Video: Reducing Administrative Waste in Healthcare Systems

Video Transcript:

Saul Marquez: Hello everyone and welcome back to the Outcomes Rocket. We are recording here live at AHIP from Las Vegas at the Wynn, and I’m so excited to be here with Eric Demers today. He is the CEO of Madaket Health. Eric, welcome back to the podcast.

Eric Demers: Great to see you, Saul. It’s fun to be back on the show.

Saul Marquez: It’s really great to be back and great to be here at the conference. Lots of insights. And so we’re going to unpack some of that for the folks that couldn’t be here. But before we do, tell us a little bit more about you. What got you into the business? What’s your background?

Eric Demers: Sure. I’ve been in healthcare my whole career. I’ve always had a passion for this business. Got in early, right after grad school. I’ve worked in the provider side. I’ve worked+ in the payer side. I’ve worked from the technology side. I’ve worked from the financial side. So I have a unique view on the whole industry. So I bring all those things together when I’m doing my current job. It helps me understand and see maybe some of the opportunities in the landscape of where we can improve the system, you know, add more value to healthcare, make things more efficient. And that’s really what we’re about. We’re about making it more efficient.

Saul Marquez: That’s awesome. And we need more efficiency in healthcare in a big way. So talk to us about Madaket Health. What’re you guys focused on, and how are you adding value to payers, providers, and members? Sure.

Eric Demers: Sure. Yeah. For Madaket Health, you know, our whole thesis of our company was to improve efficiencies and remove administrative waste in the system, candidly focusing between the providers and the payers exclusively at the benefit of the patients. But really, it’s helping the providers and the payers be more efficient and collaborative, and as a result, the patients or the members, depending on how you define, will be better served across the ecosystem. You know, so we help from things, you know, think of functions that allows them to be in business together, streamlining those, automating those, making them really easy for the providers and the payers to work together. And that has turned into a really large business over time. And it, ultimately, that created a large amount of provider data that’s high touch, very accurate. And we now help organizations, particularly insurance companies like here, help them manage that provider directory, which is a real challenge for them and helps them support all kinds of use cases such as No Surprises Act, you know, better provider network management, member satisfaction, quality. I could go on, but it has a really impact on the business.

Saul Marquez: That’s really great. And things get complicated. Things get lost in translation. Directories get messed up. What would you say is one of the biggest ways you’re helping provider and payer organizations out there? Like, what’s the one that rises to the top?

Eric Demers: There’s several, but the one that really rises to the top is helping them really make their provider data synchronized between the health/provider organization and the insurance/payer company. Right now, they are very much disjointed. They’re out of sync. The information in both sides is usually not very accurate. Providers come and go from lots of organizations. All those updates, you know, actually put in a timely manner and sent to the payers they work with. Other payers receiving that information. I’m actually able to update their systems in a timely fashion because when I don’t and you, as a member, calls an organization or works with a payer organization and you get assigned to a provider, it may not be where you expected it to be. Your cost may be different. You may be out of network, not first, and network now. The cost of care for the … will be higher for our networks. The provider might be losing revenue because they thought those patients were coming through their network, and now they’ve gone somewhere else, maybe to a competitor. So there’s a real impact on all sides of the business with what we do there. So we’re able to help them really leap well above the industry. Because of our model, we’ve touched very different parts of the data than most do, and it’s based on our transactional volume. So we can actually get in and help make it very accurate at a level that most of the industry can’t touch yet.

Saul Marquez: That’s fascinating. And so you’ve got access to all this data. It helps update records. Is it real-time? For the people that are leveraging the platform, can the updates be made in real-time, or like what’s the time frame on that?

Eric Demers: It could be made real-time, but the industry doesn’t require it, candidly. So what we do is we update it daily. So we take all the information that comes in, updates the directories for the organization working with, and then they receive a fresh copy of that data every single day that they can then populate all their core systems to manage their business.

Saul Marquez: That’s great. And there’s a lot of players in the healthcare. So it’s not just the providers, the payers, and the patients, but there’s care management organizations, chronic care management. Help us understand how those players also get impacted by this misinformation.

Eric Demers: Really, if you think about the huge landscape of people who participate in healthcare, all trying to support a piece of the industry to move it along, right? You know, there’s really some core foundational pieces of how the business is run, right? You have patients, physicians, and insurance. It’s kind of like a triangle, right? They kind of, both everything flows through those three key areas. If one of those is out of sync, then the other two are obviously out of sync. So, that information flows across everything that happens in the organizations and the industry. So that data is critically important to all the people who are participating. They may not be directly impacted. But somewhere along the line, if they’re working with someone that is impacted and ultimately, has an effect on the entire business.

Saul Marquez: I appreciate you highlighting that. If you had to highlight one insight from AHIP so far, we’re just at the beginning of day two; what’s risen to the top for you as an aha from the conference?

Eric Demers: I don’t know if it’s so much an aha, but I think it’s just more of what people are talking about. Obviously, everyone’s been talking about AI for a while. I think there’s a general consensus that we’re not ready. Healthcare is not ready for full use embracement of AI. They’ll get there over time. Machine learning is much more likely to start, and then you keep going in that direction. And then, you know, just talking about where’s the future of the industry going and what’s the impact. You know, obviously, a large portion of the US population is covered by CMS. So the government, Medicare and Medicaid, they cover a significant portion of the American population, so those models and how they impact everyone in the business. And there’s been a lot of news about that in the last year or so. How do we optimize that to go forward? And what’s that effect on the organizations everywhere, and ultimately, the patients? So I think those are a couple of key areas that I’ve definitely heard over the last 24 hours come up quite a bit.

Saul Marquez: Yeah, yeah. There’s a desire to leverage the tech, lack of readiness, but opportunities to kind of engage maybe in segments to advance healthcare. No, this is great. The meeting’s been great. I’ve enjoyed chatting with you here today, Eric. For all of our listeners and viewers that, you know, haven’t been able to be here, what call to action would you give them as far as steps they could take to improve their game?

Eric Demers: You know, ultimately, this might sound a little off, but we find that in our industry, there’s a lot of desire to want to do something but not a lot of action to step forward. So I would encourage everyone to step forward and actually take that step to improve something in an organization that they haven’t done it. When it comes to us, it’s helping organizations tackle that provider directory, which has a huge impact on quality, cost, and ultimately, revenues. But there’s so much going on. A lot of organizations feel like that. Can I do another thing? So, trying to weed through the mess and do the things that are best for the organization, I think, is probably the call to action, I would say, for everyone.

Saul Marquez: I love it. Great call to action, great call to action. So everybody, step forward. Make it happen. Now’s the time. Leverage platforms like Madaket Health’s to get your provider directories in order, stop revenue leakage, and really take advantage of all the opportunities for your business that ultimately help patients. Eric, thanks for being with us today. It’s been a lot of fun.

Eric Demers: Good to see you, Saul.

Saul Marquez: Likewise.

Eric Demers: Bye.