Latest / Becker’s Payer Issues Podcast / Mitchell Gorodokin, VP of Business Development at Certify

Transcript

Mitchell Gorodokin, VP of Business Development at Certify · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
• 0:02
  innovation to create world class pharmacy care and
• 0:05
  benefit solutions. Our connected health services make the
• 0:09
  treatment, prediction, and prevention of health care's most
• 0:12
  complex conditions
• 0:13
  easier and more accessible as we drive organizations
• 0:16
  and people forward. Ever North Home Based Care
• 0:19
  provides value based care that helps patients with
• 0:22
  multiple chronic conditions
• 0:23
  and social determinant of health barriers get the
• 0:26
  care they need and the personalized experience they
• 0:28
  deserve. We serve patients who struggle to navigate
• 0:31
  the health care system by bringing high quality
• 0:34
  primary
• 0:34
  and preventative care services to the home. By
• 0:37
  providing clinical care and support services that provide
• 0:40
  whole person care, we improve health equity, access,
• 0:44
  and outcomes for the populations we serve.
• 0:47
  This is Gracelyn Keller with the Becker's Healthcare
• 0:49
  Podcast, and we are live with the 2024
• 0:52
  payer issues roundtable.
• 0:53
  I am joined right now by Mitchell Gordorkin,
• 0:55
  who is the VP of business development at
• 0:58
  Certify. So, Mitchell, thanks for being here. Let's
• 1:01
  start our conversation off today by briefly introducing
• 1:03
  yourself and talking about your current role at
• 1:06
  your organization. Sure. Thanks. Well, first of all,
• 1:08
  thanks so much for having me. It's, it's
• 1:09
  an honor to be on, and, love the
• 1:11
  conference. We come here every year.
• 1:13
  So like you said, my name is Mitchell
• 1:15
  Gerdogan. I'm the vice president of of business
• 1:17
  development at Certify,
• 1:19
  an API first provider network management platform.
• 1:22
  We are a provider data infrastructure directly plugged
• 1:25
  into primary sources.
• 1:27
  Returning thousands of provider data points in real
• 1:29
  time.
• 1:30
  What that does is that enables us to
• 1:32
  modernize the entire provider life cycle from initial
• 1:35
  onboarding through credentialing,
• 1:36
  enrollment, ongoing monitoring, and roster management.
• 1:40
  And perhaps even more importantly, we store every
• 1:42
  single data point using entire provider journey in
• 1:45
  a centralized provider database
• 1:47
  at the atomic level. Those data points can
• 1:50
  be easily updated from other systems or reused
• 1:52
  across the health plan's downstream network operations
• 1:55
  to power accurate directories or claims payments.
• 1:58
  All of this is in a pursuit of
• 2:00
  our mission to lay the provider infrastructure
• 2:02
  upon which the next generation of provider data
• 2:04
  products can be built and our vision of
• 2:06
  1 API, 1 provider ID, frictionless provider data.
• 2:11
  Wonderful. Thank you for being here, and let's
• 2:13
  start our conversation off with engagement. So at
• 2:16
  an industry level, how would you describe the
• 2:18
  biggest barriers to effectively serving and engaging members?
• 2:21
  And what opportunities
• 2:23
  do you see for large scale improvements,
• 2:25
  and how are you applying this in your
• 2:26
  current strategy?
• 2:27
  Yeah. I think it's a great question. In
• 2:29
  in our industry, the biggest barrier,
• 2:31
  to effectively serving and engaging members
• 2:34
  really starts with the providers and reducing the
• 2:36
  administrative burden on providers
• 2:38
  to maintain up to date data, which ultimately
• 2:41
  feeds health plan directories,
• 2:43
  claim processes, and member experiences.
• 2:45
  Today, on average, a provider must engage with
• 2:48
  10 different systems to accurately update their data
• 2:50
  across multiple different health plans.
• 2:53
  That means every time they have to update
• 2:54
  an address or contact information,
• 2:57
  they have to go to 10 different places
• 2:58
  to update that information.
• 3:00
  The burden on them leads to noncompliance,
• 3:02
  stale datasets,
• 3:04
  that immediately become inconsistent and inaccurate across health
• 3:07
  plan directories.
• 3:08
  And due to the inefficiency, the error rates,
• 3:10
  and the rework, the admin spend by payers
• 3:13
  and health care organizations currently represents 30%
• 3:16
  of excess US health care spending.
• 3:18
  That cost ends up being borne by the
• 3:20
  members.
• 3:21
  And moreover, more than half of US providers
• 3:24
  report delays in patient care due to inaccurate
• 3:26
  provider data. So in addition to those higher
• 3:28
  costs, the patient experiences themselves are suffering tremendously.
• 3:32
  From our perspective, the work to maintain accurate
• 3:34
  provider data starts at the time of credentialing.
• 3:37
  It's the first interaction a provider has with
• 3:39
  a health plan, and oftentimes,
• 3:40
  we hear that credentialing just is not an
• 3:43
  asset to our company.
• 3:44
  And we understand that. And to some extent,
• 3:46
  that may be true.
• 3:48
  However, the provider data that a health plan
• 3:50
  receives during the credentialing process is robust and
• 3:52
  is certainly an asset that can be and
• 3:54
  should be used across a health plan's organization.
• 3:57
  When collected, ingested, and stored correctly,
• 4:00
  that data becomes immensely valuable in feeding streamlined,
• 4:03
  efficient downstream processes
• 4:05
  and reducing the ongoing burden on providers to
• 4:07
  maintain just that small piece of dataset.
• 4:10
  In Certify, we're laser focused on reducing provider
• 4:12
  burden by asking the provider for only the
• 4:15
  information we can't get from primary sources during
• 4:18
  the onboarding process.
• 4:19
  Through our open APIs, we enable peak interoperability
• 4:22
  with other provider data systems. We can ingest
• 4:25
  full rosters or just atomic level updates from
• 4:27
  providers, provider groups, or health systems in any
• 4:30
  format.
• 4:31
  And the data updates on our back end
• 4:33
  directly stored cleanly and centrally to be used
• 4:35
  in any downstream provider data processes.
• 4:38
  Our thesis is that if we ask providers
• 4:40
  for less data in less places, we can
• 4:42
  get them onboarded with less friction, get them
• 4:44
  into the network, help them maintain the accuracy
• 4:47
  of that data, and, essentially,
• 4:49
  increase access to quality care for the patients
• 4:51
  that need it.
• 4:53
  And shifting gears to leadership,
• 4:55
  keeping pace in today's dynamic health care leaders,
• 4:58
  landscape is challenging.
• 5:00
  So what is a piece of advice you'd
• 5:01
  share with peer leaders to grow their businesses
• 5:04
  while keeping members top of mind? Yeah. I
• 5:06
  would just encourage healthcare leaders to pressure test
• 5:08
  and future proof their existing systems and processes.
• 5:12
  Ask yourself critically if you're just trying to
• 5:14
  accomplish a point in time function,
• 5:16
  or if you're setting yourself up for long
• 5:18
  term growth and success.
• 5:20
  You know, we hear it all the time
• 5:21
  that the seven worst words in healthcare are,
• 5:23
  that's the way we've always done it. And
• 5:25
  my advice to health care leaders is to
• 5:26
  look at your 5 year provider data goals.
• 5:29
  Ask yourself, are you laying a modernized infrastructure
• 5:31
  today to help set your providers up and
• 5:34
  to set your organization up for your goals
• 5:36
  of tomorrow? And are you improving the provider
• 5:38
  experience, which ultimately improves the member experience and
• 5:41
  patient outcomes?
• 5:43
  Your provider network is one of your greatest
• 5:45
  assets of the organization.
• 5:46
  And are you making the right investments today
• 5:48
  to enable that network to meet the right
• 5:50
  members at the right place at the right
• 5:52
  time?
• 5:54
  And shifting gears again here, let's talk about
• 5:57
  technology, for example, since that is something that
• 6:00
  is obviously playing a huge role in the
• 6:02
  landscape today. So what role is that playing
• 6:05
  in your organization's growth strategies, and can you
• 6:07
  share examples of that? Yeah. Sure. So, I
• 6:10
  mean, technology is the core and the foundation
• 6:12
  of everything we do here at Certify.
• 6:14
  And as I mentioned earlier, our mission is
• 6:16
  to lay the infrastructure upon which the next
• 6:18
  generation of provided data products can be built.
• 6:21
  So it's not just technology for us. It's
• 6:22
  also how are we enabling other organizations to
• 6:25
  leverage,
• 6:26
  their own technology and improving their own workflows
• 6:29
  and processes.
• 6:30
  But to us, that means 4 key pillars.
• 6:33
  It means that we are a data first
• 6:34
  organization.
• 6:35
  Real time visibility into provider data at the
• 6:37
  atomic level is the core of everything that
• 6:40
  we do. And because we store that data
• 6:42
  discreetly and atomically, that makes us highly flexible.
• 6:45
  With just one line of code, we can
• 6:47
  configure our workflows to meet your organization's specific
• 6:50
  policies and procedures.
• 6:51
  And because that data is stored in a
• 6:53
  centralized data model, it feeds all of our
• 6:56
  modularized products and services from initial intake through
• 6:59
  credentialing,
• 7:00
  network enrollment,
• 7:01
  monitoring, and roster management.
• 7:03
  It can also feed any sort of claims
• 7:05
  processes or directory processes, which leads us to
• 7:08
  the 4th pillar that every single data point
• 7:10
  is available via APIs.
• 7:12
  Use whichever data points you need, whenever you
• 7:14
  need them, wherever you need them, send it
• 7:16
  to whichever data system you need upon any
• 7:18
  underlying trigger.
• 7:19
  It's not just the core of what we
• 7:21
  do, though. You know, it really enables our
• 7:23
  customers to grow into new markets, our health
• 7:25
  plans are in health systems to open new
• 7:27
  markets,
• 7:28
  to onboard new providers, to increase access, and
• 7:31
  ultimately,
• 7:32
  improve access to care and serve their members.
• 7:35
  And in an ever evolving regulatory environment, what
• 7:38
  tools and key strategies have helped your organization
• 7:41
  improve quality and clinical outcomes for members while
• 7:44
  staying compliant?
• 7:46
  Yeah. I think it's a great question. We
• 7:47
  are constantly in a in an evolving regulatory
• 7:50
  environment.
• 7:51
  Compliance regulations are changing, and and we live
• 7:53
  in a an amazing country with 52 individual
• 7:56
  jurisdictions, including Washington, DC and Puerto
• 8:00
  Rico. Each of them has its own unique
• 8:01
  primary data sources for upwards of 40 to
• 8:04
  50 different license types. They each have their
• 8:06
  own compliance rules, verification requirements.
• 8:09
  They vary by provider type, line of business.
• 8:13
  You know, historically,
• 8:14
  one small compliance change meant new job aids,
• 8:17
  new trainings,
• 8:18
  significant change management processes, which ultimately led to
• 8:21
  error prone processes, onboarding providers that may be
• 8:24
  noncompliant
• 8:25
  or not being able to main direct maintain
• 8:27
  directories, with the most up to date, legislature.
• 8:31
  For us, it's just one line of code
• 8:33
  to adjust one or any number of rules,
• 8:35
  or new compliance regulations spanning across those state
• 8:38
  lines, across those provider types, or across those
• 8:40
  networks.
• 8:41
  Because every single data point or action or
• 8:44
  event is logged on our back end, we
• 8:46
  can run programmatic scripts to ensure that workflows
• 8:49
  and datasets comply with the regulations and regulators
• 8:52
  of each individual jurisdiction, license type, or line
• 8:54
  of business, ensuring that providers are onboarded with
• 8:57
  peak quality and compliance, and they maintain that
• 9:00
  way throughout the life cycle of their engagement
• 9:02
  with the health plan or the system.
• 9:04
  Well, Mitchell, as we wrap our conversation up,
• 9:07
  are there any parting words you'd like to
• 9:08
  share on the podcast today?
• 9:10
  Yeah. I would just say that, you know,
• 9:12
  here at the conference, one of the big
• 9:13
  themes is how do we take a a
• 9:15
  data first approach to be able to improve
• 9:18
  access to care, improve outcomes for our members?
• 9:20
  It's really encouraging to see, the emphasis and
• 9:23
  the focus of data in today's healthcare and
• 9:25
  regulatory environment.
• 9:27
  I oftentimes
• 9:28
  compare health tech today to where FinTech was
• 9:32
  maybe 10 or even 20 years ago,
• 9:34
  you know, access to your financial data was
• 9:37
  historically
• 9:38
  you know, protected and siloed. And of course,
• 9:40
  it still is dealt with the highest security.
• 9:43
  But now it's actionable, it's accessible, it's transparent,
• 9:46
  and you have a big boom of different,
• 9:48
  you know, financial apps or financial platforms that
• 9:51
  can be built on top of that data.
• 9:53
  And I would just encourage everyone to think
• 9:55
  about health tech in the same way today
• 9:57
  where, you know, access to data access to
• 9:59
  analytics can really help us drive decision making
• 10:02
  processes,
• 10:03
  not just for providers,
• 10:04
  but patient outcomes as well. And so it's
• 10:07
  been really exciting to see all of that.
• 10:08
  It's been really exciting to see all the
• 10:09
  great leaders here at the conference.
• 10:11
  And, yeah, we're looking forward to a great
• 10:12
  time. Wonderful. Well, thank you for joining me
• 10:15
  today. Again, we are live at the 2024
• 10:17
  payer issues roundtable.
• 10:19
  Thank you.