Video: Spring WEDI Webinar 2024

Denny Brennan: This is a topic that is near and dear to many in the weedy community, which is essentially how do we find the providers we need to work within the interoperability use cases that we see today and we expect to see in the future, not the least of which is around no surprises, where provider specificity in terms of the convening provider, in terms of the treatment provider needs to be not only precise but extremely accurate. Joining me today are and joining us are Brian Marsella from Health Payment Solutions. And Martin Cody, the senior vice president for sales and marketing at Madaket health. I would also want to add that Madaket is a sponsor of the conference this this time around, and we are very pleased to welcome them to the community and have their support of all the activities that we undertake. Martin, I’ll turn it over to you.

Martin Cody: Danny, thank you very much, and good afternoon, everybody. I will express my regrets for not being there in person and looking forward to the next time we can all convene together. There’s just something about the in real-life personal connections that can develop, but we’re going to make do with the next best thing. I appreciate the community for rising to the occasion and putting together this forum. It’s working very well. I look forward to sharing some of the things that Denny just talked about, as he indicated. Martin Cody, SVP of Sales and Marketing. And with me virtually will be Brian Marsella. We’ll get to Brian in a second. But one of the reasons that Denny just hit upon as it relates to why we’re here is, is a little bit of an edit to the famous quote. Houston, we have an accuracy problem. Now, in my day to day life, I meet with payers, with plans, with tpas, with provider organizations, every single day. And every single one of them just shrugs their shoulders and puts their hands up and says, we do have a problem. We aren’t really confident in the accuracy of our directory. It has a lot of downstream impact and ramifications, and everyone on this call can probably articulate some of those ramifications far more elegantly than I can. But you know all too well that provider information is essentially the foundational building blocks of efficiency and member experience.

Martin Cody: And part of why we’re here is H.R. 133. We could almost all quote verbatim, kind of some of the areas of this comprehensive legislative package that pertain to each organization. It introduced a whole host of, you know, new characters and letters and acronyms and ideas and the such and price transparency. But it really now has been in law for over two years, and it requires certain aspects of your provider information to maintain attestation compliance as it relates to accuracy, and you have to respond in accordance with those compliance requirements. Michael, I would like you to go ahead and launch the poll question now. And the poll question is, and many of you have inside information on the answer to this question. But if you could guess, what percent accurate do you believe the nation’s provider directories are? And if you recall a survey that came out probably, I think it was 18 months ago, indicating the top five payers and what their level of accuracy were and the number of errors. It’s a pretty daunting number, so I’ll let that run while people continue to vote, and I’ll move along. And I’ll tell you a little bit about how Mattock had kind of approached this program and what it means to us. But as I said, the foundation of important, of accuracy, of provider information, it literally touches everything and little secret.

Martin Cody: I also sit on the Provider Information Sub workgroup. I co-chair that with Michelle Barry from Ivaldi. And as you can see, this is a slide that we’re actually going to be producing as part of a work project, if you will, that we’re releasing provider information 101. It’ll be a series of four different releases, and we just took a snapshot of what provider information touches. And it is the foundational bedrock of your organization because it has so many downstream permutations, ramifications, potential for things to go bad when it’s garbage in, garbage out scenarios. So I’m particularly interested in if you’re a payer, uh, the call center volume that is on the rise and we hear it from every payer we talk to, and there’s an Aetna. We’re very familiar with some of the challenges with regards to the call after scenario and the reduction of that call center volume. Spiking is a very expensive labor to try to resolve the number one bucket for call center issues as it relates to the member directory is inaccuracy. Providers not practicing at the location he or she you said she was or they were. They are not in network. They are. They don’t have office hours. So there’s a lot you have to do to make to become in compliance. And that’s where we can help you. So think about that as we move on.

Michael: Hey, Martin, real quick, the because your screen is somewhat blocked to the attendee viewers, you might be putting another.

Martin Cody: Could that be the poll because the poll is still up on my end.

Michael: Oh, I closed it. Okay, let me see if I can close it again.

Martin Cody: Or I can just minimize it.

Michael: Oh, yeah. If you can minimize it. Okay. Now mine’s off now.

Martin Cody: Okay, good. I didn’t answer the poll because I think I have an inside information. So the provider information, as I was saying, that touches everything. And thank you, Michael, for that artifact disturbance there bills, insurance network participation. This is all germane to many of the environments you live in and work in on a day to day basis, but this is coming from the sub work group of provider information, because we recognize that we have to get this right, because it’s going to help the members and it’s going to help everybody. So Brian is a regional president or the president of a regional plan slash network in Wisconsin? I, as Michael indicated and Danny indicated, run sales and marketing for Medicaid. I also am a co-chair at the Provider Information Sub Workgroup. And also germane to this audience is I host a podcast for Medicaid called The Edge of Healthcare. Lessons from leaders to use today. And what we’re trying to do is to pay it forward. Aspect is there’s a you know, healthcare is an amazing industry. It’s a $4.2 trillion. It’s about 20% of the GDP. But there’s a new wave of entrants into the healthcare environment and ecosystem, whether it’s through new tech, whether it’s through clinical, whether it’s through operations. And we want to figure out a way to help those folks advance far more, faster and higher in their careers than we did and let them learn from the mistakes of leaders. So if you have someone in your organization that you look to for guidance, mentorship, and you think they would be a good candidate for the show, it’s a great opportunity to pay it forward. We’ve had some amazing guests, most recently Doctor Eric Bricker, who I refer to as the Energizer Bunny of Clinical and Hospital ecosystem content. But there’s a lot of folks coming up on some episodes that were dropping soon, and I’d love to have more input from great leaders. Here’s where we focus. Michael, you have a question?

Michael: Yes. Real quick. You’re still having some visual issues on your screen. Folks are saying there’s some black boxes on the top and bottom. You may want to stop sharing and then reshare. Let’s see if we can get that fixed.

Martin Cody: Okay. The black box on the top is this meeting is being recorded. So let me hit okay and get rid of that. Let’s see if I can hide the floating meeting controls. And I appreciate the feedback. And let me know if that goes away.

Michael: I’d say click everything. That’s zoom. There you go. Is that good? Everyone give a thumbs up.

Martin Cody: So, Michael, you’re going to be my eyes and ears because now I have no visible communication to the outside world.

Michael: No problem. I’ll help you out. Denny is your moderator. He’ll handle your QA.

Martin Cody: Awesome. All right, so these are the areas that we focus on at Madaket. These are probably all numbers that many of you are familiar with. You know, providers. Send your org some information on where she’s practicing or added a new location, or got rid of a location. You have to acknowledge within 24 hours that you’ve received that 48 hours, it’s got to be updated in the directory. And every 90 days you have to attest that the director has been touched, updated and verified. These are the ones that brought the system to a screeching halt. And I still speak with today. Payers and providers, orgs that have no idea how to comply with these requirements. More recently, in the last month, I was just at the Becker’s Payers Conference in Chicago, and every single payer that I talked to had, you know, one on one, 27 of them intact, indicated we can’t really do anything until the fines start happening because we have no idea how to solve it. Real problem, especially when you’re talking about interoperability. So let’s get into what Bryan and his organization organization did as it relates to the Hbss challenge. And Bryan, by the way, and he’ll tell you, is a lifer in this industry. It’s been a long time at Cigna. Spent a long time at Aetna. And so he knows exactly what you’re experiencing. Excellent. Well, let’s get into the heart of the matter on the partnership with Medicaid and all the things they’re doing to solve the provider information attestation challenge, certainly around HR. 133 and the No Surprises act. And to do that, some of you may remember meeting Brian at the fall conference in Washington, DC, but we’re lucky enough to have him back here because I know he’s really busy. And, Brian, it’s good to see you again. And I would like you if you would, because you have one of the more impressive and storied careers on the payer side in healthcare kind of bring people up to speed on, on what have you done in this side of the space, who you worked with and walk us through kind of that history?

Brian Marsella: Sure. Hi, Martin, good to see you again and good to see the folks from Wedi. I, I’ve been in the industry for a little over 30 years. Uh, the vast majority of that was in different leadership positions with Cigna and Aetna. I also spent some time as a partner in a large consulting firm, Mercer, and I’ve been at my current company, which owns a network in Wisconsin but is also working to develop some patient financing outside the state for about a year and a half. So I’ve seen the industry from a lot of different areas. I’m also the board chair of a nonprofit clinic that participates in a lot of entities, networks. And so I’ve seen a little bit of it from that side as well.

Martin Cody: Basically a little bit of everything from all angles, so to speak. What what drew you from those large organizations and, you know, internationally known consulting firm to more of a regional situation and a regional payer plan?

Brian Marsella: Yeah. What I really excited me about HP’s paramedics is that we weren’t just looking to be a network, we were looking to actually solve a big issue for providers and for patients around how simple it is to understand the bills and the eobs that they get, and how to make sure that they can afford those bills and eobs. And that’s really what Hgps is and payments is looking to solve. We’ve been doing it in Wisconsin for about 15 years, and we are now having conversations with different entities outside of the state to to bring our solution to bear. What we’re trying to accomplish is that they say 43% of Americans are avoiding or delaying care because they don’t have the money to pay for it, and we’re trying to make sure that’s not the case. They get care when they need it, not when they think they can afford it.

Martin Cody: Yeah. And you are probably have at your fingertips some of the statistics that are alarming when you first read them as it relates to, you know, X percentage of families are literally one medical bill away from bankruptcy.

Brian Marsella: Yeah. You know, they say 49% of Americans can’t pay a surprise $400 bill if it came their way. And yet the average out of pocket is almost $1,800, uh, across plans. And that’s across all sorts of plans, including high deductibles. So if you’re in a high deductible plan, it’s even significantly higher. And, you know, 63% of the folks have medical debt that have that have debt. So it’s it is quite alarming that, uh, people aren’t getting the right care in the first place. Um, if they get it, they’re having struggles to pay it back, which is then causing mental anguish and exacerbating their underlying condition. Uh, so that’s what we’re looking to try and to help solve.

Martin Cody: It certainly needs solving. And you mentioned something in that answer with regards to a standard American family or an average American family couldn’t handle a surprise medical bill of 400 plus dollars. And so the Consolidated Appropriations Act, obviously, one of the elements within that legislation was no surprise medical bills or surprise billing. And also some of the provider information requirements and accuracy of directories that when this came out and when you got to the organization, you and some of the senior leadership team took notice and said this could be a real challenge for us. So walk us through kind of some of those early meetings with the group and trying to comply with some of the NSA data requirements that you determined that we had to solve by via an outside partnership.

Brian Marsella: Yeah. You know, I’ve been with the larger, even the larger organizations I was with, um, had significant errors. We knew in the provided directories, um, some of it things not getting updated properly, some of it not getting sent in to us properly, and with our focus being on, you know, not only ensuring somebody gets an in-network level of benefit, but to make sure that we can help finance that. I thought it was even more important that our directories were accurate, um, than ever. Um, and, and then I looked at the, you know, the, the, the no surprise act and it was putting forward, you know, uh, let me start this over. Um, the. As I was looking for, you know, at the no surprise act, the CIA, it had some pretty onerous timelines that were in place, you know, 24 hours to update a provider, 48 hours to make sure it was in the member directory. Um, and also, we had to attest that it was accurate. You know, every 90 days. And there was just no way that my organization could possibly keep up with that, given the size of the organization. And also, we were a small player in the market. So the ability for providers to, you know, have the time to get back to us was not as high as maybe with some of the larger plans. And so when you think about that, but we’re a small growing company. I had to find a way to take this and outsource it off the desk of of my IT team, of my provider facing teams, and find someone that could really get this to a good spot. Um, and also, um, also help us with the actual display of the information because I didn’t think ours was in a very good spot.

Martin Cody: Well, and it’s interesting too, because you talk about you’re a smaller player in the market. Give us some specifics on kind of the size of your membership and number of members.

Brian Marsella: Yeah. So we’ve got about 60,000 members that use our plan through a number of different tpas in the market. We’ve got about 15 different tpas that we’re connected with. Um, and we’ve got about 100 hospitals in a little over 30,000 providers on our plan. So, you know, we’re not big comparison to others. Um, but we do, you know, interact with a number of, of members in the Wisconsin marketplace.

Martin Cody: And it’s interesting from a directory and a member facing perspective, one of the things I hear on an almost daily basis in working with Tpas and plans and payers is just how critical and important that member experience is when you when you walk through it for us, give us a little insight into kind of your perspective on that and why it’s important to your members and the downstream impact that that say, inaccurate information can have.

Brian Marsella: Yeah. You know, I think that if we do not have a provider in our network, then a member is not going to be thinking they can go to them and get the patient financing, and that may be the provider that they want to go to. So that’s causing a bad negative experience. Um, or if they are, uh, if they are not in our network and they’re showing up there and they have a different expectation. Um, then downstream, we just get into a number of different issues. So, you know, my view is someone should be able to go to the directory, know exactly who’s in the network, what they get as far as, uh, financing associated with that. And then they can, you know, enjoy the rest of the experience that we have, which is a consolidated bill and EOB and the no interest loans, but that needs to come after they’ve made a choice of a provider and hopefully that that provider has been in network for them.

Martin Cody: My guess is that it also might make it easier for you from a chief growth revenue officer and president of the company, and in charge of bringing in new revenue to sell the services of the organization, knowing that on the back end, the provider’s information is going to be displayed accurately and their patients and net new patients are going to be able to find them. Is that all go hand in hand?

Brian Marsella: Well, I absolutely you know, our 15 tpas that work with us have an expectation that our information is accurate as well. So, um, you know, we we certainly owe that to the to the tpas, to the employers and most importantly, the individuals searching to get care.

Martin Cody: Yeah. That’s awesome. I also love the, uh, the unique patient financing component of what you’re doing. So, uh, knowing on the heels of the families that can’t afford a 400 to $500 surprise medical bill, and you guys actually have a patient financing solution to help them be able to afford that and get the care. Certainly a unique. Aspect of what you’re doing. So congratulations to you and the team for that. Yeah.

Brian Marsella: Thank you.

Martin Cody: All right. I’m going to share with the group next just some of the details surrounding the success you’ve had to date. And then we’ll try to make you more available. What if some of these payers and plans and groups that are watching this have a question for you. How do they get Ahold of you?

Brian Marsella: Yeah. Happy to talk to anybody. I’m just be Marcella at https MD. Uh, and then happy to get back and engage with anyone. I’m on LinkedIn as well if folks want to reach out to me there.

Martin Cody: Perfect. Brian, thanks so much for spending some time. Hopefully in, uh, fall of this year, we might do it again in DC with a couple other opportunities and some other folks that decided they want to tackle this no surprises challenge and get their whole process automated.

Brian Marsella: That’d be great. I think when you think about the entry point of the system, this is so important for people to solve.

Martin Cody: Agreed. Uh, we will chat soon. Thanks so much for the time. Appreciate it.

Brian Marsella: Thanks.

Martin Cody: All right, so you you got an inkling of kind of how they solved it. Uh, Brian, has he mentioned he’s a smaller shop, you know, 60,000 members. I know the IT constraints that they have. They’ve got a number of competing initiatives. They have a number of open recs for new IT people, and they have a gigantic staffing issue like just about every other organization in healthcare. So the reason why we’ve been successful in this area is partly due to the way we approach it. So if you look at how most of the industry looks at this provider directory accuracy and the conventional wisdom approach, they usually follow a multiple or any variant of these four paths. Brute force. They just try throwing bodies at this. The more people we hire, the more we’ll be able to get this into scale. Uh, they’ve tried this for years, unsuccessfully. And as I said, there’s a staffing issue. This is also expensive and labor intensive, especially with turnover and manually entered data, is the longest tenuous process and also the most error prone, so brute force isn’t really viable. Big data. There are a number of entities out there that indicate, well, we have 50,000 provider data information sources or 100,000 is one I’ve heard recently. They have access to 100,000 provider data information sources. Um, not certain. The authenticity of all of those sources. But that’s great that you might have access to a lot of data, but that data is historically a snapshot in time. It could have been from two weeks ago. It could have been from six months ago. It’s not current data. And also it is only the data side of the equation. It’s not necessarily the compliance side of the equation. So having a lot of data isn’t always an end all be all solution to make this efficient and scalable and accurate.

Martin Cody: Then you can pull data from the payers. And Brian indicated you know sometimes their information is inaccurate. They don’t have a way to scrub it internally and they receive it oftentimes inaccurate. So not necessarily a reliable entity their credentialing vendors. It’s an understandable source. But you know, that’s a process that happens every 2 to 3 years. So some of that information is also 24 months old. So that’s 1 or 4 ways or a variety of four ways to do it. And I think that is also part and parcel to why this hasn’t been solved. Because the old way and what got us in this situation is not going to get us out of this situation. So pictorially and visually, this is what that process looks like easily a 3 to 9 month manual process. It requires batch approvals. It does happen, you know, systemically with a cadence. It can be monthly, it could be quarterly. But usually the data is curated about every 2 to 3 years. When you start talking about all the external sources, people send in rosters, they have batches of outbound faxes. That information gets sent to the health plan, not necessarily whether or not it’s accurate, but it gets sent to the plan. Providers are often asked to self verify the data, which takes time out of their day when they could more effectively be seen in patients, which is, I think, what we all want them to be doing anyways. And then this usually produces 50% accuracy. And Michael, I’m curious if you could break down the buckets of respondents to determine, you know, what was the lion’s share of the audience’s belief of the directory access and or accuracy in the United States? Do you have that figure?

Michael: Yes, I do. Um, 24% felt it was 20% accurate. 34% felt it was 40% accurate, 21% felt it was 50% accurate, 17% felt it was 70% accurate. So the majority group was 40% accurate.

Martin Cody: So if I’m loosely going after 2434 21 819, so nearly 70% of the respondents believe that the accuracy is currently, and I’m not too far removed from academia and f 50% or lower. That’s a problem. We could, we should and can do better. And I actually believe you. I agree with you. It is that level. So if where do we go with the 50% accuracy rate. And it’s ironic, I’ve actually worked with health systems that say in that first bucket, we’re 24% of the people said it’s 20% accurate. They believe and have set forth initiatives that they want to get up to a 50% accuracy rate, which I guess if you’re 20% is a good bar, but you’re still striving for failure, you’re still striving for 50% accuracy. Think about that for a moment. There’s really no other area in life where you would be teaching people your children, okay, just go for the F, go for, well, maybe baseball, maybe baseball. Because if you get on base five out of ten times, heck, if you get on base three out of ten times, you’re going to be in the Hall of Fame. But in healthcare, we need to do better and we can do better. So it has a bunch of different data sources that are unique in the industry. We also have some processes that we bring to bear at speed and at scale from an accuracy perspective and automation perspective. So we use a curated attestation process, which requires us, from an automated standpoint, to engage with the provider office.

Martin Cody: We focus on the end user experience. We have a success 70% success rate on these long tail provider orgs. And I’m going to show you some tables here in a second. Data sourcing. Many of you know in the audience that Matakite basically got us start by doing EDI automation. Some of you in the audience are customers. Our EDI automation platform is inside many major clearinghouses and has been for 12 plus years. So as a result of that, we have access not to 100,000 data sources, but to a very, very real current fresh data source, the providers information. Keep in mind, if a provider is going to change a location or move out of state or, you know, open up a behavioral health practice, the first thing they’re going to do is want to get paid electronically. They’re going to fill out an EDI application. They are not going to update. Unfortunately, the MPs directory, they aren’t going to update right away, but they are going to make certain that the money is flowing freely and with as little amount of friction as possible. They don’t want paper checks. So from that standpoint, our EDI platform and our enrollment platform has very current provider data, data ingestion. You heard Brian mention this. A lot of times payers and plans get information from provider orgs that’s inaccurate. They also get it in a variety of formats.

Martin Cody: And each payer and plan wants the organization to send it to them in their unique format. We don’t care what format it is. We will take all formats. We will consolidate it and get it into the appropriate format for endpoint sharing and more on that in a minute. Data delivery will send it anywhere you need. If you’re interacting with 50 plans, and each one of those 50 plans has a unique set up and format for how they want their roster or their data sent to them. We handle all that. That would require an army of labor. Normally on the organizations end to configure all that and then send it all out. But that’s exactly what we do to help free up some of that time. And our enrollment platform or provider data exchange platform, all of these things continue to feed each other from a provider information and data ingestion perspective that the data is always getting curated. So visually, here’s what that looks like a little bit different than the standard conventional aspect in the industry. So all of its data is front loaded and augmented by the provider rosters all formats. And again, we don’t care. We refer to this as crudely the Statue of Liberty approach. Give us your poor, your huddled masses, your unstructured data. We want it all. We’ll take care of assembling it in the format that’s required. And that includes all your outbound emails, your inbound Zendesk tickets, where a provider calls in and leaves a voicemail that says, I’ve got a new office location, we get all those, we intake that information, we transform all that data into a standard schema.

Martin Cody: Underneath the covers, we harmonize and then standardize that data. And then we create a master data set that gets you 90% accurate. From there, the output of this gets daily freshness checks. So we are constantly curating it with some external sources that have high confidence ratings of the data. And then we also can then take this information via outreach to the provider groups and orgs via custom secured portal. And we can send this to any endpoint. That’s the unique thing about it. You want to send this to 25 or 30 payers and their format. Not a problem. You want to bounce this off your credit system and make certain that that’s updated with fresh, pristine provider data. Not a problem. And then the attestation process is also internal. But here’s specifically as it looks at Brian’s. So Brian and their group cemented the partnership in December. We had a late December kickoff off call and really started things rolling in January when people got back from the holidays. We sat down and worked with them and this, by the way, is their independent provider org. This is not rosters. So these are those onesy twosy ad hoc ones that are the bane of every single plan and payers existence where the three doc practice calls in and they added two more locations and there’s a high percentage of these.

Martin Cody: But what I want to call out is we broke these down into separate cohorts with the collaborative process of HSPs. And so cohorts one, two and three are all less than three docs. Cohorts 4 or 5 and six are greater than 50 docs. And there’s a blend that we work in between. So cohort one, you can see very quickly by looking at the table. It has 83 organizations in this cohort. There’s also 83 providers in this cohort. So a quick math lets me know that these are all single doc practices. They have an 81% attestation rate since April 4th. So we began this process in the outreach April for cohort two was begun. April 8th. Cohort three was begun April 20th something. So as we blend, some of these cohorts and providers and contacts fall out of the system, they get added to future cohorts for different methodologies of outreach. One of the things I want to call attention to is the total attestation completion rate since April 4th. This is what are we six weeks later, and we’re at nearly a 65% attestation rate for nearly for over 5000 providers. That is extremely fast and it’s extremely repeatable, which is what’s important to all of you. This is something that can scale, and this is something that continues to improve week over week as we get more and more data in.

Martin Cody: So that 64% in two weeks is going to be upwards of 75%, and then it just continues to build on itself. That again, has the exact same downstream positive ramifications that Brian said his organization was trying to ford from inaccurate data. Similarly with rosters. Rosters have and I’ve blocked the names of the healthcare systems that they’re working with. But you can see some of the size of these, you know, 1000 1800, 1300, 2000, 5000. These are some potentially gnarly rosters, as some of my IT brethren like to call them, columns everywhere, hanging data all over the place. And it’s very tough to standardize these things. All of these rosters now that we receive on a monthly basis, are getting attested. So this has a cadence with it where the system is intuitive enough that at a certain timeline, usually about 73 to 75 days without contact from the org, the system wakes up and pings them. And it looks something like this. This is just one screenshot. You know, here’s a group that has they didn’t answer the 75 day ping. They didn’t answer the 80 day ping. They didn’t answer the 85 day ping either via email or phone call. And so now we’re at 94 days. So every one of these folks hasn’t been attested to in 94 days. This then kicks off internal business processes that have been designed with NPS collaboratively to say, what do we want to do with this information? We’ve now shown them in six weeks that they have over 100 different organizations that have no contact, with just about 3 to 400 providers that are listed in their directory, some of which we’ve now asked them to compare with claims data.

Martin Cody: So the claims data is interesting because now I can take an NPI. I can see what the claims are. And many of those 100 plus provider orgs, there have been no claims issued for these NPIs in over a year. So that could mean a whole bunch of things. It could be maybe that provider just didn’t see any patients at that location, but it could also mean that provider is not in the network any longer and probably should be removed from the directory. So what the net net of it all is it’s giving them very real, accurate insight to be able to make business decisions based upon their own data and not kind of well, suppose the data is accurate if it’s 30% accurate. This gives them very real intelligence to be able to make verifiable decisions for the organization and then get those providers out of the network if they are no longer in the network. This is a question that we get asked all the time. How much could this be worth to your organization? This is a simple answer. You can go to market Health.com ROI right now, and if you’re a payer org or a plan.

Martin Cody: There are nine fields for you to enter and consistent with our theme to make it easier for provider orgs, there’s only eight fields. And these are fields that most folks working at a payer know off the top of their head. There’s not anything you have to attach or it’s really high level stuff. And then when you click See my ROI, it’s going to show you the data. It’s going to show you the number. We’re not going to gate it with any type of oh please send us your email and social security number and mom’s maiden name. We want you to have the information. If it’s a compelling enough number, which we think a lot of it will be. Give us a call. Go ahead and put in your email, and we can walk through the math with you and walk through the speed with which you can start addressing this challenge. It’s very real. I haven’t seen a lot of improvement in the industry in over a year. It’s definitely something that is known to be a problem. And what Denny said as it relates to interoperability, this is the hallmark and the foundation to help that process along. And it’s what we do. It’s we’re simply here for you to make this better. And we look forward to any and all ways to help with the provider information accuracy. I will now happily take a sip of water and open it up to questions.

Denny Brennan: Thank you. Martin. Um, those on the the call. Please enter your questions into the chat box. I have several of my own, but let me start with Rob Tennant from Wedi. What do you think are some of the causes for provider reluctance to update their information with their payers? Martin, did you hear my question?

Martin Cody: Oh. Oh, sure. Yeah. I’m sorry, I thought you. My bad. I think part of the reluctance is time. It is, you know, at the at the October conference, there were several provider orgs there, and and they’re just exhausted. You talk to the provider orgs. And now this is just one more thing for them to do. But if you can make it easier for them and they can see immediate impact and I mean immediate, it’s like instantaneous. My data is updated. I don’t have to do anything for 90 days versus some of the things that they have to do where they get asked to do this survey, they get asked to participate in this, they get asked to, and they don’t get to see the downstream impact of their efforts right away. So when they get their data updated through the market tools and platform, there’s an immediate ROI. And more often than not, the information that’s getting sent in that outside of market when we ask questions like is is it accurate? The number one answer we get is it’s good enough. Well, no, that’s not good enough. And and attested doesn’t equal accurate. And that’s something that people are slowly beginning to recognize. You get a thousand roster in and someone just checked the box that said yep we attested it. They haven’t looked at it. So we need to do better on the front end because it’s still true. Garbage in, garbage out. And that’s where we kind of roll up our sleeves and get into the nitty gritty. And once the physicians see things are happening and moving in a positive direction, and that their patients and that new patients are going to be able to find them and see the office hours, because we feed this information to directories and we actually help organizations design their directory around sometimes CMS requirements, and also for the commercial requirements. So that has an immediate impact. That would be what I’ve seen from observation. Great question though.

Denny Brennan: Thank you. Devin Hunter asks what types of comprehensive payer reports are you able to generate with this solution?

Martin Cody: Uh, that’s a also a good question. The solution? We’re partners with AWS and we’ve got their reporting module, QuickSight. We can report on virtually anything in the system. I can tell you by payer, by plan, by tin, by NPI how long it’s taking, who’s responded. I mean, there’s a great deal of information at our fingertips. All of it designed to say what is going to help you as the organization. That’s meaningful. You know, we don’t want to inundate people with reports. We’d like to give them some data to help make better informed decisions, to improve the accuracy of all downstream processes. And it’s it’s part of the process. It’s iterative. It’s not a one size fits all. We have a bespoke process with every single payer and plan that we work with. And it’s also something I see Janice Janice’s question payer reporting errors are are are patient reporting errors. I’m sorry are a little bit tougher to quantify. But we do factor them into the overall model because the patient reporting errors are typically via the call center. And every pair that I’ve talked to, their call center volume has spiked in the last 12 months. And the number one bucket that we hear that they tell us is the information on your directory is inaccurate. I went to that provider’s office. They aren’t even there. They aren’t taking new patients. The largest bucket of growth for call center calls is in fact inaccurate directory information on the website.

Denny Brennan: Thank you. Um, what are some of the technology innovations that you see coming soon that will advance your ability to increase provider directory attestations above 90 and approaching 100%?

Martin Cody: It’s a great I mean, has anybody ever heard of I. Yeah, that seems to be the buzzword du jour, but I think I can play a role here because there’s some large language models that can also play a role. There’s some machine learning and we use, you know, some of those tools as well to say, okay, if it’s looking like a duck, sounding like a duck, quacks like a duck, this is pretty much a duck. This is this provider. This MPI hasn’t generated claim in a year. We look at a lot of different data around that. And I don’t see any magic wands though, if that’s what you’re looking at to say, oh, we can clean this up and get to 95% accuracy in 90 days. It is an ongoing process because providers are moving all the time. So you you have to have it be static and efficient. And I mean, if someone knows of a tool out there, let us know. We’re all ears. We we work with a lot of third party organizations that have some sophisticated tools, and so we bump our data up against some of their findings and score all of that data. But it’s a constant effort to to get as close to, to 95% accurate. I don’t think you’ll ever achieve 100 just because the data is in flux.

Denny Brennan: Very good. Rob tenet asks us, do you anticipate the no Surprises Act directory requirements will move the data quality needle somewhat or significantly.

Martin Cody: A two part answer yes, but only if the stick is enforced. Once the fines start coming, then the data accuracy will skyrocket. I hear it from payer and plan and provider org every day. Can’t do anything. Don’t have the bandwidth. Way above our tech scope. Don’t have the internal rails. We’re trying our best. I’ve got, you know, a dozen competing initiatives. And until the fines start rolling out, I’ve kind of like the old meaningful use aspects and the Medicare payment enhancements, and then the Medicare payment penalties, if you will, for meaningful use EMRs. There needs to be a carrot. I don’t see anybody really doing this to move the needle significantly, Rob, for accuracy of the goodness of their hearts. They’ll do it to avoid the penalty at the pocketbook. I wish it wasn’t true, but money seems to be an ultimate motivator.

Denny Brennan: Money does speak. We understand that. We appreciate that. When you look at provider directories, we often it’s it’s sometimes like a projective test. Many of us think of provider directories as different things. And perhaps you can help us understand some of the distinctions we have. Provider directories that are used by patients to find providers. We have provider directories that are used by health plans for certification enrollment. We have provider directories that are used in his to enable his to manage a large bolus of of providers within their network. Could you talk a little bit about the the the provider directory rubric and what fits under that and where Medicare fits specifically? It’s one of the questions I keep coming up with respect to provider directories.

Martin Cody: Yeah. We haven’t done ourselves any services have we by introducing as many definitions of.

Denny Brennan: Of one term. Right.

Martin Cody: Exactly. It’s like if you ask someone what is provider information and which is what we recently did and got about ten different answers. The the directory, there is a consistent theme. It’s with regards to what it is. And it obviously it contains demographic information pertinent to the individual care provider. It also then gets extended on beyond that with regards to location information. Then it gets extended on further for the entity’s own individual needs to include other things as far as practicing locations. Languages spoken. Office hours. Accreditations, educational history. So each one of those organizations that you mentioned has a different, I guess, fundamental requirement of some variation of all that information. But at the core of it, it’s still provider directory is the curated aspect for your organization of the elements you need. That’s the directory. And that directory will change based upon the organization. So but the core of that, the core tenants of that of that directory are the same as it relates to some of the demographic information for that specific individual. It just gets more broader with more terms and more fields of data dependent upon the organization that is sharing that information with with other entities and their requirements, either by their own policy or also state, local, federal policies.

Denny Brennan: I have one additional question, and that is, and I’m sure you get this question almost daily, Martin. But this sounds like a blockchain part, you know, case par excellence, multiple ledgers, multiple different, you know, unique ID points, some responsibility for the endpoints to keep their information up to date. Are you looking at technologies like blockchain or or other tools that will enable this kind of one to many challenge that we have in maintaining an individual organization, maintaining a huge provider directory of putting some of that technology in the providers hands, so to speak, so they’re able to maintain and keep their directory up to date. Do you see that in your future, or do you see that playing a role, or do you see your model as being sufficient to to make those kinds of, to make those kinds of adjustments?

Martin Cody: Oh, no, I absolutely see that in the future. And I agree with you 100% that this is tailor made for some of the blockchain capabilities. We are we’re a technology data company that happens to have a provider data management platform. So as a technology data company, we are constantly scanning the, you know, the ether for other like organizations that have it, have the next greatest sophisticated mousetrap, if you will. And then there’s a bunch of things coming that we see that could play a significant role in this. But one area that I, that I, I haven’t seen the adoption that you just mentioned is the physician side owning the running of this data and owning the, you know, the methodology to get to the accurate directory. Our data and our experience is that the physicians, they just want to see patients. They want this to be taken care of for them. And I don’t blame them. This is complex. This is hard. And it’s but it’s very important. But they also want to see patients. They want to get paid in a timely fashion. So I don’t know outside of maybe a few teaching orgs and stuff like that, and the larger provider organizations where they want to entertain bringing this in house. Most of the folks just want this problem to be solved so that they can practice clinical care.

Denny Brennan: Well, Martin, I want to thank you. Um, I want to thank your colleague. I want to, um, extend our appreciation from Wedi for what you’ve shared with us today. This is a subject that’s near and dear to our hearts, and I know we look forward to hearing from you and Matakite further. And.