Revolutionizing Healthcare Management: Certify OS's CEO on Streamlining Provider Data and the AI-Driven Future

Discover the cutting-edge transformation of healthcare provider management as we sit down with Anshul, the trailblazing CEO behind Certify OS. His journey from Oscar Health to launching a company at the forefront of streamlining provider onboarding and credentialing is nothing short of inspirational. Through Anshul's eyes, we see the cumbersome world of healthcare data evolve into a slick, efficient system that could very well reduce administrative costs by 40% and slash the time for provider onboarding from months to mere minutes. This conversation promises to leave you with a keen understanding of the pressing need for accurate provider data and how it dramatically affects patient outcomes and satisfaction.

In an industry where the stakes are life and death, the significance of correct and comprehensive provider data can't be overstated. This episode takes you through the alarming nexus of medical errors, patient frustration, and the herculean efforts to combat these challenges. With Anshul's guidance, we explore the beneficial ripple effects of Certify's streamlined process, not only for patients but also for health plans and providers. Imagine a world where searching for in-network providers is no longer a confusing labyrinth but a clear, straightforward path—this episode turns that dream into a foreseeable reality.

Finally, we map out the future, with AI's role in healthcare taking center stage. Specialized AI models, the intricacies of data protection, and the thrilling potential of technology in clinical settings are all on the table. Anshul's commitment to shaping a secure, efficient, and compassionate healthcare ecosystem is palpable, leaving us both informed and galvanized. If you're fascinated by the intersection of healthcare and technological innovation, this dialogue with Anshul will resonate deeply, leaving you eager to witness the next leap forward in healthcare infrastructure.

More at https://linktr.ee/EvanKirstel

Transcript

Speaker 1: 0:02

Hey everyone. Super intriguing discussion today about reinventing healthcare certification and with Certify OS Anshul. How are you?

Speaker 2: 0:15

Doing well. Thanks for having me. Super excited to be here.

Speaker 1: 0:19

Hi Anshul being here. We really admire the work you're doing at Certify and we're going to dive in with all kinds of questions, but before that, perhaps you, as a CEO and founder, could introduce Certify and your mission and some of the great work that you're doing.

Speaker 2: 0:36

Absolutely. At Certify, we believe that every healthcare operations is touched by provider data, and yet there is no single source of truth for provider data within an organization, as well as for the US healthcare industry. So we fundamentally believe that is because the basic data infrastructure for provider data is missing, and our entire goal is to create that next generation of provider data is missing and our entire goal is to create that next generation of provider data infrastructure where you make a change and it propagates to every single other system within the organization. It impacts your member experience, it impacts your claims, it impacts all the caregivers in the country and we need to make sure that the administrative burden on them gets reduced. That's what we do at Certify. One API, one provider ID, frictionless provider data is our goal.

Speaker 1: 1:36

A fantastic mission and there's so much to unpack there. But before that, maybe share also a little bit about your background, from Oscar Health and earlier to your current role and that journey. It looks really intriguing.

Speaker 2: 1:50

Yeah, there's a running joke in the industry. Like PayPal mafia, there's an Oscar mafia in healthcare and I feel I'm the most underrated person of that mafia People who are doing amazing things. People have gone and done amazing things in value-based care, quality of care. People have started companies in home health care space and we feel that we empower all of those companies. But I would have never when I was at Oscar, I would have never imagined to be part of these elite group that have gone out of Oscar and started companies. So my background is very interesting and very unconventional at the same time.

Speaker 2: 2:36

I moved to New York City because I watched a lot of Bollywood movies growing up and I always wanted to live in New York City all by myself growing up and I always wanted to live in New York City all by myself. That was the big Indian dream and by accident, became one of the earliest employees at Oscar, when they had absolutely no infrastructure on provider data side and over seven years, anything that I should provide a data network, management and compliance was built by my team at Oscar. So the training about how it should be built was majorly because I had first-hand training building the same, solving the same problem at Oscar for multiple years and realized that there was no vendor who was solving end-to-end. There were a bunch of point solutions, manual work and that's led to our starting story at Certify.

Speaker 1: 3:31

Phenomenal.

Speaker 3: 3:33

Very interesting. So let's dive further into Certify. Can you tell us more about specific services that you provide and, typically, who benefits from your solutions? I know you address different market segments within healthcare.

Speaker 2: 3:48

Yeah, that's such a great question. I think what people fundamentally miss is that if you streamline onboarding for a provider, a lot of downstream impact gets resolved. People spend a lot in figuring out accuracy of provider data, but it all starts with onboarding and credentialing of a provider. That's our hero product. That's what we started in the industry with. We believe that if you streamline the onboarding part as well as the credentialing part, you will automatically have accurate provider data and we have actually proven that our customers tend to have about 32% more accurate data by using our products and services. So credentialing and onboarding has always, for people, it's table stakes. For people it's a commodity. That's our brilliant basics, that's our bread and butter and we majorly believe that if you solve that, there's a huge downstream impact that you can see in the healthcare industry. You can reduce a lot of administrative burden both on providers as well as teams, corollary business operations like licensing and enrollments that use exactly the same data but in a different way. So we said that as long as we have this data infrastructure, we can build end-to-end workflow automation on top of this data infrastructure.

Speaker 2: 5:18

We started selling to a lot of digital health companies in the gold rush of 2020, 2021. A lot of digital health companies in the gold rush of 2020, 2021. That was our playing ground. But we always knew that if we wanted to make an impact, the goal was always the traditional health care of hospital systems and payers. So from the outset, our strategy was very simple Use all the data to test and get the product market fit on the digital health side, but focus extensively on healthcare enterprise of hospital systems and payers. And that's what we focus on today. That's our major focus. For most of the BD team, that's the major focus.

Speaker 1: 6:01

Wonderful mission and talk about the inspiration behind. Certify what was you know early on, the problem that you saw over and over again, or you know some of the real pain points that you observed firsthand?

Speaker 2: 6:15

Yeah, in fact, when I was at Brown, where I went to graduate school, I've always learned that the best solutions come from the problems that you have experienced firsthand. And that's really the story of Certify. I faced this problem so much at Oscar. I tried to find vendors who would solve all my problems, but what I found was most of the vendors were point solution, primarily built for compliance and security, with human automation at the center, which meant big offshore teams doing the manual work and sending a PDF back. You can imagine how many errors that had, how much time it took. It took us 120 days on an average to bring a provider in network. People were just waiting for 120 days to see a particular provider if they wanted to see that, without any fast tracking to that mechanism.

Speaker 2: 7:22

I'm an engineer by background, so, like every engineer, I decided to re-engineer the problem, reverse engineer the problem and figure out a solution. Our infrastructure has two parts One is a data part and one is the application part and we fundamentally believe that the data and the workflow automation makes it a very unique solution and that's what's needed in the healthcare industry right now. If you sell data, the healthcare industry, from a tech perspective, is not advanced enough to use that at an optimum level, and if you just give them workflow automations without data, it's still going to be a lot of manual work, and a combination of data flowing through an end-to-end workflow automation tool makes Certify unique, and that's why we have grown so crazily in the last two years.

Speaker 3: 8:13

Wow, that's certainly so interesting and, as you pointed out, healthcare faces many different challenges and you decided to address a couple of specific areas. I'd love to hear some more, maybe specific examples how maybe patients benefit from your solutions, even through, like, improved onboarding, et cetera. So to make it more tangible for our audience how you specifically solve these problems. I know you have plenty of examples you could share with us.

Speaker 2: 8:46

Yeah, it's such an interesting question. People don't think about provider data directly impacting member care, but there are so many ways. Just to give you a stat medical errors are the third largest reasons for deaths in the United States. What we do is making sure that the bad actors don't get into network and don't interact with patients. That's the most basic service that we provide for most of our customers today. So immediately we can relate the work that we do to the quality of care that you get. The more. It is also proven that the higher quality providers that you have in network, the better outcomes you can have at a much lower cost. So members immediately face that benefits in a very intangible way. But you can also think, maybe, if I can ask you a reverse question, if you have ever tried to find a doctor in your network for a particular specialty that you are looking for, can you tell you what your experience has been?

Speaker 3: 9:52

It's been frustrating. It's almost. Sometimes it feels like wait, you don't want me to find the right doctor. Like what are you doing to me?

Speaker 2: 10:00

Guess what? You're not the only one, it's the exact. I used to work at Oscar and this was my bread and butter and it took me three days to find a doctor that met my need. And so having a provider speciality where they work, what diseases they can treat and if they accept your insurance is what the consumers need, and if they accept your insurance is what the consumers need, and that's the work that we give to, that's the work that we streamline at the upfront so that members can benefit directly at the end and don't have like surprise billings can go to the right providers and so much more. Also, it's also about like not waiting to see a doctor for 30 days or 45 days or maybe two months, especially in rural areas. Getting providers in network much faster so that members can see patients, members can see the providers when they want to see, is a core part of what we believe that we do at Certify.

Speaker 1: 11:04

Fantastic value proposition. Of course, Irma always takes the patient perspective as a patient advocate, which is great, but also you have a lot of benefits for the health plans themselves, which will in turn help providers and health plan members. But what are the other benefits beyond just the patient side?

Speaker 2: 11:28

As I said in the starting, every part of it's so surprising. Every part of health care operations is touched by provider data. You think about claims processing 50 percent, almost 50 percent of the data that goes into claims processing is about providers. Almost 50% of the data that goes into claims processing is about providers. But yet everyone wants to solve the revenue cycle management problem, but no one wants to focus on provider data problem.

Speaker 2: 11:56

Member experience when you're care routing appropriate member to an appropriate doctor, you want to know the speciality of a provider. If they have taken a board certification course recently. Have they updated their credentials? These are the most basic, fundamental building blocks, lego blocks of care routing, and yet there are no systems who are talking to each other. So by creating this single source of truth, by streamlining the upstream impact, you can almost immediately see reduction in cost by about 40% on the administrative burden.

Speaker 2: 12:31

That's an immediate benefit that our health plans customers see today. They can see better, accurate provider data, much better provider experience so that they become a preferred plan experience. So that they become a preferred plan when a provider is taking in members. You can imagine like a provider can only take so many patients, but if health plans give them a better experience. They're going to prioritize members that come from that health plan instead of getting stuck into this long administrative cycle and not even being sure if they're going to get paid or not. So that's a tangible impact. And then, of course, like you know, every regulator is looking at member facing directories. If you resolve these upstream impact, your data accuracy is going up and you're not getting dinged by regulators to pay fines for inaccurate directories and not having updated information.

Speaker 3: 13:31

This is interesting. I didn't know some of these specific aspects of regulation and kind of following up on this, on the provider experience and how the experience differs from health plan to health plan. We were talking earlier and you gave me this statistic that just blew my mind how onboarding you could take onboarding from like 60 days, which is typical, to what less than a minute Can you talk about that?

Speaker 2: 14:00

It's such a because we have invested so much in data, because we have invested so much in creating this single source of truth. I'll just give you an example. Generally, you know, healthcare is risk averse, takes long time to sell to enterprise customers all the fun stuff that happens in healthcare. We went on a call with a potential national plan and asked them can you give us a provider that has been stuck in your onboarding for about 60 days or more? On a live call, they gave us a random provider in Texas who they couldn't credential and onboard and has been stuck for some random reason.

Speaker 2: 14:48

Instead of asking a provider to fill out a 40-page application form, which is a status quo, we only asked for five data elements Give us your first name, last name, npi, degree and state. With just five data elements, we were able to pull up to 1600 data elements on a provider in real time because we had already collected all the information for that particular provider and were able to onboard that provider in less than a minute. That blew their mind and they are one of our customers. Now they are live with us. They do about 60,000 onboardings with us every single year at this point Wow, you can imagine if one provider can see 10 members, the impact of onboarding 60,000 providers in a year and making them operational to see members, that we don't even calculate it in dollars, we just calculate it in the amount of impact that it could have on members.

Speaker 3: 15:53

Which I think is a very good, very good kind of measurement from a patient perspective and patient advocacy perspective. Yeah, tell me how it actually benefits patients, and you just gave this great example. So thank you.

Speaker 2: 16:05

Of course yeah.

Speaker 1: 16:08

It'd be interesting to you're so enthusiastic, obviously, and energetic. Tell us about you know, beyond yourself, the team you've built and the culture you've kind of created, nurtured within your organization, and what's that like behind the scenes day to day?

Speaker 2: 16:28

I've been extremely lucky to work with every single member of my team who's much smarter, much more experienced and much more expert at what they do. I'm a first time entrepreneur and I've always known where I'm good at and where I'm not good at, and I think like I know a little bit about healthcare industry and especially provider data industry, and I can talk about it all day long but I was also not an expert in product or engineering or operations or business development, and so every team member has been at a series a company and scaled those companies multiple times in their career, and I've been very mindful of bringing those kind of people to be my blind spot. I don't like. We are a high functioning sports team. That's how we look at ourselves, but I'm also very conscious that these are the people that make, certify what it is, and some of the values are like you know, ideas are great, but execution is king. That's what we fundamentally believe in. Show me the process, show me what we have done.

Speaker 2: 17:44

We focus a lot on inputs without thinking a lot about results. The results are outside of our control and we are a process oriented team who focuses extensively on like did? Did you give your 100%, did you give your 110%? And even after that, if you don't get the results, we don't fuss about it because really it is outside of our control.

Speaker 2: 18:06

And I think like one of the best things that I like about our team is just low ego and collaboration. Low ego and collaboration. Everyone is so accomplished but I've never had a moment where anyone was trying to get get a credit for something that they did everyone. If you look at our slack messages, we just won one of the biggest deals in our company history. The head of business development basically wrote on our slack channel and gave shout outs to seven other people. Most of them were not from their team and that is so special about like being aligned in solving the problem and not making sure like who gets the credit and we are getting bogged down into company politics and that's like I feel that, of all the things that we'll do, that will go down as one of my biggest accomplishments in getting this team together and aligning them on what we are doing.

Speaker 3: 19:02

Wow, that's really phenomenal. It's just your passion and the whole team spirit for the organization just really comes through, and it makes me feel so good knowing that there's people like you and your team are working on solving these very difficult challenges in health care. So then, stepping back now specifically from Certify, I'd love to hear your thoughts on the future of health care and maybe specifically the role of AI or any other technologies that you think will make a huge difference. So where do you see industry going in the next five to 10 years and you know, any other predictions for the future?

Speaker 2: 19:45

Yeah, oh my God, I think everyone is talking about AI and it's going to be like everyone I'm not the first one to say this Everyone thinks and knows that AI is going to change how everyone I'm not, I'm not the first one to say this everyone thinks and knows that ai is going to change how we do things. So that's table stakes. We are not debating that at all. I feel that, um, there are two things that people need to keep in mind with ai come security concerns. You can't you can't put the data that you have in publicly available LLMs and risk that data being available and not being secure. So there's going to be an era where small language models which are very specific to a specific problem and the AI is trained specifically on that. Those kind of models are going to be much more accurate than the generic AI LLM models out there. So I feel that that is going to be important. I also want to. There are two types of AIs. One is that takes huge amount of data to train them, and the new age generation LLMs that are available. The new age generation LLMs that are available. Because Certify has such huge amount of data. I think we are uniquely positioned to use the traditional AI models and use them for data acquisition, for data standardization, for data normalization, and create this infrastructure. I also feel that the new age generative AI models are going to have more administrative use cases, first before clinical use cases, and then eventually, when they become accurate enough, they are going to go into clinical models and diagnosis and radiology and other things For the next five to 10,.

Speaker 2: 21:35

I think like one thing very unique about me is I only know so much about provider data. I'm not an expert on PBMs or I'm not an expert on value-based care, but we are so passionate about the provider data problem to a level we are obsessed with it. I think one of the things that I feel that everyone has been saying that healthcare is the next, next fintech, but it has been very difficult in healthcare to get from an infrastructure perspective to get where fintech um, uh fintech went, and one of the reasons for that is, you know, if, if your financial information gets leaked, it's, it's horrible, but it's not impacting your health, right, like if your health information gets leaked, it has a huge impact like health, wealth, everything else. That's what we have learned from uh early days and I feel that that's why healthcare has been so risky, risk averse, and we have to be at the right places. We have to be risk averse because it has direct impact on people's health.

Speaker 2: 22:44

Value-based care is going to have a huge impact in the near future, I think, and I think there are going to be companies who are going to build fundamental lego infrastructure blocks the blocks that you can use to build the next generation of technology, next generation of apps. Those are going to be the key players who's going to define the next 10-15 years of the healthcare industry, and not just in provider data, but in other other other parts as well. We'll see those companies being core and being public and being such a huge part of our lives in the next 10, 15 years.

Speaker 1: 23:23

Wow. Well, that's phenomenal. We're going to come back in 10 years and we're going to do another interview and we're going to see where you are. I suspect you're going to be in an interesting place, so just remember the little people like us on your way up interesting place, so just remember the little people like us on your way up.

Speaker 2: 23:41

I appreciate it. I don't want to wait 10 years to talk to both of you.

Speaker 1: 23:47

Maybe we'll do it in a couple of years. Well, we'll do it in HIMSS or Health or one of the other industry events. For sure, we're at the bottom of the hour here. So, just as we wrap up, what are you looking forward to of the next weeks, months? Any travel or events or meetups or other industry activity you want to shout out?

Speaker 2: 24:01

Yeah, I have a 14 month old. I spend very little time with that boy and I just like every minute I have I want to spend time with him because I feel like I'm losing on his childhood. That just comes with being a CEO. And we are going back to India to visit our family in a couple of weeks, so I'm looking forward to my parents and my wife's parents meeting our son. That's going to be exciting and you know, like in health care, I'm always on plane, I'm always on plane, I'm always on plane, I'm always on plane. I have to meet people, just like make sure that our value proposition is going to stick, and that's what I do as a part of my job and I thoroughly enjoy it. We love the problem and that's what it comes down to and we wouldn't be doing anything else. Even if CertifyOS is done, we'll start another provider data company and another provider data company and another provider data company.

Speaker 1: 25:03

Well, your life's work is super exciting and we're all rooting for you. We all need you as we get older and we all have various ailments and challenges.

Speaker 3: 25:13

Wait, Evan, you're getting older.

Speaker 1: 25:16

I'm actually getting younger, but I know you guys are getting older. But you know, even as we, you know, fight aging, you know we need the system to work for all of us family, friends and countrymen. So thanks, so much. Thanks, irma, for joining us and we'll catch you at a future point, take care everyone.

Speaker 3: 25:35

Bye everyone. Thank you for listening.