
new regulations are just a small part, I
think, of what's driving the need for more
efficient and reliable credentialing processes, but it's a
really good catalyst for the industry.
Yeah. Absolutely. And, Jocelyn, I'm just wondering, you
know,
if you've seen any organizations
make intentional improvements to their legacy systems, whether
that's a new system or an upgrade, something
along those lines, can you share an example
of how improvements there have made a measurable
impact?
Absolutely.
Here at Verifiable, we work with both health
plans and providers of all sizes. But one
recent example that comes to mind is a
client of ours, MidiHealth.
Now their goal was to close the menopause
care gap by providing
compliant provider networks nationwide. So after securing their
series a funding in the fall of twenty
twenty three, they had intentions to expand clinical
availability to all 50 states by July 2024.
But many health relies on nurse practitioners to
deliver care, which means that they also had
to hire physicians to fulfill state specific regulations
surrounding collaborative agreements, all while maintaining affordability for
their patients which required supporting four of the
major health plans to provide reimbursable
care everywhere.
The level of automation and configurability was verifiable
on Salesforce. It gave their internal team of
two everything that they needed to manage their
compliance process at scale. And what we helped
them do was achieve 50 state provider coverage,
serve over 200,000
patients to date, and shorten their credentialing turnaround
times to just two days.
Yeah. I really appreciate you sharing those numbers,
Jocelyn.
It was so helpful for our listeners.
And, you know, I I know that we've
talked about a lot of challenges here. And,
Jocelyn, you even just touched on some upcoming
NCQA changes.
So what practical steps should leaders be taking
right now to transform their operations?
And, Jocelyn, maybe you can get us started
with that, and then Brooke will kick it
over to you. Absolutely.
I think some actionable strategies that organizations can
implement to become more agile and efficient,
prior automation, shift from manual paper based process
to automated solutions, implement systems that automate the
credentialing enrollment and compliance monitoring process, and in
turn, it will reduce your timelines, minimize your
errors, and lower your costs.
Integrate your systems. Moving to integrated platforms where
credentialing enrollment provided data linked can streamline operations
and reduce the need for duplicated data entry.
This helps ensures that all systems are in
sync and compliance is being continuously monitored throughout
the process.
Start to focus on data analytics.
Leverage analytics to track performance metrics, identify where
your bottlenecks are, and improve your decision making.
For example, monitoring credentialing timelines and identifying areas
for improvement can lead to more efficient operations.
Keep up with continuous training and education, ensuring
that staff are continuously trained on all new
technology, what are the new what the new
compliance standards are, and the best practices.
This is gonna be crucial for making the
most of your new system.
You also wanna invest in scalable solutions. So
choose systems that are scalable, flexible, and capable
of adapting to new regulations and the and
growing patient provider networks.
Yeah. Thank you so much, Jocelyn. So I'm
hearing automation,
integrated systems, data analytics.
Brooke, what else would you add?
What I would add is that what Jocelyn
just outlined is really not industry specific.
It could be applied to almost every industry.
And quite frankly,
these changes have happened in almost every other
industry. So it's a tried and true playbook.
And it will help providers
to get in network faster,
improve patient access,
you know, while driving efficiency and cost savings
for payers.
Yeah. Thanks so much, Brooke. And I've learned
a lot in our short discussion today, so
I just wanna thank you so much thank
you both so much for the insights.
Before we close, is there anything else that
maybe we missed or that you'd like to
add that we haven't covered yet? And, Brooke,
let's let's stick with you since you just
so kindly answered the last question.
Sure.
What I would say is don't wait.
Don't wait to make these changes.
With every day that ticks on with payers
and legacy systems, they go deeper into the
hole of inefficiency and unnecessary cost, and it
will be harder to climb out. And this
concept of automation, as I just mentioned, it's
not, you know, it isn't new. And it's
proven in many many other industries and even
in pockets of healthcare. So the risk is
very low,
with significant upside.
And with NCQA changes as motivation, I would
encourage leaders to act now. Incredible upside,
you know, with cost savings and accelerated revenue
awaits.
Yeah. Thanks so much, Brooke. And, Jocelyn, what
would you say to close us out?
Yeah. I I would say throughout my time
in the credentialing space, I've never seen a
company or a product solve problems with legacy
systems and processes like Verifiable. Now I know
I'm biased, but I chose to join this
company because I think that they're taking the
right approach to improve the specific part of
health care. It's so essential for advancing our
industry.
On that note, I'd just like to add
that the Verifiable team is going to be
at Becker's Healthcare payer issues roundtable event, April
twenty eighth to twenty ninth in Chicago. So
please swing by Booth 1023 or stop by
our happy hour on April 28 from six
to eight, and discover how Verifiable helps payers
streamline credentialing, remain audit ready, and improve provider
network operations.
Jocelyn, so appreciate the shout out about Becker's
event coming up soon. So hope to see
listeners there.
Thank you both so much again for your
time and your insights.
Thank you for having us. Thank you so
much, Erica. And we'd also like to thank
our podcast sponsor for today, Verifiable.
Listeners, please be sure to tune in to
more podcasts from Becker's Healthcare by visiting our
podcast page at beckershospitalreview.com.