Mitch Gorodokin on Becker’s Payer Issues Podcast

Certify was thrilled to have Mitchell Gorodokin, VP of Business Development, appear on the Becker's Payer Issues Podcast live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable in Chicago. Gorodokin talked with host Gracelyn Keller about strategies for enhancing provider data workflow efficiency as well as laying out tactical advice on improving business infrastructure to ultimately drive growth. Read the interview below or listen to the podcast on Spotify or Apple Podcasts.

Gracelyn: Let's start our conversation off today by briefly introducing yourself and talking about your current role at your organization.

Mitch: Well, first of all, thanks so much for having me. It's an honor to be on the podcast, and I love the conference. Like you said, my name is Mitchell Gorodokin. I'm the Vice President of Business Development at Certify, an API-first provider network management platform. We are a provider data infrastructure directly plugged into primary sources, which returns thousands of provider data points in real time. That enables us to modernize the entire provider lifecycle from initial onboarding through credentialing, enrollment, ongoing monitoring, and roster management. And perhaps even more importantly, we store every single data point during the 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 the 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 one API, one provider ID, frictionless provider data.

Gracelyn: 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?

Mitchell: 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 unique systems to accurately update their data across multiple different health plans. That means every time they need 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 and 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 healthcare 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. 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 and should be used across a health plan's organization. When collected, ingested, and stored correctly, that data becomes immensely valuable to feeding streamlined, efficient downstream processes and reducing the ongoing burden on providers to maintain just a small piece of their own dataset. At Certify, we're laser-focused on reducing the 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 are 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 in 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 healthcare leaders landscape is challenging.

Gracelyn: So what is a piece of advice you'd share with peer leaders to grow their businesses while keeping members top of mind?

Mitchell: 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’s 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?

Gracelyn: Let's talk about technology, 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?

Mitchell: Technology is 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 provider data products can be built. It's not just technology for us. It's also how we are enabling other organizations to leverage their own technology and improve their own workflows and processes. But to us, that means four 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 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 fourth pillar. Every single data point is available via APIs. Use whichever data points you need, whenever you need them, wherever you need them, send them 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.

Gracelyn: 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?

Mitchell: We are constantly in an evolving regulatory environment. Compliance regulations are changing, and we live in 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 and verification requirements. They vary by provider type and line of business. Historically, one small compliance change meant new job aids, new trainings, and significant change management processes, which ultimately led to error-prone processes, onboarding providers that may be noncompliant or not being able to 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 are maintained throughout the life cycle of their engagement with the health plan or system.

Gracelyn: Well, Mitchell, as we wrap our conversation up, are there any parting words you'd like to share on the podcast today?

Mitchell: I would just say that here at the conference, one of the big themes is how do we take a data-first approach and improve access to care and 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. Access to your financial data was historically protected and siloed. And of course, it still is dealt with using the highest security. But now it's actionable, it's accessible, it's transparent, and you have a big boom of different 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 access to data and 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.

Gracelyn: Thank you, Mitchell, for joining me today.

You can learn more about Mitchell’s leadership journey in his bio.

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