Thinking Differently About Data

Good morning, everyone. I’m Morgan Smith, director of brand strategy here at ProviderTrust. Thank you so much for taking the time to join today’s webinar, thinking differently about data. Before we get started, I’d like to go over a couple of quick housekeeping items. Participants have been muted to eliminate any background noise. So please, please drop any of those questions, that you may have, directly into the chat or the q a section. Our panelists will be watching that and will respond accordingly. We’ll try to address any of those questions along the way. Today’s presentation is being recorded as you heard and will be distributed in a follow-up email alongside today’s slide deck, both from provider trust. So be on a lookout for that later this week. Let’s move on to introduce our presenters. We have today Chris Reddidge and Mike Rosen. Chris and Mike are both cofounders and managing partners at ProviderTrust. Chris specifically has founded and led a diverse set of health care technology and entrepreneurial ventures. He leads ProviderTrust’s vision and innovation strategy, often working hand in hand with our clients to brainstorm solutions to critical data challenges within their compliance workflows. And then Mike, as I mentioned, also a cofounder at ProviderTrust, is an expert in designing and developing innovative tools for compliance and risk management issues. Before becoming an entrepreneur, he actually served as a practicing attorney, general counsel, and president of a global background screening and identity theft restoration firm. So without further ado, I’ll let our presenters kinda take us from here. And, Mike, before we get started, I’d like to point out I’m wearing the exact same shirt as that picture. So And haircut. Mine’s a little shorter, but I’m doing the best I can. Welcome, everyone. It’s really a pleasure to get back into the webinar circuit with Chris. We, started our business in, two thousand ten by doing webinars, and that’s how we grew our image brand and and became, I guess, a thought leader. And it’s fun to be back together again. I think today, in the thirty minutes that we have, we’d like to help, educate a little bit about, our history, a little bit about what we do and why we do it. A bigger discussion on data integrity, how we see the world when it comes to data and, the importance of it, some examples of data at work, and, and then what we see as sort of the future. So please feel free to, as mentioned earlier, drop any questions that you might have about, what you would like either of us to speak about. So who we are? We are located where the convergence of health care and technology exists, which is Nashville, Tennessee. A great place both to be from where I am from. Chris is from Nebraska, but has moved here a number of years ago, and we were fortunate enough to have our paths cross. In two thousand nine, when both of us were separately looking to solve some inefficiencies in the health care compliance world. Chris from the health care staffing software side, and myself from the legal compliance and, preemployment screening side. And I think both of us realized separately and then met through the common investor, that there was really some inefficiencies in health care, and it was really right for some technology. I think one of the fortunate things is that we are located in Nashville where there is such a a brain trust of people, thinking similarly and innovatively. So we we really got lucky. And, in two thousand ten, we launched ProviderTrust. So we’re a health care technology company, and, really, what we are trying to do is help make, health care safer with better data. We’re gonna tell you a little bit about that story of how this was formed fourteen years ago, which is really hard to believe, that that’s how long it’s been. But at that time, I think I need to take you back to the thought process that HR and compliance folks like you really were at that point, doing credentialing and or verifying licenses, exclusions was really done maybe at pre hire. A license was verified about every two or three years, typically, and there was really not much, if any, monitoring going on. Very quickly with the Affordable Care Act passage in two thousand eleven and the OIG picking up on the fact that for over thirty years, they’ve been excluding providers and penalizing companies that hire and contract with them, that this was low hanging fruit. And so, our technology was, the idea was to help make that easier, more efficient, and a better matching experience for the customer. At that time, many of you, if you were in the space, you were manually verifying things and doing it on a not every thirty day cadence. We’re gonna talk about how the the health care system has evolved and how simplifying health care compliance is really what we’re here to help you do. This is the the genesis of why we’ve created the software that we do and the beauty of what goes on behind it. Our our goal was to create something very simple on its use and the face of it, but very complex behind the scene doing a lot of matching and algorithm things that, bring better practice to compliance. Chris, we also really are trying to avoid fraud in the workplace, and I know that you have a story in your history that I think is relevant here. Yeah. And and, Mike, thanks. I think when you when you think about provider trust, you wanna think about really three three things. We wanna create things that are are really simple to use. Right? We we know that there’s a lot going on in health care, and so we need to do our part to to make it super simple. We’ll talk about why that’s important from a data standpoint. We’re gonna be eliminating your risk. Right? So we we wanna eliminate your risk. And and really how my personal story and how this kind of became really a a a a mission and vision for us is I was actually leading a a different company. This is back in, the early two thousands. I feel like I’m I’m getting old. I was just a thirty year old when I I started this, this company. But, in my twenties, I was I was, leading, an investment company in Louisville, Kentucky. And I, an individual actually embezzled about a half a million dollars from an investment that we had made, in in a in a venture. And I saw how that impacted not only me from a stress standpoint, from a health standpoint, but it impacted the the the ecosystem around me, this business, families. And, overall, the impact was was pretty, enormous on on my life. And so that was kind of the the the personal story. People say, like, make your mess your mess your ministry. And I think for me, it’s like, okay. I experienced, the the impact of fraud and what it had on my life, over a half a million dollars stolen from a from a venture. And I began to see how that impacted everyone around. And so when we started provider trust, we’re we said, okay. We wanna make things really simple because there’s a lot going on. We wanna eliminate that risk. And this risk that we’ve kind of stumbled upon is exclusion monitoring and license monitoring, ensuring that our customers are compliant and that we get these bad actors out of health care, so that they don’t, have an impact the way my life was impacted, with that fraud. And and and third is being cost effective. So we we have a lot of conversations both with clients, across the industry, and internally about this is, like, we need to be simple. We need to eliminate risk, but we need to be cost effective. We don’t wanna be the cheapest solution out there because the cheapest solution isn’t the best solution. We wanna win. We wanna be the best solution both in the industry and for our customers. And so we spend a lot of time talking about how do we how how do we, leverage our resources, and how do we leverage our research, how do we leverage our top, technology to to make, your all’s job easier? One of the best quotes I’ve heard, this is back in, like, two thousand seventeen or eighteen is, why why why do why do they choose? And this was a chief compliance officer. And she said, because they allow me to sleep at night. And I think that’s what we wanna do is we wanna bring peace, in in a way that we can. So when you think about, provider trust and where we’ve come since two thousand ten, we’re monitoring ten million entities on an ongoing basis. So that’s people and entities across the entire, United States. About forty three million license verifications, performed annually. So we we do, monitoring, on an up to daily, at times, licenses, but typically on a on a monthly basis for for our customers, and and just provide real time, updates from that standpoint. And then, related to to vendors, we monitor about three point six million vendors. And so when you think about our the the, the populations that we work with, we’re we’re basically monitoring employees, we’re monitoring vendors, and we’re monitoring providers. And we’re looking at that data, across the ecosystem in really, really unique ways. So when you think about what’s the difference of provider trust, it’s really our commitment to data integrity. And what does that what does that look like, and what does that mean? So, when when we think about a exclusion list and we have a bunch of slides, we just don’t have enough time to kinda get into it. But take the state of Arkansas. They provide, a PDF of, of exclusion lists, and that includes the name, that includes the birth date, and, sometimes the reason why they were were were excluded. Right? So what we do is we go and we pull that data in. We we, extract it, and then we begin to transform it. And what’s really unique about provider trust and how we do that transformation is we’re going and we’re actually adding social security numbers to those exclusions. We’re adding, NPIs to those, exclusions. We’re mapping those licenses to Social Security numbers. We’re mapping those licenses, to MPIs. And so, ultimately, what you get is you get accuracy. So where some people are doing name matches or name searches where they come up with potentials. We actually are smarter than the primary source data. So there are times and, Mike, you could probably share some more stories about this because you’re typically on the on the phone with the states. But we’ll tell the state of California that they have the wrong Social Security number associated with the exclusion. So you could consider us, like, credit level, a data, provider, risk provider, where we’re able to go in and and map these exclusions and map the primary source data and basically augment it and make it better. Mike, do you have any other, good stories before I I flip to this next slide? Well, I do, and then we’re getting some good questions in, which we will address during the, webinar here. With regard to the exclusions, I think what’s important too on the data is that, we may have an example coming up, but a lot of times when it comes to females in the health care ecosystem, their name may change. They get married. They get divorced. They may get licensed originally under a maiden name but get married later. And, that is one way for someone to to try to hide inside the system. However, with the augmented data that Chris referenced, we’re able to track things. And I think we have an example that shows you, a name given to us by the client of of one name, but, actually, the exclusion was under a different whether whether it was married or maiden. So that’s that’s what we’re really good at doing and trying to help make you more compliant. So when you think about our our data integrity and our promise is that we’re we’re gonna assess all the all the, the the state and federal exclusions list. We’re gonna augment that data to complete it, better than at the primary source, and then we’re gonna deliver back to our customers accurate results. So we’re gonna tell you match results, not potentials, in a way that that gives you confidence so that you can you could sleep at night. So when you think about provider trust and kind of, where we’re at, you know, we found about forty thousand exclusions for for our for our customers. Fifty one percent of those exclusions were found with our enhanced data. And why that’s important, I’ll really actually slip to the next slide. So this was a a client that was using a low cost competitor. We onboarded them in late twenty twenty one. Within sixty days, we found eight hundred and sixty six exclusions, and that’s only on a on a population of two hundred and thirty seven thousand. Twenty seven twenty eight percent of those were with our data enrichment strategy. So, about two hundred and twenty three exclusions were were found that no one else would have found. And of that, a hundred and forty four of those exclusions, were OIG. So you could begin to to think, wow. That’s that’s a that’s a that’s a massive, financial exposure for, for for a hospital or for a multistate hospital system. So that would be about twenty million dollars from a self disclosure standpoint. If you’re carrying twenty million on your balance sheet of, of exposure, that’s gonna, create quite a bit of issues. And this was all a decision because they just went with a check the check the box provider that was doing name match with potentials. So when you think about what we do, the industry is really focused on basic employee ex, exclusion monitoring or basic vendor monitoring. When you look on the right hand side of of where we’re at, the scaled employee vendor monitoring, the ordering of physician, the annual data collection, and ongoing vendor attestation, this is really where provider trust is. This is the impact compliance spectrum. And so we’re gonna spend a little bit of time just kind of walking you through these services and what what, makes sense. But if you think about it, everything that allows us to do this stuff is being able to assess data, so being able to access it and pull it in, and then we augment it. So all these services that we have are are are basically, the foundation of it is our data layer. So, Mike, why don’t you talk a little bit about our scaled employee and vendor monitoring, and I’ll jump into, the referring and, vendor stuff. Sure. So, you know, when we look at the ecosystem, as Chris identified earlier, there there are three main parties, players. Those are your employees, your your hired individuals, whether they’re licensed or not. Then there are, of course, the vendors and suppliers and third parties that you contract with. And and I am here to remind you that the OIG does exclude those companies or entities and can fine you for contracting with them. So they are they should be on your radar. And then third, of course, are the referring ordering positions. Here, we’re talking about making sure that up and downstream, you’re monitoring at least the employees that you have under, your, that you’re employed. And that includes for those individuals who are licensed, monitoring that their licenses are in good standing. They’ve not been disciplined or have some type of revocation suspension limitation. I think what happens when you get to the the compliance spectrum we’re talking here, what, we do is not just search the state in which the individual holds the license, but across the whole, fifty states. And what we may find are disciplinary actions from a different state that have not yet been reported to, to this your to your state or, in fact, do have something to do with, an ex what will become an exclusion. Licenses are typically the first thing that gives you a trigger that is that there’s going to be an exclusion, that follows. And so we think it’s important to include all fifty states, and that’s what we do with our exclusion monitoring. We cover the, over forty four states that have a list and the two federalists and and OIG in every search that we do, and that is continuously monitored on your behalf. Licenses are done at your election either, monthly, quarterly, or could be daily if it’s certain, types of, like, therapist license, etcetera. So this is really the beginning of of covering at the core foundation of those for whom you are clearly responsible for hiring and or contracting with. Chris, I think ordering physicians would be the next part of the system. Yeah. And I think, just something to highlight within there is we we not only think about, our our data layer and how we display it to you, but we also are, constantly thinking about, when when someone’s coming into audit, whether it’s joint commission, whether it’s state regulatory board, whether it’s Medicare Advantage Plans, they’re gonna ask for screenshots of these, licenses. And so we actually have the ability where we’re taking screenshots of these licenses. So it really serves as that primary source during those audit periods. And that’s what you get with the scaled employee and vendor monitoring is that we’re doing all the work, on the on the back end to to really, hold into that promise of making it simple for you all. Right? We’re gonna make it simple. We’re gonna eliminate your risk, and we’re gonna do it in a in a cost effective manner. It’s really hard to monitor, you know, eleven million, entities, on an ongoing basis, but you could do it with technology. You could do it with with the systems that we’ve we’ve created, and with that base layer. So ordering and referring physicians. I always like this joke. When I’m I’m talking to compliance, officers, I would say, you know, physicians listens to their mom and dad when they say never share your security, Social Security number. That’s why ordering and referring physicians is really, really hard because when you’re getting an order, a a patient being referred in, you do have their NPI, but you probably don’t have that referring, and ordering physician’s Social Security number to be able to validate whether or not they’re excluded, or not. And so because of our augmentation, strategy, we actually have mapped all those exclusions to an MPI. So Vanderbilt is one of our clients. When they have a referring physician come in, they’re hitting our data set through an API to instantaneously tell whether or not that physician is, the MPI is active. Are they excluded? Are they not, excluded, and do they have a proper license? And so that’s just, one one of the processes that that you could see where you could begin to leverage data to be super cost effective, efficient, and simple while eliminating that risk. In turn to vendors, vendors and I’ll I’ll kind of, breeze over this, and then we’ll get to to some questions because we’re coming up on our our thirty minutes. But vendors is really, really hard. When we talk about this internally, we actually think this is where a majority of, of the risk is sitting within health care because there are so many, there there’s so much money flowing through AP systems, yet we don’t have, we don’t have company data. So we don’t have the the OIG requires that you monitor not only the entity, the owners, and in some cases, Medicare Advantage Plans are requiring that you’re monitoring their employees as well. And so we have a process where we’re actually collecting this data from the vendor on an ongoing basis. We’re validating that data, and then we have the ability for, those vendors to also monitor their employees as well. And so as you kinda see across the spectrum, basic, employee basic vendor monitoring, as you move into provider trust services, we kinda scale to employee and vendor monitoring where where we’re leveraging our augmented data to eliminate your risk. We then, you could then leverage our services for the ordering or referring physician. Again, this is all based upon the layer of data, and how we augment it. And then we have workflow tools that begin to collect this information from the vendor, validate whether or not that information is accurate, and then monitor it on an ongoing basis. So, in the in the provider space, you probably, hear a lot about third party risks these days. We we we’re collecting that information, in the payer space, FDR compliance, making sure that you’re monitoring, not only your entities, your owners, but also their employees. And so all these kind of processes flow within the impact compliance spectrum. Mike, why don’t we move Yeah. Let me go ahead. That. I I think what’s interesting on the ordering and referring because for some people, this is news that you, the hospital, are responsible for not accepting a referral from a excluded provider, but that is actually the case. What we we have, large enterprise customers with with hospitals, nursing homes, and and especially some of the larger systems that, are predominantly local care or smaller, markets outside the the big city urban markets. And so what we’ve seen, and I think unintentionally, but still a problem, you’re, I’m sure, familiar with on the compliance, and we’ve seen where doctor Chris Reddidge is employed at a local hospital in a small town. He also owns fifty percent of an MRI, company in town, which the hospital utilizes, and doctor Chris Redditch, who’s employed by that hospital, refers a hundred percent of his patients. Now that’s okay if you have asked and doctor Rededge has disclosed that he is in fact an owner of the MRI so that you can go through your Stark analysis and decide that there’s no violations there or anti kickback. However, you’re probably not asking who owns the MRI company nor has Chris doctor Chris Redditch been asked to divulge that. And so very innocently, you could be faced with multimillion dollars worth of fines and investigations on, a stark violation. We tie those together and say, did you know that doctor Reddick, your employee, happens to be a fifty percent owner of this MRI company? You need to make sure you’re above board on that. So this is how the spectrum helps across everything. Chris, we do have three questions here. One is from Marty Edwards who says, what’s included in the vendor monitoring services that you that you do, and and and why why do you search the things that you search? Do you wanna take that one? Yeah. Absolutely. So, and I’m gonna just go ahead and share my screen so now I have the the questions back up again. Can can you see my screen again, Mike? Yes. Great. So in terms of, vendor monitoring, so we’re we’re we’re doing the the actual entity. We’re also collecting the ownership information. There’s a lot of federal laws actually coming down the the pike where they’re actually, requiring people to, to disclose their ownerships, and we can have a whole webinar around that. So we’re monitoring the entity, the owners, and their employees, and then we’re collecting any of the, FDR or third party risk questions during the data collection process. And so that creates a lot of, just reporting opportunities and things like that to ensure that you’re avoiding, those star calls. The hardest thing about vendor monitoring is collecting the information. And so, you know, you would never pay your employee, if you didn’t have their Social Security number yet. I think it’s, like, thirty three percent of the three point six million vendors, so one point two million of the vendors that we’re monitoring today. Right? Our customers don’t have accurate ten or business information for them. And so we begin to see this across the industry and are like, hey. This is this is an issue that we need to need to attack. Yeah. And I think, Chris, let me add on that piece of the vendor employee monitoring. So so the downstream entity, if you will. For those of you who have attested or have contracts saying, yes. We are contracting with you as a supplier and, and therefore, as the supplier, you’re attesting to us, the hospital, that you’re, not excluded, the owners are not excluded, and you’re monitoring your employees. You really probably have never done anything to audit that and check it. And this would, a, identify which of those vendors are handling PHI, protected health information, and and whether there’s a BAA, a business associate agreement on file, etcetera, and then let alone, allowing that vendor to say, and we can attest to you, the client, that we are monitoring employees because we also use provider trust to do that. So it is a full downstream solution, Marty. Laura asks, I’ve noticed there’s very little information provided at the state Medicaid’s, I’m assuming that is for exclusions, to match or or not match a personal care provider’s type position. Let me, that is a a problem, and let me tell you that the OIG has issued some guidance on this. In fact, they’ve, they’ve identified that one of the risks, out there are the PCPs, the the personal care providers, primarily those that have evolved of recent in the home health care sector. And none of not all of those are licensed. Some states, they do issue a certificate to become a PCP. And so it is, something that you have to add in your verification as well as make sure that they’re not excluded because they’re providing care in someone’s home. But you’re correct. A lot of these boards don’t release a lot of information, and that’s why at ProviderTrust, we augment the data to try to match and find things that, the state doesn’t even have on there. Make it easy for you to to find. Mike, we probably have time for one more question. Yeah. So, the other question seem to be about foreign databases or export controls. And I I think I think the intent upon that is OFAC. So we’re in the health care space. We’re focused on the the provision of compliance in health care in the US. There are, so we won’t address the Philippines, the question here about UK and others. But as far as export controls, we do for our health plan clients. We do and can search, other databases, including OFAC, etcetera. But, I think in that’s about what we have time to address today. I hope these questions are great, and, obviously, you’re thinking I hope, like, we thought you were, a little bit deeper into your organization structure. We hope to be the ability to talk with any of you who either don’t feel you’re doing what is necessary or could improve and let us show you how we might be able to do that, to make your organization more compliant. Mike, I think we’ll end up here. We’ve we’ve got a bunch of questions that have come in. So, if, since we didn’t have time to answer those all, one, we’ll follow-up with you individually. Thank you for for logging in today. Thank you for your time. We know you’re you’re have, busy schedules. And this is really just the foundation layer for, some of the the webinars that we have going on this fall. But what really, what we wanted to do is just kind of, have a conversation around what makes provider trust data different and our strategies around it. And then we’ll begin to kinda roll out and spend a little bit more time on each of the segments, the employees, the the, the physicians, and the vendors over the coming months. So thank you again for your time. Thank you again if you’re a ProviderTrust client for for believing us, believing the story that started fourteen years ago, and we’ll continue to, make things simple, eliminate your risk, and, try to be very cost effective in doing it. Thank you.