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