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.