Improving Provider Data Management for Payers

Hello, everyone, and welcome to today’s webinar, improving provider data accuracy for payers, challenges and best practices in a shifting provider data landscape. We’re excited you could join us. My name is Laura Beth Ezell, and I’ll be moderating today’s event. Now today, we’ll be discussing the industry’s overarching challenges in provider data management and how payers can help address barriers through organizational efficiencies that overcome departmental silo. We’re thrilled to be joined by two speakers, Mike Worth, chief commercial officer at ProviderTrust, and Ben Holliday, director of provider data management at Blue Cross Blue Shield of Tennessee. Before we get started, I have a few housekeeping items. Please note the slides will advance automatically throughout the presentation. To enlarge the slides, click the enlarge slides button located in the top right corner of your presentation window. If you need technical assistance, click on the help widget located in the bottom left corner of your console. Now we encourage you to submit questions anytime throughout the presentation using the q and a widget at the bottom of your console. We will try to answer these during the webcast, but if a fuller answer is needed or we just run out of time, it will be answered later via email. So please please note please note we do capture all your questions, and you’re welcome to just go ahead and submit them as you think of them during the presentation. Alright. To kick off, I would like to ask each of our speakers to give a quick introduction of themselves and their work. So, Mike, would you like to go first? Absolutely. Thanks, Laura Beth. Great to be here today. My name is Mike Worth. I’m the chief commercial officer at ProviderTrust. And as you can probably tell by my haircut, or lack thereof, I’ve I’ve worked in health care for a very long time. And, just really, am excited to be able to, be representing the the work that we’ve done on behalf of literally thousands of clients across both the the payer and provider continuum. And as well, have spent a lot of time thinking about this problem, which is provider networks, and how to help organizations. In fact, organizations like the one Ben represents, solve a lot of the challenges that they have. Yeah. Glad to have you, Mike. And, Ben, welcome. Thank you. My name is Ben Holiday. I’m the director of provider data management, at Blue Cross Blue Shield Tennessee. I’ve been here for about twelve years. Spent my first few years in analytics, and on the client side, and, spent the last eight eight or nine years on the, on the provider data side. So learned a lot in those nine years, and we’ve we’ve built and implemented a pretty robust strategy around provider data. So I’m happy to share some of that with you and, speak with Mike today. Excellent. Well, thank you both for being here. So now I just love to dive in here broadly, with an industry focused discussion. So, you know, can you walk us through the ecosystem of provider data? You know, what data exists? You know, where does it come from? And what are some of the macroenvironmental factors that are influencing this ecosystem? Mike, let’s start here with you. Yeah. I I think, Lorbeth, one of the words you used here that’s that’s that’s material is is ecosystem. So often, for someone who’s not working in our space or our industry end up spending time thinking about the system of health care. It’s not. It’s an ecosystem. It’s it’s it’s that there’s impacts that are related from one place to the other, but it’s not all the same song that was organized to be able to do everything the right way from the from the very get go. You have let’s start with just the provider network data. Let’s start with the practitioner. The individual, she or he, that’s filling out information, trying to submit information about who they are, where they went to school, what are their bona fides that enable them to be able to practice. But but that that cascades and expands rapidly from, organizations that are trying to capture information about these practitioners, whether that’s to ensure that they can deliver that care on the provider organization, so any health system through to a, imaging center and otherwise, but then also payer organizations who are trying to keep track of this information. You have vendors that are trying to supply information to credentialing teams or to claims data management teams. There are so many regulations about what has to be captured, what can’t be captured, and I haven’t even started to talk about some of the state level sources of data that are completely different. Alabama does not operate the same way as Nebraska, which is different than what Arizona does or doesn’t provide. So you have all of these factors that are at play that just create a lot of really, it’s a it’s a a it’s a cacophony, not a symphony, of information to try to navigate. Yeah. And and kinda going off what you said, Mike, you know, from the from the health plan side, it’s, I think, exasperated, even more from the fact that we have, multiple networks and providers exist in multiple lines of business. And they work at different companies, and those companies have several different practice locations, you know, and, you know, the they they have practice locations that they’re affiliated with and some that they’re they’re not affiliated with tied to certain groups. Anybody who says provider data is is easy, is is probably not very well versed in in provider data. Coming from the member side prior to this, provider data is much more challenging. Right? Members typically live in one place. You know, they have specific people who are accountable for, communicating their demographic information. On the provider side, it’s much, much different. You’re you’re dealing with credentialing companies and contracting organizations and different groups and several vendors. You’re dealing with the federal government, state entities. It’s a it’s a tough problem. You know, when when we look at provider data internally, we generally kinda put it on a spectrum just to make it easy for, I guess, those who aren’t as well versed in it or don’t understand the problem. You know, we see provider data as as fitting one of two ends. It either fits the claims, right, that members will ultimately file or providers will file on behalf of members, or it fits a provider directory. Every everything else we collect is generally somewhere in the middle. You know, the credentialing, the information, their practice locations, are they who they say they are? It it’s generally within the spectrum, but serving one of those two ends. So it’s it’s a tough problem. It is you know, Ben brought up some some interesting points. Like, it it’s it’s where theory meets reality. Right? The the theory of this should be pretty simple. It’s a finite number of practitioners and and entities in the space, but the reality is is there’s so many different requirements that happen even within one payer organization with those different lines of business. Heck, even just with the proliferation of Medicare Advantage, the expansion of that and now all of the regulations that are on top of that, that’s different than what, provider up or, provider operations groups have been trying to to navigate in the face historically. I mean, they have to build new systems and ways of dealing with even even some of those types of changes as they evolve. Right. And those regulations, you know, I think have good intentions. But in a lot of cases, they they, they require organizations to rush to adhere to them and maybe sometimes cause more harm than than good. So, you know, in looking at the landscape and and how we can, address the current issues we see and continue to face, you know, working, you know, together as an industry is the only way we’re gonna get to the end. Yeah. Laura Beth, I’ve worked on both sides here, you know, thinking about the payers and the provider part of the world. And and, historically, that’s just it’s been a very adversarial dynamic. That’s typically how, those organizations show up. And and the the reality is that that can in turn that kind of that mindset can kind of create some problems. One of the things that I always encourage organizations to do is just go prepare organizations, go go through the process of what your practitioners have to do in order to enroll, be credentialed, and or go through recredentialing. Just do that alone and just see what that experience is like, but do it for all of the different products that you actually offer to the space. You start to understand what types of complexities emanate out of something that seems like it would be so simple to just capture a little bit of information about one person. Yeah. Three points there. And I was gonna say, is all of this complexity new? Has it always existed? You know, what has changed over the past ten years here, Ben? It’s it’s definitely not new, but I will say it’s getting more difficult. You know, it’s not it’s not just where does somebody work or who are they or what are they certified to do anymore. It’s it’s things like, you know, where does this this information come from? You know, I think the consolidation of the industry into larger and larger provider groups is making the problem much, much worse. And that’s not a fault of anyone. That’s not a fault of a provider. That’s not a fault of these these companies getting larger at all. It’s just it’s the disconnection that’s always existed is just kind of making itself worse because these organizations are getting larger. You know, where ten years ago, we, maybe interfaced a lot more with the actual physicians or the, I guess, the practice managers, within those groups. Now we’re interfacing, at least from the health plan perspective, we’re interfacing with corporate offices that a patient never walks through the door on. Right? So, you know, when it when it comes down to what do what do those people know that we’re talking about, you know, in terms of the details on who these providers are and where they work, it’s it’s it’s only what’s in their system. Right? They don’t see them walk through the door anymore. They don’t know that this person is only here on Wednesdays. So it’s it’s gotten a lot more challenging. The the other thing I think that has really, compounded this problem is just the technological barriers that exist in general. Providers are asked for a lot of information from a lot of different entities not to just include payers. Right? It’s coming from vendor communities. It’s coming from the federal government. It’s you know, you have to keep this profile up to date. You have to go to this vendor and keep this profile up to date. You know, go log in to this portal and keep that up to date. It’s really an abrasive to Mike’s point earlier, it’s an abrasive environment all around for practitioners. And, you know, we gotta we gotta do more to kinda meet them where they are. It’s and it’s and it’s not just to meet them where they are in in the individual transaction because that’s what we see a lot of is that that it’ll be, hey. Let’s make this one change or this one fix for one form or one place. And what ends up happening is that those little changes sum up to a lot of larger challenges in terms of being able to organize information to make sense of it over a longer period of time. So you’ve gotta be able to be ready to make these changes as issues or regulations evolve in the space, but you always have to have this perpetual eye towards and where are we trying to end up? And where are we trying to end up? And where are we trying to end up that exists outside of just your payer function, whether that be in managing the directory or credentialing or any place that you sit? And and, otherwise, you start kind of iterating away from what your process was built to be able to capture in the first place. Yeah. And Go ahead. Sorry. The the, the the challenges around the data, I think, are the ones that need to be addressed the quickest. Right? You know, there’s a lot of industry noise around, things like universal group rosters? Or can we create a single universal directory? Or is there a universal front end we can put on provider enrollment? You know, is there a universal vendor we can use for credentialing? And I would say those are all great ideas. But to your point earlier, Mike, operationalizing those, is very difficult, and there’s a reason it’s not done yet. And okay. Well, you know, sticking here with that macro industry lens, you know, what are you observing that addresses this complexity or at least attempts to here, Mike? Yeah. The the, Ben saying it in a very, in a polite way. I’ll I’ll say it a little bit differently. Everybody and their mother has some type of a version of, hey. Here’s how we’re gonna go solve this problem for you today. I just spoke they’re coming out of the woodwork that that have a any type of of, solution. Oh, we can solve your provider network problem for you. And I am humble enough, but also confident enough to be able to look at all the participants here and say, if anybody’s saying that to you, and I say this as a vendor, you should stop listening to them because they don’t have it. Right? We’ve watched this over and over again where organizations have tried to turn this on. We we had, a large payer organization just one year ago who said, we’re gonna go in a different direction because they can do everything. They have both the platform and data. They’ve literally come back to us, and we’re starting with them come January of this year because they said you were right. Nobody has the complete answer. You have to be able to be humble enough to say, here’s what the part of the problem that we’re gonna help you solve. So so I think this notion of the promise just to payers that there’s not one silver bullet is something that is important to embrace. It’s easier from a procurement standpoint. It’s easier from an operational standpoint to manage one vendor, but the reality is is you’ve gotta be be best in class in helping to find the right types of partners, they’re gonna help you enable that type of a solution. And by the way, like Ben mentioned earlier, one of the things I think that that Blue Cross Blue Shield of Tennessee has done a great job of is that even though that dynamic can be contentious between provider and payer, I think one of the things that that Ben and his team have done a great job on is is engaging the practitioner as a as a key stakeholder. And by doing so and saying, look. We’re gonna try to create as as as easy as as seamless of a process for you as possible and making that part and parcel of their overall data plan and keeping that central, that’s been a huge part of what one organization can do. The last thing that I’ve I’ve seen that’s that’s that’s kind of warms my my heart in the space, you know, for years, I’ve watched payers insulate themselves not just from practitioners or from from other health systems, but from each other. Health systems have have long shared in best practices around how can we be better, how can we work more collaboratively to find the right evidence base for how we can better engage patients, take care of, and treat treat certain types of cases, etcetera. That’s not been in the DNA of payer organizations. I will give credit. CAQH facilitated a group, pulled together, several different organizations from across the industry to try to help just standardize on provider data ingest. I’ve never been with a group of payers that were uniform and unified and saying, here’s how we can come together to solve this problem differently. And I give CAQH a lot of credit for helping to bring that to our space and to our industry. Yeah. And then building on that, Mike, as a, you know, self proclaimed data evangelist, you know, myself, obviously, the closer and this is is gonna sound so obvious, but it’s for whatever reason in provider data, it’s often missed. Right? For the closer you can get to, the source of truth, the better off your end result’s gonna be. The challenge with provider data is the source of truth is very it’s it’s it’s all over the place. Right? You have to literally kinda pigeonhole your use case and then design decide what your source of truth is. For instance, you cannot rely on a provider’s credentialing application, within their own practice in most cases to facilitate your your directory needs. Right? That application doesn’t know where that practitioner shows up to work every day. They know what the what’s needed for credentialing. Same with contracting. You know, you could you could make the same case for their scheduling tool. Right? You probably shouldn’t be, sending payers or or any other consumer, credentialing data out of your your scheduling application. Right? That’s that’s not what it was intended for, and that’s probably that’s not what it’s maintained maintained as. So as we as we look at this, we need to recognize those realities, again, that the that the providers have. And to your point earlier, Mike, you know, you you mentioned, treat the provider as a as a stakeholder. I’ll take it one step further, and I’ll say that the biggest culture shift we’ve seen is treating the provider as a customer. Right? Once you change the culture to treat the providers as your customer, if you work in a provider data shop, everything starts to change. Right? The things that, you know, again, has has historically been adversarial now becomes, supportive. Right? You’re you’re why why do you have this challenge? What can we do to help you with this challenge? It’s not give us this information or else. It’s how can we help. And I think that’s the key thing that we found that attempts to change, you know, the now. Yeah. I you have been, by the way, Lord Beth, he referred to himself as an evangelist. I don’t know that I’ve I’ve experienced Ben that way. To me, he’s he’s more about he’s more like a honey badger is what I kinda find him to be. But, maybe that’s just our special working relationship. But it it you know, the the other the other challenge here is sifting through what are the what are the promises that are that have have have promise, and then what are the notions that are gonna fall short? And, you know, similar to the, that kind of industry saying, let’s standardize on data collection. There’s legislation that’s been passed. Like, this is not new news. There’s legislation passed that is saying there should be a universal provider directory in existence. That there was an RFI that went out on this. And, Ben, I don’t know if it was a year ago, two years ago, what it was, but it was it’s it’s it’s somewhat recent history at least as it relates to CMS requirements. And and so this is this is out in the ether. I was at a recent industry conference, and the question was posed to literally a room of five hundred different participants from the payer space saying, how many of you have faith and belief that within the next five years, there’s going to be a CMS sponsored universal directory. And maybe I looked around the room, I saw six hands go up in the air. Right? Like, it’s it’s not gonna happen. Like, there’s false promises that are all over the place, both from from from, organizations that play in the space to other other types of of just what history tells us about what’s gonna be accomplished. So the job is evolving from just functionally how do I solve for, like Ben was saying, directory or for credentialing? The job is now. How do I make sense of everything that’s going on at the regulatory level, at the macro level, at a state level? How do I make informed decisions about trying to skate to where I think is gonna be the best place for our unique organization with our unique constellation of providers in the service areas and the service in the in the business lines that we take on. That’s the challenge today because having live, actionable, dynamic information about your provider network is absolutely a differentiator, not just an expectation that’s gonna normalize. It’s a differentiator in how these different how nimble these different plans can be. Yeah. And, Mike, I think that’s definitely a, a step in the right direction. Right? If, you know, historically, there’s been this battle in the industry between, you know, payers and and vendors on, you know, who should be the owner of this piece of information. And maybe instead of that being a battle going forward, we can take the parties that, can complement each other and start working together and come up with ways we can get to a universal source of a lot of these things. You know, you mentioned the, the universal directory. Well, that’s not a technological problem on why we can’t get there. The reason we can’t get there is because you haven’t by getting there with the data we have today, we being the industry, by getting there with the data we have today, you haven’t made it more accurate. Right? You’ve just put it all in one place. So, you know, the payers probably would love that because if CMS says as long as you use the data from this universal directory, we won’t find you for inaccuracies. Well, yes, I would love to have that. However, you haven’t solved the reason that that conversation came up in the first place, which is make them more accurate. Well, the only way you make them more accurate is to get more accurate information, and there’s not a good way to get that information today, hence why it’s not done. So, you know, recognizing the root cause, I think, is the first step in solving the problem, and I don’t I don’t know that enough has been done along that path. Well said. Yeah. Well said. And just good insights from both of you. So now on Adi, let’s let’s talk more about this from an organizational point of view as a payer. So where do you see the biggest challenges and opportunities across the provider data life cycle inside the payer organizations themselves? Mike? Yeah. Ben started to allude to this a little bit, but, it takes me back. I was with a a large regional payer, and we were having this conversation. You know? The the the the big strategic session where we’re talking about, how important this is and and literally every function across the, business is represented. Every function around the room is, yes. This is a big issue. Yes. This is a problem. And as we started to drive forward with the and who owns solving this, nobody had their hand raised. The accountability short because where does this reside? It’s like everybody has a has a has an inherent relationship to the information we’re talking about as it relates to provider data, but it’s not necessarily the one place where it is consistently owned and not every org chart and accountability structure is enabling to be able to support that both from a business need as well as from a just just the the, what I would just think of as functional IT and or IS, just data management. So the blending of those competencies and being able to look at that, that is not commonplace across payers. So one of the things that, you know, we always we look at when we’re working with organizations is just how are you structured? How are you set up to be able to tackle this? And and, like, you might have an ambition to solve this collectively, but you’re only showing up from this functional area. Let’s solve it for your functional area and then build out from there. That might be your plan because absent that grander plan or vision, you have siloed parts of those functions. And silos, I’m telling you, I’m from Nebraska. They work great when it comes to to farming. They don’t work great when it comes to, operationalizing, what you need to be able to solve for cross functionally. Yeah. I agree with that a hundred percent, Mike. You know, we have a saying here in Tennessee. If you can’t remove the silos, at least figure out a way to connect them together. Right? And, you know, technology can help with that now or, you know, you can create your own business processes to do that. You know, when when you’re talking about the the biggest challenges, when we when we set our strategy in motion back in twenty seventeen, twenty eighteen time frame, the one thing we had to kind of really take some time to outline was where do we wanna be five years from now? Where do we wanna be ten years from now? And what is our landscape going to look like? Right? We mapped out regulation’s gonna increase. Our world next year won’t be the same as our world is this year. Right? What is industry consolidation gonna do? What are what are these new, you know, value based programs that are emerging and the data structures of, you know, associated with those gonna cause? You know, how do these narrow networks or ultra narrow networks impact some of the contracting decisions we make? And then what is that gonna do from the data kinda structure that we have to maintain? And what we quickly realized is we need to eliminate redundancy in our data collection points, if we’re ever gonna have any chance of, you know, really getting strategic about this stuff. So, you know, things that that we we did right off the bat is we streamlined our enrollment process, and we eliminated the multiple front door approach that we we used to have. You know, we would allow providers to give us information on a napkin. They could drop it off an enrollment form at the front door. They could, you know, send it in in as PDF. They could copy and paste that and send it from another email as a PDF because we didn’t get to the first one in time. We didn’t have clear metrics on how long things were taking, and it was just it was just a mess. Right? So, you know, internally, I think to your point earlier, Mike, each organization needs to kinda be honest with themselves on where they are now and where they wanna go and make some decisions. Right? You know, providers are providers will adapt as long as you don’t make their lives worse. And, you know, I think that gets back to treating them like the customer that they are, and giving them an experience that is straightforward and at least as unburdensome as possible. You know, we’re we’re, we’re we’re we’re old guys who are talking about sayings here, I guess, Ben. Right? So I guess, you know, it’s like I’m I’m showing up as, like, somehow like the Paw Paw provider networks. But, one of the sayings that we also have is just that there’s there’s a a a when when you’ve seen one payer, you’ve seen one payer. And when I think about how the work that you’ve done there, especially on the enrollment side, focusing on that one thing was how I watched Ben begin to create change. And the partner in crime that’s not on this call today, the SVP of provider networks, she’s fantastic. Stacy has, takes a long view. And and I’ve watched this team be willing to endure and navigate some short term challenges knowing that what they’re building toward is the right thing longer term, but that’s a shared, articulated, and managed point of view that has been stated and defined. And then everyone is enrolled and bought into that, and then everyone works relentlessly to that. And I’m gonna set Ben up for this. He doesn’t know that I’m gonna say it today. But, Ben, would you share the data about your enrollment time frames, your time of enrollment from when you first got there, how you looked at that, what you’re clocking at today, and then what you’re continuing to improve against? Would you mind doing that? Yeah. Sure. So, back in twenty seventeen, we were, we were trending around a hundred and twenty days. Best guess. Right? We didn’t have a good system to track it. But we were trending, you know, ninety to a hundred and twenty days depending on if it’s a, you know, a practitioner or facility, different types of providers. And we we had no idea where our stuff was at. Right? You know, in order to come up with that, we had to put a team of people on the world’s largest research project just to figure out, you know, how many applications did we have in process, who were we waiting on, you know, where was it at, why do we have fifteen applications for the same person at the same time, Submitted four months apart. You know, just documenting all of that stuff. And, you know, what we what we did is we we, again, sat down. We figured out, you know, what don’t we know. And in a lot of cases, worked backwards and figured out, you know, this is the workflow we need and the appropriate steps for it to pass through. So without hiring in a single additional person from an operations perspective, we were able to take our enrollment time from from around a hundred and ninety to a hundred and twenty days down to, you know, around twenty one to twenty five days. You know, and we can also now with the capture of metadata, we know how long do these applications sit with the practitioners. We know how long do these applications, stay in a certain team. We know how long does it take a certain person to work these as compared to someone else. So, you know, there’s a lot of analytics, a lot of reporting tied to it, and, there’s escalation mechanisms involved. So and that’s just that’s just one thing. Right? And there’s there’s a lot of other things we’ve we’ve been working on. But, you know, we we started with enrollment because we we were in trouble from one of our our regulators, and they said y’all need to fix this problem. And not letting a good compliance action go to waste. We said, well, in order to fix this problem, this is what it’s gonna take. Our company obviously agreed to that, and and we got it done. So and, you know, it’s it’s kind of the the building on the wins in order to to push it forward. It’s such a great nugget not losing sight of, you know, an opportunity, you know, like this, the showing up when we have a real problem that’s quantifiable and then building on top of that and turning it into an opportunity to be able to make improvements. It’s one of the things that, you know, just just having to watch you go through this. It’s it’s, it’s it’s fun to see how you’ve been able to drive change, in that regard, and and that’s a massive increase. That also represents the point of view that the organization is taking on by saying, this is a key stakeholder, a hundred and twenty days for that practitioner than in order to be able to go through and be paid. That’s ridiculous. Right? That’s not something that we we’re gonna be okay with. And by being able to reduce that down, they’ve got brought it to less than a month on average, and this is across this is across the the the entirety, of their of their network. It’s it’s it’s a great success story. And I know that other Blue’s been involved with a lot of the, their processes up the progress you’ve made. Yeah. Yeah. It’s been a it’s been a fun project. And I’ll tell you what, the main thing we learned as part of this is that not only will providers change, but our internal teams will change. Right? And that’s a lot of times, that’s the hardest thing to do is get your people within your organization to be better. And, you know, we we were very siloed, before. We we had credentialing kinda did their thing. And then, you know, our contract management team kinda did their thing. And then when we got to the, you know, network activation or enrollment team, they they did their thing. There was there was not real good communication across those teams. And now, you know, we even have the ability to to push work backwards and say, you didn’t do what you were supposed to do. So we need you to go back and fix that before we can work this. Right? And it’s all within one one workflow. And, you know, team members as well as our entire process holds itself accountable. Yeah. Great thoughts there from both of you. And, you know, what are the cost and risks of provider data mismanagement resulting from these, you know, silos and difficulties in data access? So so what’s at stake here, Mike? Well, there’s there’s a lot, and there’s there’s a lot more coming down the line. It depends on on what you believe and and when you think things are gonna happen. But, you know, the no surprises act was suspended during COVID. The reality is is that there is a fine. There is a penalty to be levied, for data inaccuracy inside of provider directories. That fine or penalty is twenty five thousand dollars per infraction or instance. That has been suspend the the the prevailing belief is that that is going to stay suspended, but not forever. And part of the reason it’s continued to be suspended is because some of these major payer organizations have publicly stated that their directory is no better than fifty percent accurate. And there’s a lot of down, downline downstream pieces of information inside a directory that relate to that, and that contribute to it. There’s also a lot of requirements that are very challenging for any payer to be able to get right. But today, I mean, seventy percent accuracy is is great data. And and that’s that’s one of the things that that is just gotta be understood. There will be fines and penalties coming. It’s just so bad today that nobody really believes that it’s coming, but it’s going to happen at some point. So it’s it’s it’s kind of that question of, do we get on about doing this now, or do we wait until somebody has it done unto us? I’m certainly of the mindset that I wanna be on the former, not the latter. But that’s that’s part of just quantifiably what’s out there. Now you also have in run the the complete risk of I’m I’m a I’m actually, believe it or not, I’m a believe it or not, I’m a member at Blue Cross Blue Shield Tennessee. And one of the things that that I’m thankful for is that they’ve worked very hard to try to get provider directory data correct. Because when I need to go find a practitioner for myself, for my sons, or otherwise, like, that’s a big part of my own member experience. So it’s not just the actual quantifiable fire penalty that I deal with, but it’s my own member engagement. My my my member satisfaction, in my own interaction with them that says that that’s a payer that I care about being with. That’s another stakeholder that in this competitive landscape, payers and provider data organizations are gonna have to pay a lot more attention to. Yeah. And, Mike, building on, you know, the risks and, you know, I guess, stick with financial, the financial penalties we have kind of sitting on our shoulders. You know, if if we have a provider in our network or keep a provider in our network that, has, some history in another state and we don’t have a way to see that in real time, there’s there’s a chance those those practitioners could be in our network when maybe they shouldn’t be. Right? So credentialing, you know, looking at the the reason we credential providers to begin with, you know, we need the most up to date information as possible. And I know, you know, at ProviderTrust, y’all are working on a lot of a lot of that good stuff. But if you take it down to the the core operational stuff, like the consolidated appropriations act, there’s not a fine yet or a penalty detailed yet. But that that was a regulation that or that was a, series of regulations that required a lot from a provider data perspective. You know, one of those was, most directory changes need to be processed within two days. There’s there’s payers out there that can’t process them in thirty days. Right? There’s payers that can’t process them. We used to be a hundred and twenty, you know, not very long ago. So getting the two, if you don’t have a strategy in place for single point, data ingestion, it’s it’s impossible. Right? Because, really, what what the federal government has said is you need to not only get it operationalized within your systems, you get need to get it to the directory in two days. Right? And directory, replication time for those directory files can be up to four or five days. Right? And now it has to be it has to come from the provider. We have to we have to, triage that, intake it, process it, make the systems replicate, and get it to the directory in two days. Well, I can tell you we’re doing it, but it was not easy. And it took a lot of baselining of our strategy to get it there. The next one is, to your point, Mike, the directory inaccuracies. You know, seventy percent, is a terrible number. Right? I don’t think anyone would say seventy percent is great, great data accuracy. Right? You wouldn’t book a flight with the assumption that you had a seventy percent chance of walking on it at the when you get to the airport. Right? I I certainly wouldn’t. But that’s the reality for our provider directories today. And I I don’t again, I don’t think it’s because we don’t, as a group, manage it well, but it’s definitely, it’s definitely because we have a industry data problem that, so far has not really, has not really solved itself. Out of network claims is another problem, another, function of the No Surprises Act. You know, if if we can if we put a provider in our directory that’s not really there and that provider has told us they’re not really there, we we are responsible for for paying, you know, that out of network claim cost. It’s it’s not the member. Right? We have to give them in network benefits on that. That could be a problem if you don’t if you don’t maintain your data very well. But I think, you know, if you if you really boil it down, the biggest the biggest cost is the, Mike, you you probably have a less friendly phrase for this. But it’s it’s the, the burden we put on ourselves. Right? The operational challenge of us chasing our tails, trying to find out where this data actually is and, you know, how many of these whatevers do we have and how fast do we need to process them, you know, that inefficiency that exists when you you don’t really have a strategy associated with it and you have all this stuff coming in from everywhere is a problem. Right? It’s it’s the thing that, you know, if if I had to put a a cost on it, prior to our strategy, it would be, you know, twice as much as what this entire project has cost us. Ben, I don’t I don’t have a better phrase for it, but at times, I, take confessions from people who are your peers, and they’ll talk about just how they’re trying to solve some of these problems. And one of them goes back to the siloed issue where these different functions will say, look. We’re like, I know I know I have these different functions, and we bought this similar data from four different vendors four different times. And we’re doing it because we’re trying to solve these point solutions, but they’re not not only are they not integrable, they’re not interoperable. And by not having an interoperable point of view on how we’re gonna try to make data live and not not about accuracy, but about relevance and making that relevance to be able to utilize, that’s where their the the the provider network operations can be rife with overspend and inefficiency. And taking that long view to say, how do we get off of this train of being siloed or or procures of this and get onto a train that says, here’s how we’re gonna have a hygienic strategy that’s gonna be interoperable. Anybody who’s not on that train yet, like like, you better get on because because the station, is is gonna get pretty empty pretty darn quick. Yeah. Agree. Well, great thoughts there, but, let’s talk about strategy now. You know, you guys have brought up a lot of great points, but what are some, you know, opportunities to improve provider data management and connectivity within the payer organizations when health plans themselves are so inherently siloed. So how should health plans, you know, be thinking about this? Mike? Yeah. So I think that, let’s go back to some of the themes that are that we’ve we’ve kind of planted here and very purposely or I think trying to help encourage folks around. It’s it’s having a collective or shared point of view that comes across and comes from, leadership. Now that point of view doesn’t mean that we have to go rip and replace every piece of technology and infrastructure. Gosh. Wouldn’t that be nice, Ben, to be able to do that? Right? Wouldn’t it just be nice to be able to say, look. We’re just gonna start over. Right? Like and and every once in a while, you know, we we fantasize about these types of things. The reality is is we have to keep the lights on, folks. And that work does not stop just because we’ve decided that we’re gonna move in a different direction. So that change is going to occur. How you choose to do that inside of your organization, we have seen organizations do the complete rip and replace. We have seen organizations do and follow the model, and this is one of the things I think Ben did incredibly well. Start with one place. Start with enrollment. Have a point of view around how this is gonna work. Have a point of view around what’s gonna be our source for data around enrollment and start building to that point of view. Having that shared and having that plan mapped out, Ben Kent doesn’t have everything solved for today. But he and his team and how he partners with provider network operations, how they have collaborated together, they know what they’re picking up next, and then they know what they’re gonna pick up after that. Right? So picking out those first areas to be able to be successful at and then build on top of that, taking advantage of, right, a a good compliance problem has been would, would say and and offer. Right? Let’s build on top of those areas, But having that plan ready to go, that’s what’s been that’s what’s enabled that team to move, not waiting for that to happen and then having to build a plan. That’s the first thing that I would say is have a point of view and have a plan. You will then find your right opportunities to be able to take take these on and operationalize them. Ben, talk a little bit about how you’re you’re continuing to build on some of that today. Yeah. It’s I think, you know, the the hardest thing again is get started. Right? Or or getting started and know where to start. And, you know, a lot of times the answers are right in front of you. Right? You know, if if you don’t if you don’t know where to start, maybe start by outlining what you don’t know. Right? Or maybe what you assume you just can’t prove it and then figure out what does your system look like that allows you to prove that. Right? What do you need to collect that you don’t collect today? And it’s it’s just in general, how how do you how do you, get moving? And, you know, you could you could what is it? Analysis paralysis. You could look at this thing until you’re blue in the face and you’ll you never get anywhere. We have one of our executives, his favorite phrases don’t let perfect be the be the enemy of good, which is always quickly followed by fail fast. And, I think it’s it’s good advice. Right? It’s not applicable to everything, but it’s it’s definitely good advice when you’re stuck in the mud. Right? It let’s let’s at least get going. You know, when we got started on our enrollment process, it wasn’t a, hey. Let’s build it in twenty seventeen. And in twenty eighteen, we’re done. And, you know, we’ll we’ll, we’ll move on to the next thing. It was we built it in twenty eighteen. We recognized the value, and we’ve been iterating on it ever since. Right? We’ve we didn’t just fund we didn’t just fund, the build. We funded sustainment. You and I think that’s the thing that gets missed a lot of times is you you set yourself up up for initial success, but you can’t, in the long term support what that ultimately needs to look like over time. So and setting yourself self up for long term success isn’t just within your own team, and it’s not just within your IT teams. It’s both of them. Right? You have to have people who can manage the technology, and you have to have people who can own the technology. Requirements. Right? They work directly with the business. They work with us in an operation shop, but they are recovering IT folks as as they call themselves. So, you know, you you have to you have to get your technology under control. You have to master the small win. Right? You’re not gonna go out there and say, hey, executives fund me, you know, dollars fifty million so I can go build this this grand tower to the moon. It’s it’s just not gonna work. Right? You’re gonna have to pick a problem. You’re gonna have to figure it out. You’re gonna have to solve it. You’re gonna have to prove the value, and then you need to move on to the next thing. Right? And just keep iterating and keep building and keep solving problems. If if they’re noisy with your executives, there’s a big hint here. Eliminate that noise and they’ll give you more money. Right? I think the biggest thing we need to do is, when you’re building out your strategy is make sure that your goals or incentives for your your technical teams, which are often different from your own, and your internal or operations or business teams are directly aligned. Right? So you share in the successes and you and you share in the failures, but you’re sharing in it together and both both sides are are motivated for the same cause. Yeah. I think then you you just you’ve gotta you’ve always had that having a plan in your hip pocket is important. Right? And then capturing those moments of opportunity, to get the, you know, to get the, the ball and the joint and get it things moving out of the hip and not just keeping it in the hip pocket. Like, that’s that’s the thing that I’ve seen you all do as well that that it’s like you gotta move when you need to be able to move and and be ready to go. There are organizations that will take on that fully funded, like, let’s rip out and put in place the whole thing. I will I will say this, every time we’ve watched that happen, it’s it’s a two year implementation burn, and it typically ends up in a real different place than when people start. Iterative, we’re biased, but we’re we’re very much about start with where you are and iterate to get there. Not saying it can’t be done. I’m not saying it doesn’t happen, but boy howdy, that’s a that’s a lot of bucks to be able to and a lot of time to be able to sit to see where we’re gonna end up. Right. Alright. These are all great recommendations, but for many organizations, we’ve gotta bring this topic up, particularly larger ones. Change management is always a challenge. So what advice, you know, would you give groups that are slow to embrace new processes then? Yeah. So this one’s this one’s fun. And, you know, in the in the past couple years, we’ve given entire, presentations on this. Change management internally and with the providers in general is very difficult. We we spoke on that a little bit. You know, a few key points here. One, a lot of payers are scared to disrupt the provider’s world. The providers, again, they they will change with you. Just make sure whatever you’re building is better than what they have today. The next thing is communicate with your providers. And when you think you’ve communicated enough, communicate a little more. Right? Because they need to know when things are gonna change. They need to know what that’s gonna look like. They need to know, even simple things like that, you know, we have in our daily lives everywhere that some, for whatever reason, have never made it into health care. Things like statuses. You know, if a provider submits a enrollment form, shouldn’t you give them a way to check up on where that enrollment form is? Right? Especially if it’s gonna take you a hundred and twenty days to do it or even thirty days to do it. I mean, Domino’s has it for a pizza that they get done in five minutes. I’d I’d I think it’s unrealistic that we can’t have that as an industry for something that can take up to thirty days. One of the biggest things that I think we have to be very clear on and every organization needs to be very clear on is what are you marching towards. Right? You you should never try and sell we’re gonna be done with this by this date. It’s we are gonna be in this place by this date, but we have a lot more work to do once we get there. And I think it it’s it’s generally, it’s a it’s a good way to present that mostly because if you if you have your detractors still within your, you know, I guess your change management environment, you can easily say, we’re we’re gonna note that and we’ll get to it. We’ll put it on the backlog. You know, we’ll whatever your your, I guess, task, enablement mechanism is, it lets people know that there’s not an end to this thing. There is a chance they can get what they don’t have today. And I think, you know, maybe to close out from my perspective, the change management side, is you gotta celebrate your wins and create a culture where, where people don’t settle, right? It’s push harder. One of the gentlemen that works for me, he calls it reach higher, right? Everybody, if you tell them to raise their hand in the hair, they’re going to raise their hand is, you know, they’re just going to stick it up there. But if you ask them to go a little more, they’re going to reach a little higher. So if you can create a culture where, you know, your hands are always as as as high as they are and and you can push people more, they’re gonna expect that, and they’re just gonna do it naturally. And, you know, that’s what that’s what we’re trying to do here in Tennessee. Ben, I love how you just the curiosity. Curiosity to me is a is a significant part of this. Right? It’s not natural in the payer world to be curious about what’s best practices in other organizations. Standard is not standard. And figuring out what’s unique about what one organization does, what’s what’s their point of view, bringing in outside experts, bringing in people that may have not grown up inside of the four walls of your culture, your organization, Being able to bring in some of that type of perspective, I think brings brings a lens. Heck, I even love the fact that the folks who are on the call today are stretching themselves a little bit just to consider. Even if you don’t agree with everything that I or Ben have here at deposit, just being able to consider what works and what doesn’t and looking at at it a little bit differently, allows that allows opportunity to be able to take home and take root. Yeah. And let’s bring in technology here. You know, how does technology fit into this conversation? What innovations are underway to solve this industry problem? Ben? So there’s a lot going on in the industry to try and solve this problem. I think, you know, one thing to Mike’s point at the very beginning of this conversation is, you know, he mentioned there’s no silver bullet in provider data. And if you’ve seen one payer, you’ve seen one payer. You know, it would it I would probably have fifty people drop off this call if I started recommending solutions that, they should go with, right, within their own plans. Because I don’t know their plans. Right? I know what works for us. But you need to know where you wanna go and then what works for you. And a lot of that is it’s region based. It’s state based. It’s, you know, what line of business do you operate in based? It’s what are the requirements for those lines of business, and what is your what is your local and and and federal government environment look like for the lines of business you’re in? So, you know, from a technology perspective, it’s it’s don’t just do what everyone else is doing. Right? Ask a lot of questions and find the partners that work for you. You know, when you’re looking at the build versus buy, decision making process, what we found internally is it’s almost always better to buy. Right? It’s to find the people who really know their business and then let them be responsible for maintaining that. There’s been very few things that we’ve made build decisions on that have come back and we’re like, wow. It’s it’s good thing we did that. Right? It they generally end up being much more expensive over time. And then, you know, the the last thing, and I’ll say this is the biggest thing we did in our entire strategy, is figure out your analytics and reporting strategy. Right? It’s make sure you have a plan to gauge your success, to collect the data you need, and to communicate your story. If you can’t if you build the best applications in the world, but you can’t tell anyone how good you are, you you’ve basically not done yourself any good. So get really good at analytics and reporting, data warehousing, whatever it takes in your own environment to be able to report on the technology wins that you’re that you’re making. Technology is exploding in this space. We all know this. Right? It’s it’s it’s everywhere. And I think overall, that’s a good thing. If we reflect back on, you know, bank transactions, I told you earlier, Laura Beth, I’m old. I can remember driving through, like, literally be going through at a bank and driving through. And my mom would take that little tube and that little canister and drop it in the tube, and then I’d get a sucker at the end. Right? And, you know, now and and it was great. Right? It was awesome. And now today, you can take a check and you take a picture of it with your phone and deposit it. And my son’s sitting there going, dad, why do you have a check? Like, where did that even come from? Like, who uses those things anymore? But the crazy thing though is that in our industry, there’s still manila folders that are moving around. Now I’m not against somebody having a manila folder to file some information. But for my somebody having a manila folder to file some information. But for my own use, great. But for being able to make that ubiquitous and accessible to literally thousands of people inside of the organization for transactions that I need to process, that makes no sense anymore. Right? Let’s not let’s not just build for that sake. So we’ve gotta be able to embrace technology. But at the same time, you can’t technology for technology’s sake does not solve problems. There’s lots of slick stuff that’s out there. If you find yourself and you’re a non technological professional who’s asking vendors or internal business partners for a button that does this, that’s not a good way to be thinking about the problem. Let’s think about what is the business problem we’re trying to solve. Let’s think about the process that we can use, and then find the right partners and the right partners that that can help engineer next to you to say, oh, if that’s the need, we could do it like this. That’s what I think goes hand in glove and where you have to have individuals who are I always think it’s you gotta be humble but confident. You gotta be able to know where where you’re great and know where you’re not. And what I know is that it takes great people, it takes great data, and a great platform to enable the right business process. And if you’re looking at blending all of those things into one bucket, you’re probably looking at the solution really, really wrong. You know, we’re we’re, I know we’ve been we’ve been on with a lot of folks here at Lord Beth for a long time, but but, like, technology is gonna disrupt how this work is happening. We you know, recently with a with a, with another payer organization, we took a provider network of forty five thousand individuals, and we’re able to verify and provide results back on all of their credentials within within forty eight hours. That’s that’s a screenshot. That’s data extrapolated. That’s information back. And and what people will say is, well, that’s amazing. How could you do that for credentialing? And and we look at this and we say, you know what? We’re we’re on the cusp of and and I’m gonna whisper this. Right? Credentialing could go away. Like like, that process that we’ve used historically to ensure that an individual has the bona fides that are required for them to be able to deliver care and to be eligible to be able to bill for those services. Like, this can just be something that we check literally all the time. It could just run into perpetuity. We don’t need a fail safe by checking through some other list or having some investigative team to be able to do it. The data exists. It’s how to be able to organize it and wield it in a way that could enable me to be able to say, I know that this individual is eligible, but I also know that that claim can be paid because that eligibility still exists. And that comes from a completely different area where today the credentialing function isn’t always thinking with that same kind of a mindset. It’s going to be transformative, and those who are embracing what technology can do, are, are gonna be it’s gonna be sifting through some hard stuff, but really building out a very different future for how work’s gonna get done in and around managing a provider network. Wow. Well said. And and just great points from all of you. We only have a couple minutes left, but I wanted to get in one question from our audience here, if you guys can, do that for us. And I really like this question. It says, you know, all of this sounds great, and we’ve explored various solutions already, but our solutions already, but our day to day workload often continues to get in the way of more strategic initiatives like this. So how do you drive change while also keeping the lights on? Who would like to take that one or start on it? Flip a coin, Ben. Go for it, Mike. You know, I, back to our sayings, change happens when the pain of doing something different is less than the pain of doing something the same, and that’s when change will occur. We’re given lots of recommendations and suggestions and encouragement and all the things, and, I would never say it’s easy. It’s hard. Right? Ben and I, we’ve been talking about stuff for a long time. We’ve been working, for Blue Cross Blue Shield. Proud of that relationship. But but we’ve been trying to work for him for a lot longer. And and, that it it just it takes a lot of effort on our end. It takes a lot of effort on Ben’s end to be able to get the the sun and the moon and the stars to line up right when things make sense from them from an organizational perspective to be able to take it on. All I would say is that, you know, a lot of the nuggets that we shared are very real things. Be ready. It’s coming. Don’t let it happen to you. Go make it happen. Right? The best way to predict the future, is to be able to go, make that change happen. That’s the best way to get it done. So go create it. And just to add on in our last couple seconds, you know, what what I would say is, you have to, to your point, Mike, set yourself up for success. Right? Operational people on operational teams don’t have time to drive strategic initiatives. If you if you think that they can do both, I’m here to tell you they can’t. And there’s probably a lot of you shaking your head on the phone right now, thinking the same thing. Right? That’s been the problem is organizations haven’t been willing to invest in the people, or the technology or both to actually solve these problems. So, you know, if you’re looking at, again, where do you begin, you need to begin with your own internal structure. Right? You need to make sure you have the right people who can be entrusted to pull this off and have the ownership and autonomy to actually do it. So, pay attention to that because you’re shooting yourself in the foot if operational people are are tasked to pull off a comprehensive strategy as well as keep up with day to day operations, especially in a in a environment where the work is relentless. Excellent answer from both of you and and great discussion today. Thank you, Mike and Ben, for today’s great discussion. We appreciate you sharing your insights and expertise with us. And I’d also like to thank our audience for joining us today. Again, if we didn’t get to your question, it will be answered later via email. So we hope to see you again soon. Have a great day.