Latest / Becker’s Payer Issues Podcast / Legacy Systems vs. Patient Access: Transforming Payer-Provider Alliances

Transcript

Legacy Systems vs. Patient Access: Transforming Payer-Provider Alliances · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Erica Spicer Mason with
• 0:02
  Becker's Healthcare. Thank you so much for tuning
• 0:04
  into the Becker's Healthcare podcast series.
• 0:07
  So today, we're going to talk about legacy
• 0:09
  systems versus patient access
• 0:11
  and how to transform payer and provider alliances.
• 0:14
  And joining me for this discussion are two
• 0:16
  leaders from Verifiable.
• 0:18
  We have with us Brooke West, president,
• 0:20
  and Jocelyn Wood, senior solutions consultant.
• 0:24
  Brooke and Jocelyn, thank you so much for
• 0:25
  making time for Becker's today and for coming
• 0:27
  on the podcast.
• 0:29
  Thanks for having us.
• 0:31
  Really happy to have you both. And just
• 0:33
  to kind of give a bit of context
• 0:34
  for our listeners, I wanted to see if
• 0:36
  you could both just share a little bit
• 0:37
  more about yourselves, your work in health care,
• 0:40
  whatever you think would be helpful for our
• 0:42
  listeners to know.
• 0:43
  And, Brooke, how about you can get us
• 0:45
  started with that?
• 0:47
  Sounds good. Thanks for having us, Erica. My
• 0:49
  name is Brooke West, and I'm president of
• 0:51
  Verifiable.
• 0:52
  I've just joined this past December.
• 0:55
  My career arc up until this point has
• 0:57
  always been in software and technology, and it
• 1:00
  was about twelve years ago that I got
• 1:02
  into health care. It it was really quite
• 1:04
  a moment,
• 1:06
  when I began my first role in health
• 1:08
  care as I realized that I was missing
• 1:09
  purpose in my career and didn't know it
• 1:11
  up to that point. And that at that
• 1:13
  point, you know, now I was lucky enough
• 1:15
  to be able to do what I love
• 1:16
  to do, which is drive go to market
• 1:18
  strategies.
• 1:19
  But that this time the result of my
• 1:21
  work could impact a human life.
• 1:24
  It's pretty hard to do anything different from
• 1:26
  there.
• 1:27
  So since then I've been on a career
• 1:30
  world tour of health care experiencing
• 1:32
  roles that address all different sides of health
• 1:35
  care including electronic health records,
• 1:37
  behavioral health, primary care,
• 1:39
  the employer market of healthcare centers of excellence,
• 1:42
  bundled payments.
• 1:43
  And now I'm thrilled to be part of
• 1:45
  the verifiable movement to transform
• 1:47
  the very first domino that falls in healthcare
• 1:50
  which is credentialing.
• 1:52
  Without it, healthcare would not happen full stop.
• 1:55
  Providers simply cannot see patients if they're not
• 1:58
  credentialed.
• 1:59
  And the state of credentialing is in dire
• 2:01
  need of transformation and automation and it's it's
• 2:03
  really the epitome of legacy
• 2:06
  as it's it's incredibly costly, labor intensive,
• 2:09
  you know, all the things.
• 2:11
  So verifiable, we exist to change that and
• 2:14
  get high quality providers seeing patients faster
• 2:17
  at a significantly lower cost to the payer,
• 2:20
  provider, or health system.
• 2:22
  Brooke, what a great overview, and thanks so
• 2:24
  much for that initial framing on credentialing. Really
• 2:27
  interesting. And I know we'll get deeper into
• 2:30
  that as we go through the discussion, but
• 2:31
  really appreciate,
• 2:32
  kind of those high level insights.
• 2:34
  Jocelyn, would you like to go next?
• 2:37
  Hi, Erica.
• 2:38
  I'm Jocelyn Woods, senior solutions consultant here at
• 2:41
  Verifiable. I serve as a subject matter expert
• 2:43
  across credentialing, enrollment, privileging. I work really closely
• 2:46
  with our go to market teams to ensure
• 2:48
  we're meeting the complex needs of this industry.
• 2:51
  I joined Verifiable
• 2:52
  last May with nearly two decades of experience
• 2:54
  in health care. I've had leadership roles across
• 2:57
  national payers and provider groups in health systems.
• 3:00
  I've also sat on both sides of the
• 3:01
  credentialing table, leading CVO operations and managing provider
• 3:04
  relations, overseeing things like contracting.
• 3:07
  This broad lens that I brought to Verifiable
• 3:09
  gives me a deep appreciation for just how
• 3:11
  broken and burdensome the credentialing process has been
• 3:13
  for far too long. Verifiable is a solution
• 3:16
  that I wish that I had as a
• 3:17
  credentialing specialist
• 3:19
  back when I sat in a sea of
• 3:20
  cubicles surrounded by real paper, stamps, and rubber
• 3:23
  fingers. So the opportunity to help bring real
• 3:26
  meaningful change to such a critical piece of
• 3:28
  the health care puzzle made joining this team
• 3:30
  an easy decision for me. I'm proud to
• 3:31
  be part of a company that's reimagining what
• 3:34
  credentialing can and should look like.
• 3:37
  Thanks so much, Jocelyn. And so funny to
• 3:40
  hear you or at least envision that image
• 3:42
  of, a real cubicle with lots of paper
• 3:45
  flying around. It seems like a different lifetime,
• 3:47
  but was not that long ago, I suppose.
• 3:50
  But also appreciate this experience that you're bringing
• 3:52
  from the payer and provider side, and it
• 3:54
  sounds like both sides of credentialing too.
• 3:56
  So with that, let's let's get into this
• 3:58
  idea of payer and provider collaboration. I know
• 4:01
  I kind of teased that at the beginning.
• 4:03
  And it's often seen as a key strategy
• 4:05
  for improving patient access.
• 4:07
  So, Brooke, what are the biggest roadblocks that
• 4:09
  are preventing organizations from expanding their provider networks,
• 4:12
  and how do these changes ultimately affect patient
• 4:16
  access?
• 4:17
  Yeah. What are the biggest roadblocks?
• 4:19
  Legacy systems.
• 4:20
  Legacy systems are the biggest roadblocks.
• 4:23
  They're expensive,
• 4:25
  slow,
• 4:26
  a suboptimal
• 4:27
  provider experience, and they delay patient care.
• 4:30
  There's really not too much positive to say
• 4:33
  here.
• 4:34
  The the growth of partnerships between health plans
• 4:36
  and providers, it's essential.
• 4:38
  I feel like that's obvious saying that out
• 4:40
  loud.
• 4:41
  You know health plans wanna grow their networks
• 4:43
  while maintaining a certain level of quality
• 4:46
  while providers wanna get delegated. But
• 4:49
  there are incredibly long processing times,
• 4:52
  manual errors, sky high administrative costs, and lost
• 4:56
  revenue due to long processing times that can
• 4:58
  really get in the way. All of these
• 5:00
  have negative downstream implications
• 5:02
  on patient outcomes.
• 5:04
  Delayed credentialing timelines lead to longer wait times
• 5:06
  for care.
• 5:07
  You know, the provider experiences are not great.
• 5:10
  The operational costs are high and the revenue
• 5:13
  is delayed
• 5:14
  I e lost. So organizations, they've gotta be
• 5:18
  nimble and action oriented.
• 5:19
  The the lack of performance of legacy systems,
• 5:23
  it really holds them back from every perspective
• 5:26
  and it hinders their ability to scale
• 5:28
  and and remain compliant with all of the
• 5:30
  industry guidelines.
• 5:32
  Yeah. Really good points that you're raising here,
• 5:34
  Brooke. Thank you so much.
• 5:36
  And, Jocelyn, I know Brooke just touched on
• 5:38
  how legacy systems can affect
• 5:41
  really key processes and metrics like wait times
• 5:44
  for patient care and, of course, patient access
• 5:46
  metrics.
• 5:47
  Can you also touch on how legacy systems
• 5:49
  can affect speed and efficiency
• 5:51
  of processes that enable network growth, like credentialing
• 5:54
  and enrollment? And why is this something that
• 5:56
  leaders should think of as something that they
• 5:58
  need to address urgently? It's a great question.
• 6:02
  One of the major roadblocks that health care
• 6:04
  organizations face every day in the space of
• 6:06
  credentialing enrollment is just a sheer volume of
• 6:08
  paperwork and manual process that's still involved.
• 6:11
  Leads to inefficiencies,
• 6:12
  errors, delays, all of which have a ripple
• 6:14
  effect through the entire organization.
• 6:17
  Some specifics, manual data entry. Relying on manual
• 6:20
  data entry can lead to human errors. We're
• 6:22
  all human. Missing information, delayed updates, which all
• 6:25
  results in noncompliance or delayed reimbursements.
• 6:29
  Long credentialing timelines have always, been a barrier.
• 6:32
  They continue to be a barrier. Traditional systems
• 6:34
  often take weeks or even months to process
• 6:36
  provider credentialing and enrollment application.
• 6:38
  This delays the provider from accessing the network.
• 6:41
  This impacts care and delivery as well as
• 6:44
  reimbursement cycles.
• 6:45
  It's also a compliance risk. Keeping up with
• 6:48
  constantly evolving regulations and compliance requirements is another
• 6:50
  major issue. Legacy systems struggle to adapt to
• 6:53
  these changes and guidelines,
• 6:55
  leads to possible fines, penalties, and organizations for
• 6:58
  all who fail to meet these standards.
• 7:00
  Network optimization,
• 7:01
  without automation,
• 7:03
  monitoring and optimizing provider network is a manual,
• 7:06
  time consuming process that's prone to errors. This
• 7:08
  also affects the ability to quickly identify gaps
• 7:11
  in your network coverage and reduce unnecessary administrative
• 7:14
  overload.
• 7:15
  Previously, credentialing and monitoring has been somewhat overlooked.
• 7:18
  New updates to NCQA are going into effect
• 7:20
  on 07/01/2025,
• 7:21
  and they indicate a major shift in priority
• 7:24
  towards achieving specific quality and compliance goals. It's
• 7:27
  essential that today's organizations adapt quickly for providers
• 7:30
  so that they can speed up the time
• 7:31
  to revenue. And for health plans looking to
• 7:33
  scale their networks while ensuring quality access, these
• 7:36
  new regulations are just a small part, I
• 7:37
  think, of what's driving the need for more
• 7:39
  efficient and reliable credentialing processes, but it's a
• 7:42
  really good catalyst for the industry.
• 7:45
  Yeah. Absolutely. And, Jocelyn, I'm just wondering, you
• 7:48
  know,
• 7:48
  if you've seen any organizations
• 7:51
  make intentional improvements to their legacy systems, whether
• 7:54
  that's a new system or an upgrade, something
• 7:56
  along those lines, can you share an example
• 7:58
  of how improvements there have made a measurable
• 8:00
  impact?
• 8:02
  Absolutely.
• 8:03
  Here at Verifiable, we work with both health
• 8:05
  plans and providers of all sizes. But one
• 8:07
  recent example that comes to mind is a
• 8:09
  client of ours, MidiHealth.
• 8:11
  Now their goal was to close the menopause
• 8:13
  care gap by providing
• 8:15
  compliant provider networks nationwide. So after securing their
• 8:18
  series a funding in the fall of twenty
• 8:20
  twenty three, they had intentions to expand clinical
• 8:22
  availability to all 50 states by July 2024.
• 8:26
  But many health relies on nurse practitioners to
• 8:28
  deliver care, which means that they also had
• 8:30
  to hire physicians to fulfill state specific regulations
• 8:33
  surrounding collaborative agreements, all while maintaining affordability for
• 8:36
  their patients which required supporting four of the
• 8:39
  major health plans to provide reimbursable
• 8:42
  care everywhere.
• 8:43
  The level of automation and configurability was verifiable
• 8:46
  on Salesforce. It gave their internal team of
• 8:49
  two everything that they needed to manage their
• 8:51
  compliance process at scale. And what we helped
• 8:53
  them do was achieve 50 state provider coverage,
• 8:56
  serve over 200,000
• 8:58
  patients to date, and shorten their credentialing turnaround
• 9:00
  times to just two days.
• 9:03
  Yeah. I really appreciate you sharing those numbers,
• 9:05
  Jocelyn.
• 9:06
  It was so helpful for our listeners.
• 9:08
  And, you know, I I know that we've
• 9:10
  talked about a lot of challenges here. And,
• 9:12
  Jocelyn, you even just touched on some upcoming
• 9:14
  NCQA changes.
• 9:16
  So what practical steps should leaders be taking
• 9:18
  right now to transform their operations?
• 9:21
  And, Jocelyn, maybe you can get us started
• 9:22
  with that, and then Brooke will kick it
• 9:23
  over to you. Absolutely.
• 9:25
  I think some actionable strategies that organizations can
• 9:28
  implement to become more agile and efficient,
• 9:30
  prior automation, shift from manual paper based process
• 9:33
  to automated solutions, implement systems that automate the
• 9:36
  credentialing enrollment and compliance monitoring process, and in
• 9:39
  turn, it will reduce your timelines, minimize your
• 9:41
  errors, and lower your costs.
• 9:43
  Integrate your systems. Moving to integrated platforms where
• 9:46
  credentialing enrollment provided data linked can streamline operations
• 9:50
  and reduce the need for duplicated data entry.
• 9:52
  This helps ensures that all systems are in
• 9:54
  sync and compliance is being continuously monitored throughout
• 9:57
  the process.
• 9:58
  Start to focus on data analytics.
• 10:00
  Leverage analytics to track performance metrics, identify where
• 10:03
  your bottlenecks are, and improve your decision making.
• 10:06
  For example, monitoring credentialing timelines and identifying areas
• 10:09
  for improvement can lead to more efficient operations.
• 10:12
  Keep up with continuous training and education, ensuring
• 10:15
  that staff are continuously trained on all new
• 10:17
  technology, what are the new what the new
• 10:19
  compliance standards are, and the best practices.
• 10:21
  This is gonna be crucial for making the
• 10:23
  most of your new system.
• 10:24
  You also wanna invest in scalable solutions. So
• 10:27
  choose systems that are scalable, flexible, and capable
• 10:29
  of adapting to new regulations and the and
• 10:32
  growing patient provider networks.
• 10:35
  Yeah. Thank you so much, Jocelyn. So I'm
• 10:37
  hearing automation,
• 10:38
  integrated systems, data analytics.
• 10:41
  Brooke, what else would you add?
• 10:43
  What I would add is that what Jocelyn
• 10:45
  just outlined is really not industry specific.
• 10:48
  It could be applied to almost every industry.
• 10:51
  And quite frankly,
• 10:52
  these changes have happened in almost every other
• 10:55
  industry. So it's a tried and true playbook.
• 10:58
  And it will help providers
• 11:00
  to get in network faster,
• 11:02
  improve patient access,
• 11:03
  you know, while driving efficiency and cost savings
• 11:06
  for payers.
• 11:08
  Yeah. Thanks so much, Brooke. And I've learned
• 11:10
  a lot in our short discussion today, so
• 11:12
  I just wanna thank you so much thank
• 11:14
  you both so much for the insights.
• 11:16
  Before we close, is there anything else that
• 11:18
  maybe we missed or that you'd like to
• 11:20
  add that we haven't covered yet? And, Brooke,
• 11:22
  let's let's stick with you since you just
• 11:23
  so kindly answered the last question.
• 11:25
  Sure.
• 11:26
  What I would say is don't wait.
• 11:29
  Don't wait to make these changes.
• 11:32
  With every day that ticks on with payers
• 11:34
  and legacy systems, they go deeper into the
• 11:36
  hole of inefficiency and unnecessary cost, and it
• 11:39
  will be harder to climb out. And this
• 11:41
  concept of automation, as I just mentioned, it's
• 11:44
  not, you know, it isn't new. And it's
• 11:46
  proven in many many other industries and even
• 11:49
  in pockets of healthcare. So the risk is
• 11:51
  very low,
• 11:53
  with significant upside.
• 11:54
  And with NCQA changes as motivation, I would
• 11:57
  encourage leaders to act now. Incredible upside,
• 12:00
  you know, with cost savings and accelerated revenue
• 12:03
  awaits.
• 12:04
  Yeah. Thanks so much, Brooke. And, Jocelyn, what
• 12:07
  would you say to close us out?
• 12:10
  Yeah. I I would say throughout my time
• 12:11
  in the credentialing space, I've never seen a
• 12:13
  company or a product solve problems with legacy
• 12:16
  systems and processes like Verifiable. Now I know
• 12:19
  I'm biased, but I chose to join this
• 12:22
  company because I think that they're taking the
• 12:24
  right approach to improve the specific part of
• 12:27
  health care. It's so essential for advancing our
• 12:29
  industry.
• 12:30
  On that note, I'd just like to add
• 12:31
  that the Verifiable team is going to be
• 12:33
  at Becker's Healthcare payer issues roundtable event, April
• 12:36
  twenty eighth to twenty ninth in Chicago. So
• 12:38
  please swing by Booth 1023 or stop by
• 12:41
  our happy hour on April 28 from six
• 12:43
  to eight, and discover how Verifiable helps payers
• 12:46
  streamline credentialing, remain audit ready, and improve provider
• 12:49
  network operations.
• 12:51
  Jocelyn, so appreciate the shout out about Becker's
• 12:54
  event coming up soon. So hope to see
• 12:57
  listeners there.
• 12:59
  Thank you both so much again for your
• 13:00
  time and your insights.
• 13:02
  Thank you for having us. Thank you so
• 13:04
  much, Erica. And we'd also like to thank
• 13:06
  our podcast sponsor for today, Verifiable.
• 13:09
  Listeners, please be sure to tune in to
• 13:11
  more podcasts from Becker's Healthcare by visiting our
• 13:14
  podcast page at beckershospitalreview.com.