Why Shared Credentialing Has Failed Every Time (and Why It's Different Now) | Tyler Ford

When you really think about what credentialing is, it's a risk mitigation and it's a liability type exercise. That's where some of the complexity comes in. On a health plan side, there's a lot of different risk mitigation. When you really think about it over on the provider side, when it comes to credentialing, it's speed and efficiency. The kind of question is how we bring those two concerns together. Hey, it's Nick and Mitch, and this is Provider Data Dorks. We're joined by Tyler Ford, senior vice president at Union Healthcare Insight, talking about provider data, shared credentialing, and why broken systems stay broken. I think there's going to be a forced efficiency leap in healthcare. There just isn't the money to fund all of this administrative waste that there used to be in healthcare. We'll go bankrupt because standards are only as effective as the carrots and sticks and the enforcement that's kind of put behind those carrots and sticks. So when we talk about things like directory accuracy, I think what you would hear a lot of health plans say today is that there really hasn't been the accountability. The consequences for not living up to some of those standards that they expected. What do you think is the biggest problem today in provider data? Why don't people understand it? Why is it such a huge challenge? Imagine you were trying to work with a set of information on your customers, on your consumers, your vendors, that's all wrong, when that's constantly changing. Really, really hard to do that. Why hasn't there been this successful national shared credentialing program every provider could go to and just say, "Hey, I want to go through this workflow and I'm not going to have to go to 17 different plans to get the process done." I'll get in trouble if we're saying this one. Welcome to the provider data dorks. I'm Nick Helfrich. And I'm Mitch Gordokin. Gord Dorkin. Never gets old. We started this podcast because one of the most important problems in healthcare is also one of his most complex provider data. It's the invisible backbone of healthcare. You can't see patients. You can't get paid for seeing those patients. It drives directories, network adequacy, everything within healthcare. It is critical to how we function. Most organizations that we talk to are still working out of spreadsheets, manual processes, fragmented, siloed systems, and a bunch of vendors that just don't talk to each other. We want to use this time to talk to the leaders that understand how provider data works. We're talking about the people that know where the skeletons are buried. Know why it was built, why it's broken, and what needs to be true to fix it. We're really lucky today. We have Tyler Ford with us currently with union healthcare insight. But a pretty illustrious career in the provider data space started at the advisory board before moving on to United Health Group. I quickly noticed he's an SVP at United Health Group. You must have been the youngest SVP in history, but we'll get into that. Leading a lot. It's just really good skincare. He's one of the vice presidents of strategy before moving on to CAQH's SVP growth. As currently as we said with union healthcare insight is the SVP of strategy and operations. He is a career of really leading delivery, product innovation. I would say just being a consultative partner for people in the space that are struggling with highly complex problems. I think some of those highly complex problems over time have been provider data, but it's been much more than that. We're lucky to have them in this room as a fellow provider data door, but outside of the podcast we consider a friend. And to many degree, I'm a mentor in this space. So Tyler, thanks for joining us today. Thank you guys for having me. I don't know about all that background and all that, but I really appreciate particularly with provider data. It's one of these fun spaces where there's a really tight group of passionate people across healthcare that are trying to solve it. It's one of these, and I thought what you did in your opening, Nick, really summarized it really well. It's probably one of the underappreciated problems that break different systems and different economics in healthcare, but it's not deeply understood across different executive sets. So it's great to be here. I'm glad to be participating in a Dork conversation. And let's see where we go today. That's start right there, Tyler. I mean, there's not many people in this industry that understand provider data better than you. I don't think that's true. Well, we know you pretty well. And we'll dive into that here today. But what do you think are one of the biggest problems today in provider data? Yeah, it's one of those things where I think when you talk to someone senior at a health plan, senior to provider organization, it's something that's inherently understood in the way that it shows up. The operational problems, the frustration with all the resources that go into trying to fix provider data. But when you talk about why the problem exists at the systemic level, I think it boils down to a couple things. One is just the overall complexity of how many consumers and contributors to provider data there actually are. When you really think about it, it's it's almost like describing to someone outside of healthcare. Imagine you were trying to work with a set of information on your customers, on your consumers, on your vendors, that's all wrong and that's constantly changing. So the overall complexity of all the stakeholders and where the data flows into the claims process, into operations, into patient care, just make it a very difficult problem to solve at the systemic level. Number two is the incentive problem. And we'll probably get into as we talk about that today, but health plans, providers, regulators, and even consumers and employers have very different attitudes and very different incentives when it comes to different processes related to provider data, what they want out of it, what they need out of it, and bridging those together isn't always a zero-sum game, solving for that incentive problem is actually a big deal. And then part three, I think, is just the mechanics of understanding all the complexity with at the very tippy-top level. Is it a data problem? Is it a definitions problem? Is it a technology problem? So when we come into all these different elements of how you kind of think about it, I think it's the complexity in the intersection of all of that that brings it together about. But we are all the time, an address is an address. Why is it so hard to keep it updated? Why don't people understand that concept? An address is not really just an address. It could be many different addresses. Yeah. And it comes down to that different level problem where an address is an address, but it's how do you structure that when we get into the subatomic level of what does comprise an address, the different levels of how you describe that address, the data elements itself become challenging. There's also an address may not just be an address. So when you think about the natural flow of where providers actually exist in the world, well, Mitch, if I were to ask you, where does Dr. Ford practice? That answer could be incredibly complex. I may have a provider office that's corporate and related to a health system. I may practice in three different locations. I may attend at a hospital. So when we talk about kind of the address out there, there's not a common set of definitions that we're just working off of to understand the concept of what that data actually means. Yeah, we are the time. There's those billing addresses for payments and claims, there's service addresses for directories. You can be in five different addresses for one group, ten different addresses for another one. Then you throw in the concept of delegated providers. That's right. Non-delegated providers. Well, I even think about, so we work with a large national health plan. When we started talking about, let's say, provider data management, their PDM and addresses, they have 1800 downstream partners within their health plan that use that data in some way, shape or form. If we think about an address, contracting is going to use it differently. Then the claims team, which is going to use it differently than the directory team. Every single one of those teams probably actually doesn't know how they're getting that address. They know, okay, it's wrong for what I need, but how do I actually clean it up at the end of the day? I think it even gets worse. Now, some health plans are actually moving in a great direction, which is there are dedicated teams required to or who are responsible for actually addressing and fixing some of these problems. There are plenty of health plans that all of those different departments and different use cases you just listed out. This problem exists across all of them, and there's no central person looking to fix it, which I think even adds to some of the problem of who do I even interact with around the issue itself. Is those central person? Then we're also dealing with really large legacy organizations with dozens of different systems, none of which talk to each other. So sure, a contracting person may update an address in a contracting system. That's not updating their claim system, which is an updating their directory system. Can you maybe talk about some of the challenges you've seen there in terms of some of these systems not really talking to each other? Maybe some of the changes you've seen in the industry in the last few years. So I think it actually starts even before we get into an individual organization and their operations. It actually starts with all these different patient populations and contracting types. And in some ways, I think you would hear a lot of folks talk about it's really a pervasive problem across healthcare designing for the difference between commercially contracted patients, patients under public programs, and that's both Medicare and Medicaid, and then self pay. And when you think about those different populations, that gets even more complex to the level of call it 50 states, different divisions of insurance. So actually in the market, when we talk about designing for a system or a system of record, the different regulatory regimes or even how we talk about that data is very different depending on the line of business that we're talking about. What we've probably been seeing in the industry more commonly is trying to think through one, just an overall modernization of systems and a push toward interoperability and flexibility in systems. So it's probably an old trail that nobody, no health plan is ever going to rip out or change out its claim system. It's too difficult. It's the heart and lungs of the operation financially and for all the data that flows throughout the system. We are trying to see to overcome some of those limitations of systems talking to one another. I think you really have to concentrate and think about data standards and how data is ported across individual technologies. And so big organizations that have come together either through merger and acquisition. organization or organizations that have had to design to be multi-state in nature have gotten good at that. This becomes an even bigger challenge though when we're talking about organizations that operate in one location It could be a state blues plan or a regional health plan attached to a provider for instance versus one of the big national plans So I guess one of these big trends that we've seen that we've seen is overall just a modernization and an emphasis on interoperability as opposed to the fact of standardization of a single technology platform across a health plan and I think what that lends itself to and probably where we want to go is talking about the set of standards and the set of kind of operating practices that come with good data management That is probably how the industry is going to bridge all of these problems with systems talking to one another I'm more encouraged by a common set of standards like that that the industry comes up with or that are that's developed in partnership with regulators Then I really am with hey, we're gonna see a bunch of systems really working together. There's there's a Convergence of the technology especially if it's what's best for the consumer as you think about those sets of standards And I think we'll talk about this here in a second But it's Q1 of 2026 the CMS National directories really popular. Yes, that will be its own set of standards What are some other standards that you think have been successful or maybe more importantly unsuccessful and why have they been unsuccessful? Yeah, I do think back in the early 2000s one of the big wins that we can kind of point to is the development of the standard credit application by C-A-Q-H And I think originally the kind of intent of bringing health plans and providers together to codify what almost To use an example kind of outside in college applications. You remember the implementation of the common app right the applying to college There's a set of information that we should be able to know on you That's going to be common across all these different schools. You may be applying to I kind of think that's a helpful Example or a kind of representation of what was Attempted with the standard credit app is to say there's just a common set of information that regardless of who you are as a health plan You're going to need to be able to Kind of work within standard and sets of information there the implementation of that really that has become the standard kind of across the industry for when we accept Credentialing applications and then when we kind of go through the re-credentialing process That was a really helpful exercise in bringing the industry together moving quickly to kind of define that set of standards and then let health plans kind of adopt them So that was probably an example today even of consolidation that's that's actually helped pass the test of time I think one learning from that is over time that set of credentialing information grew in terms of its The needs that individual health plans had and the utility of how people were using that credentialing application And so the learning from that is probably just it's not a one-time exercise This is always a dynamic living process that has to be continually updated There's cost implications for that updates are difficult to make but I think for the credit applications a great example of where it's worked I do think why wildly adopted absolutely every provider is leveraging it in some way shape or form So it's definitely been successful. That's right. And I think to see a QH's credit sometimes you know But the hallmark of that is the C a QH app or the C a QH name kind of became it's almost like the Kleenex name in credentialing right It's we kind of associate credentialing now with that name What I do think is important though and what you'll probably hear a lot of leaders who are deep in the weeds Probably the listeners to this podcast would say is Standards are only as effective as the carrots and sticks and the enforcement that's kind of put behind Those carrots and sticks so when we talk about things like directory accuracy I think there's really been a mixed history for standards and expectations set With the no strings attached at no surprises acts. Sorry The the NSA there's been a really mixed history of Implementation of some of the carrots and sticks the penalties associated with that and I think what you would hear a lot of health plans say today is that some of what they were expecting in terms of Kind of behavior change and data submission from providers There really hasn't been the accountability or some of the kind of the consequences for not living up to some of those standards that they expected And what that simply means is there's kind of a lack of standardization of about how seriously some of those regulations are taken across the country Yeah, it seems like the health plans are the ones that are you know liable for their directories be an actor at the end of the day But the providers are the ones that need to provide the information and then even if they do provide the information It's really difficult for the health plans to actually integrate those updates into their databases either because of a structural hierarchical reason or sometimes You know, we've heard from plants. Hey, I know this providers out of new address I don't really want to make the change because now I don't have an adequate network And I need to go recruit a provider before I make the change right can you talk about maybe some of those like misaligned incentives You have great experience from the provider side, you know obviously we're premier CQH experience from the plan side of United Talk to me about why we haven't really been able to find a middle ground here where providers are incentivized to get their data updates And plans are incentivized to update their directories. Yeah, it's a brilliant question match when you think about the incentives around each side I think let's take the credentialing use case for for one when you really think about what credentialing is Credentialing is trying to make sure that the plan that is offering a health network out to its members Is trying to make sure that all of the individual practitioners within that network are Licensed to practice medicine are of great quality that it's a risk mitigation And it's a liability type exercise that is ultimately what it boils down to and I think the incentives that we get with some of the other use cases out and provider data That's where some of the complexity comes in so on a health plan side There's a lot of different risk mitigation. I would say concerns there Wanting to make sure that there's no liability in patient safety issues wanting to make sure that there's no compliance issues Well, when you really think about it over on the provider side who is submitting that data They don't take on as much of that liability or that's more of a health plan concern What is much more important to a health provider and I don't want to dismiss like the the shared concern there But a health provider when it comes to credentialing it's speed and efficiency They are trying to get their providers in network able to access the patient panel so that those providers can start to build claims Can start to treat patients and can start to do their jobs and don't have delays there When you think about that you have a accuracy and a compliance case on one side that's going to necessitate full accuracy Timeliness completion of information and then on the other side you've got speed And so I think bridging the two there The kind of question is how we bring those two concerns together Do you do it regularly and make sure that there's upside and downside for each side But ultimately I think We maybe don't appreciate how different the two sides and what they're solving for our well We've had conversations too on if we're looking at speed and quality or quality and speed we've had conversations with health plans Well, we've had conversations on both sides of the ecosystem and we've heard some health plans And this is definitely the minority sure of health plans where they're like speed doesn't matter to me If you do this faster. I'm paying claims faster sure a provider would say I need to run my practice I need to function. I just got out of school. I'm standing up my primary care clinic So there is a little bit of misalignment there in that process and You know, it kind of gets into a mission eyes At least what feels like our favorite topic for the last 18 months of That workflows a commodity this credentialing workflow if you're United your past employer or sygna centine blue cross blue shield plan of any state You know a local plan like summa health care You're doing the exact same thing at the end of the day So why hasn't there been this successful national shared credentialing program that Every provider could go to and just say hey, I want to go through this workflow I know that you're gonna get what you need out of it and I'm not gonna have to go to 17 different plans to get the process done Yeah, why is that failed? Yeah, one I would say there's no one reason that it's actually failed in many ways I think that's hoping this was gonna be easy. I know No But then we wouldn't have this cool podcast. That's true. That's true. Nothing's easy about this I do think it's better thought of as a guardian not it is a system built up with different layers of complexity over time And so kind of untangling that Really comes down to a matter of solving for technology incentives processes and people and when we think about kind of One of the root cause like why isn't it so easy to just implement a solve here There's been a lot of efforts out there one is just there is no single source of truth. There's no system of record That's been designated out into into the industry and in a lot of other industries I think you would find that there are regulatory bodies that aren't quite king-makers, but really define What counts as a system of record what counts as a verification in healthcare that doesn't really exist today And there there's a bunch of different groups between NCQA between CMS between state each the each state regulation and so the question is probably how you get representation in that Or the other reality here is that if the problem persists the question is do we eventually reach a Paranime where it becomes so expensive and so complex to do all of this That an entity like the federal government steps in and says I've had it with this. There's too many problems the industry hasn't been able to solve this I will now sell this and there's tons of downstream revocation You bring up a really interesting point here. You have CMS you have 43 different state Medicaid groups You have NCQA You know, I can't tell you the number of conversations I've had with Health plan credential leaders with like hey, can we just cut to the chase here like why can't you just do this one time and share it across the board And I say I would love to but the thing is your Medicaid plan in these 10 states They're commercial planning these 10 states. You all have a few extra verification that you do because that's the way you've always done it. And so it's not really the same across the board. It seems like it should be the same, but the requirements are vastly different. If you want everybody to be able to actually use the same packet, we really do need a line on shared standard. And I do think that takes somebody to take a leap of faith and say, okay, I'm gonna do a little bit extra here so that everybody can pull from this pool. And maybe that'll hit my margins or maybe that'll be a little bit less efficient in the beginning. You got a commercial plan and a Medicaid plan that are both sharing the same packet. The commercial plan needs to accept that it might take a little bit longer because you have a few extra verification that they're not gonna need. Yeah. And I think that raises a really interesting question, Mitch, of, so it's funny, you even talk about kind of the conversation of somebody saying, well, why can't you use this one packet? Or I'm gonna submit once and then why can't you figure out what to do there? Well, the you in that case, if it's a health plan, the you might be a lot more used than we're actually appreciating. So when you think about even just within a big national health plan, I'm picking on my old employer, United Health Group, United Health Group is a lot of different companies rolled up into one kind of corporate entity. And the different standards even across those, even within the ecosystem that is United Health Group is gonna vary. So I think even if you were to say, hey, for one health plan, there isn't just a one-cred packet idea. So then that leads me to kind of say, hey, if we wanna solve this problem, we really have to think in one of two vectors. One is either going to be, how do we have a lowest common denominator that can be modified over time? So it's kind of updating the idea of a shared cred packet. Or it's, do we actually break even the concept of, there is one national's cred standard? And then we have to think more through flexibility of saying, hey, when data comes over, how are, what are all the ways technologically that we can actually bring more data together to make that record really robust, to meet all of these business use cases. And I think there's merit in both approaches that we might explore together. - If I'm here in what you're saying, you have a few different reasons why it doesn't happen. The technology just hasn't existed, right? We need the architecture and the scalability to be able to manage this sort of scale, this sort of volume, and also the different complexities that exist across these different plans. So programmatic logic across the different requirements. I think that's right. We have different plans that require different things and have different incentives as well. And so if you're gonna give for one plan, the other plan needs to be able to come to the table and say, sure, I'll accept that this will take a little longer or maybe a little expensive, but I don't really wanna do that. We also have this concept of aligning record dates, right? And so now we talk about the thought of pull forward economics, right, like one plan has to pay for something sooner than the other one does. Why would I wanna credential my provider two years earlier than I have to? - Yeah, and we've gotten into that. So for listeners who are kind of following along, there's this challenge of depending, there's obviously a concept of an initial credentialing exercise and then there's consistent every 90 days. However long you wanna set the calendar, recredentually, efforts. And when you're a provider, depending on when you come into a network, that starts a set of calendars and a schedule for that data flow that really becomes difficult over, you know, the number of networks each provider is contracted with to manage. Well, I have a lot of hope, Mitch, I think someday that we're gonna have a system where we can think through breaking the whole paradigm of cred and recred and more think through, hey, if we really need to verify documents, there should be a credentialing event that gets as much verification as much data submitted on a one time kind of event. And then can we move into a paradigm of consistently using data feeds to look for what changes. - Back 20, 30 years ago, there was only one way that you could prove that you verified something from a primary source and who verified it and when. - That's right. - And that's a screenshot of it, a screenshot of a data on an everyday. Today we have API verifications, right? So now, you know, NCQA says, actually, we don't really need screenshots. Like all I need to know is when you verify it from where and who did it. - Now having said that, I absolutely do not believe you don't still get screenshots from some providers that you have to manage through. - Oh, well, the problem is some providers agreed to delegate agreements with health plans. - Absolutely. - And I'd say sure I'll do give you a screenshot of no problem. But now, I've said we have to agree to, you know, delegate a credentialing agreement that if you've agreed to something in a contract whether it's a Medicaid contract or a DCA, sure, we have to do screenshots. But we always ask like the seven why. I was like, why do you do this? Why is it still this way? So that's one thing I think that's sort of relic of the past. But you mentioned a good point here, which is that recredentally also a little bit of a relic of the past. 20 years ago, you credential provider, they go off into the abyss and they do whatever they need to do. Three years later, you want to check in on this provider and say, hey, are you still a good-boy or girl? - That's right. - But we also have new CRPN requirements that came out that says, I need a monitor of your licenses every single month. I need a monitor, you're expirable. So I need a monitor of your sanctions. So monitoring, ongoing monitoring, which is a requirement is kind of making a little bit old news out of the re-credentching process. And we're hopeful that maybe re-credentially itself would be something that would become a relic of the past. - Well, the new NCQACRP and requirements, you guys know this concept like Apple kind of eases us into things. Or they're just like, we'll make a little bit of a little bit of tweak and now we've got Apple Glass. And Apple Glass is now the tweak to all of us wearing smart glasses all the time, 10 years from now, we just don't know it. - Look at the NCQACRP and requirements, be maybe NCQAC thinking a long way out. We've got a lot of respect for the team there. But maybe that's us easing into, okay, we're just gonna do initials. And then we'll move into a monitoring sequence. And that's how we'll check on as Mitch said, good boys and girls. - Yeah. - And I think it comes back to, without picking on any of the old standards, without picking on any of the groups that are kind of affiliated here, I do think it's important to come back to and say, hey, if we were designing the system to avoid the Gordian knot problem, if we were designing the system of what credentialing is meant to do for stakeholders today, I don't think the credentialing cycle is exactly the system. We would all build today knowing what we know about technology, the complexity of the healthcare ecosystem and all the different players that there are today. And I do think kind of the availability of some of the new technology to bring together outside sources and do a more monitoring based exercise, especially given all the other things that health plans have to track and monitor. I'm pretty helpful that that is going to be part of the future and that there's more flexibility to kind of break from some of the old systems of the past, understanding that there's concerns that those things solve for too. - I think especially if you get a group of health plans, provider groups that are willing to attack that problem. The other side of the shared credentialing motion, and Mitch and I, we've interviewed five, six different people associated with more than people, but versions of these failures over the last 20 years where it hasn't happened. And one that always comes up is it seems like they're really focused on re-credentialing. - Yes. - And yes, we have to align the timelines we talked about that. But there's also initial credentialing. And if 20 plans, you know, there's 444 plans right now in the market, if 20 plans participate, but they still maintain their own portals, their own access points for the providers, how are we actually serving the provider as the consumer who's frustrated? They just want to serve, they just want to serve patients. They want to serve the people that they went to med school for, and now they're going to 20 portals to do that. You know, how do we move past that so that there's just one stop? - I think it's also even getting to the level of like, who is actually doing this work. A lot of times we talk about providers who are doing the credentialing activity. That's not true at the actual local level, right? It's teams of people that have been doing this, that are serving a bunch of different administrative purposes. And so I think there's also a reality of trying to say, who is providing this information, what are the source systems and where it's coming from, and getting back to that business intent. But ultimately the goal needs to be to relieve all of this administrative burden on the providers. And we're going to all sorts of reasons as to why, I think there's gonna be a forced efficiency leap in healthcare. We'll go bankrupt. - Yeah, I think like, you know, what we've been kind of hinting at here is that there's been these incremental changes that have happened over time. - Yes. - And it's really difficult to make incremental changes on the system that's really ingrained already. And you can make initial crunching a little bit better. You can make recrunching a little bit better. You can add CRP and requirements to firm monitoring to make it a little bit better, but you're still building on an old legacy infrastructure. Maybe today with AI, we can see a step function in this where we can really leap past some of the incremental changes. - For sure. - Have you seen AI make a huge difference in provider data accuracy or provider data management in your day to day, or what you're seeing at union health insights? - Yeah, I would say we haven't seen maybe a silver bullet that gives me an example of, hey, AI has been the unlock for all of this. And I think the reason there is, AI is just an upgrade in the technology and the mechanisms. It doesn't solve for all the problems we were talking about before. The incentives, the timeliness, the complexity of it all. So I'm hoping that AI is not seen as necessarily this silver bullet that's gonna fix credentialing or this problem of all the complexity with the national intent. I hope AI introduces a cost-effective mechanism when we do design a system as the country or when we can come up with the right approach to kind of simplify it all. AI does create a system that allows us to do that very effectively and bridge some of the technology challenges we talked about earlier. I do think you raised an interesting question though, is what is sort of the atomic unit of how we can go about solving or biting off the problem? And I think the more that we've been thinking, the more that I've been thinking about this, right? I think it really matters that you have both a national effort to try and think through what are all the concerns that could bridge all the different patient populations, all the different lines of business and come up with, like I talked about before, it's kind of a modernization of that standard CRETAP concept. But then I also think there's a lot of opportunity to approach states as individual units and the plans that kind of serve those patient populations within those states to try and say, as an individual unit, can we also get innovative pilots going and you've probably seen examples all of the country of things like that and directory management in some shared credit apps. But I think the important thing is to kind of bring the right set of stakeholders together that has to be provider representation, plan representation, cross lines of business, regulators, and then probably even others kind of associations, patient advocacy groups, things like that. So we talked a little bit about directories as a problem shared, well, credentialing in general as an opportunity for improvement in the provider data space. Where else are you here in noise? Where else are you here in health plans, partners you're working with where it's like, hey, this part of provider data is just fragment and broken, destroyed. How do we adjust that? Yeah. I mean, it's, I would say when you think about some of the big strategic challenges that are coming around for health plans. One of the big things that we track that I think is maybe underappreciated this year is kind of a renewed push for appealing to a consumer. And without going in totally off tangent and off the provider data track, when you think about kind of where health plans are moving, there's now these kind of innovative pilots that employers are getting into called get grids. And these are insurance arrangements that are effectively defined contribution type models where an employer might put a amount of money that they want to fix or set for an employee benefit. And then an employee can effectively go by their own health insurance that can be portable across different states, networks and employers. If you think about that world and it's kind of, so we talk about that as kind of the four-o-oneification of healthcare. So it's the movement from defined benefit to defined contribution. And what that means is the consumer is sort of the unit that we're designing for as opposed to all of these big organizations that today healthcare is revolving around. If you think about a health plan starting to have to serve a bunch of different individuals that can move across plan types, can move across geographies and isn't switching insurance so much in big groups, that has seismic changes for what you have to offer people in order to be competitive. And one of these things that I think smart health plans are starting to think through is in that world, what are all the core systems that they have to fix and provider data and an effective directory, a robust set of information on these providers that's accurate in flows, that becomes mission number one. Because how the hell do I influence consumers? How do I provide the right information for them to succeed under a benefit structure that's more consumer driven? If I don't have good information on my network and that's not flowing pretty seamlessly. So what I would say is we've seen some of the incentives and the strategic priorities of the plans changing that is going to put this solving this problem in much, much more focus. And what I hope that does is actually for these individual plans and providers a movement toward that and kind of seeing that coming down, solves for some of that the complexity and the inertia associated with not wanting to get over some of the incentive problems. I think about these Icras and I just think about the hot topic in healthcare affordability. Yes. And the lack of affordability right now and as we move towards new models that can bend that cost curve, the impact that's likely going to have on provider data and its necessity to build networks. Yes. So make sure these directories are clean once the networks have been built to fit these new models. It's going to be a whole new world, I think. In my previous careers, I've always seen the trends of the consumerization of enterprise right. And it seems like healthcare is just slightly behind for lots of reasons, like regulatory reasons. We work with 50 different state governments or 52 if you consider some additional territories. And they all have their own regulations, they all have their own governing bodies. It's very difficult to be able to create one system that offers a transparent and user-friendly experience. But it sounds like what you're saying here is that if we can give providers access and ownership to their data, if we can give consumers visibility into that data, then they can have their own choices. They can make their own choice as to who they want to go to. What providers treat my condition. What providers look like me. You know, historically, I've had high quality outcomes with my type of condition or my type of procedures. Right. You hear a lot of times, I think, it's putting a consumer expectation. We have all sorts of expectations for data, timeliness, the information that we can work with outside of our healthcare experience. And we simply don't have those same expectations in healthcare because the technology and the systems have never been there to offer it. So I think the hope is that we're kind of modernizing the healthcare experience and the set of information that's out there to help people to navigate through the system or with assistance, but that's kind of the objective. It's like you think about this navigation of the healthcare experience. So I always imagine it as like, you're going through amazing. You hit a wall, right? So I go through amazing. I'm not the one paying for the service, right? There's a payer. Okay. So now I got to go to the payer. The payer now has their own incentives that are not aligned with my consumer incentives. The provider has their own incentives that are not so many different stakeholders that, you know, I think doing their best and all trying to make the system better, but it is fragmented and complex. Yeah. And the, you know, my personal take on this is the kind of ideal state would be trying to lean into the consumer and people as they naturally exist, right? There's lots of regulatory reasons for it. Does every health plan in the country need to maintain its own directory with the same information on the same providers? And is that naturally what people want to do when they get sick and they need care? Is wake up and log into their insurance company's website? I'm not sure that's the way we would design the system if we were really cart-b launching it. But I think to your point, it's really important to try and say, how are we taking all those considerations, kind of designing a business intent there? And then putting together initiatives with the right stakeholders that kind of come up for, come up with a plan to kind of bridge where healthcare is today to where we want to go in the future. Yeah. I mean, it's a problem we've been thinking about. Like I said, for the last 18 to 24 months, working with various health plans at a regional and national level, as we've gone through, I think the most important part is like we've designed this is to ask the question we asked you is, why has it failed? Because if we don't adjust for how it's failed, it will fail again. And there's been a lot that's come out of those conversations and we've essentially aligned on five pillars that we really need to focus on. The first one is that we don't compete on provider data and we have to serve the provider. Yes. We have to make sure the providers that ultimately serve our members are happy. And to do that, there has to be a unified single portal for them to enter. The other is the economic model. This industry has long been structured around the concept of a per packet cost. That per packet cost leads to gamification. It leads to in a shared model, it leads to gamification and structure. So all three of us own health plans. Congratulations guys. Tyler's recruitment and day it's going to be different than Mitch's. One of you first has to give up your legos and move that forward. And if you're doing a per packet cost and it's like, okay, per packet's 20 bucks. Now it's 10 bucks for each of us. And I'm health plan C looking on the outside. I'm like, okay, two people are participating. Now I can participate in the rate will be 20 divided by three for sure. Do we then give you a rebate and then I get the lower it just leads to this big issue. So you got to change that. You got to change that economic model. So that's the two pillars that I think are important as a starting point. Single source for providers. Very clean economic model that doesn't lead to gamification of the system. Nick, and you like to quote the last scene in the Martian, which I love. And so for those of you who haven't seen the movie, the Martian, you know, last scene Matt Damon comes in, he's teaching a class about surviving in space and he says, yes, what you've heard about me is true. I did survive on Mars for, you know, however many years and I got home. And what you really, you know, what they don't tell you about is that you find yourself in these really difficult situations and there's a ton of different problems. And if you solve one problem, you just have to solve one problem after the next. And if you solve enough problems, you get to go home. And I think that's kind of how we approach this shared cred model is like, okay, let's look at all of the problems that have happened. You talk about the onboarding portal, right? Sure. I have one single point eventually, but you know, to Tyler's point, until your point from earlier, all these health plans have their own onboarding portals that they invested millions of dollars in do, right? How do I create a single fund door, but also then feed it through those other portals for their own eligibility and contracting purposes, right? So we developed APIs and developed workflows that work through, you know, each of those different planned portals. The regret day one is, is I think the one that has always been the biggest challenge, because sure it's easy to align a regret date, but to your point, you know, these plans are paying per event. And so now, you know, we kind of touched on earlier, but, you know, plan number three that has a regret date in 2029 does not want to pay earlier for a provider to get credentialed, regrettional in 2027, you know, I may have tens of thousands of providers. That's a multi-million dollar line item that I'm paying sooner rather than later, right? So the, you know, the subscription model is the third is the third pillar. So the first pillar is the single point of entry. Second pillar is the regret alignment. The third one is the subscription model. So you don't care how many regret events you do. You just pay based on the total number of providers in your network. So as new providers come in, they may get credentialed for the new plan. And they may go through a regret event six months later, because that's when their anchor regret date is plan shouldn't care that they're paying for another regret event because they're just paying based on the roster that really, again, in terms of one of the problems that we're moving, I think that removes the problem of pull forward economics. You know, I don't really care when or how many credits I do. I'm just paying to be part of the system and you're giving me data out. The fourth one is SLA is obviously so we need to make sure that we're, you know, we're meeting industry best SLA's from a turnaround time and a quality standpoint. And then I think the most important one is the biggest problem that we have touched on here a few times is the highest verification standard, right? So, you know, we need to be able to credential at the Medicaid level. And you know, that is across all states. So if a provider has 10 different licenses and you're just credentialing that provider in New Jersey, well, but we also have to credential him in the other nine states that he has a license and because a new plan the BCBS horizon may come in and they may say, "I actually want that New Jersey license." And so we need to be able to credential across all licenses, across all verifications and across all regulatory bodies at that highest level. So just to repeat, it's a single point of entry, aligned recruit dates, the subscription models, opposed to the event model, best in class SLA's on turnaround time and quality, and credential at the Medicaid level. So that's what we've seen. We've tried to solve one problem at a time, and it sure seems like the market reaction has been great. Tyler, one of the things I've really appreciated about our relationship is how consultative you are. I feel like I can come to you with a problem in this complex base. You're like, "Okay, let's talk through it. Let's talk through." Not just that question, but what is the root cause of this? What's the foundation of it? Where does it all come from? I think that consultative relationship you've built has served you really well throughout your career. And now your union healthcare insight. We've done some work with the team. Can you just kind of give us the summary on, "Hey, what's important to you guys? How does the organization work in function?" And some of the things that we love to do is actually very similar to what you guys are doing here, is we throw some thought leadership events where we're trying to bring together all of the different voices that have a stake in an individual topic or conversation for provider data. I think it's really hard to have a conversation with just health plan leaders. You would want regulators. You would want NCQA. You would want health plan leaders. You want up. on health plan leaders. You want ops, finance, and then providers in the mix. That's where you actually make progress and where you get the difference of opinion there. And that's the, where all about is kind of bringing that together into one consistent model. - What is the most interesting or surprising insight you've uncovered through some of your interviews? - That is, you would be amazed, Mitch, at how that is like everybody's number one question. - Oh, yeah. - You thought it was a good question. - And it's so, and it's so stressful. It's like, what is the most insightful thing you could possibly say on this whole point? - On this point, it's like, yes, exactly. - No, I would say maybe like to dodge that question and to say what are some things that we're tracking that maybe you wouldn't hear kind of on the conference circuit or maybe things that are underappreciated. One is how this big shift, so this big shift in care today that's going on from procedural care, so people getting procedures in office moving to more medical utilization. And so this, that actually has huge implications for the economics of how different organizations run. It's also one of the explanatory variables we think for some of the underperformance of the ability of the health plans nationally to sort of forecast their economics and their utilization more recently. So one is all of this care is actually moving to things that are more medical in nature, that are more pharmacy in nature. Very hard to track that from like a unit of care, type perspective and big implications there. The IKRA and the movement to more individualized or consumer driven health plan products, I think is something that's going to be slow to roll out but then move very quickly. So we're tracking all of that. I guess I'd say those are some of the things that we're having some interesting conversations with the industry. - I would say those are interesting and surprising. - Yeah. - But I'm in that neutral on good and bad questions today. - No, hey. - Well, thank you. - Well, thank you. - Todd, I got one last question for you. And so, we talk a lot in our industry about all the problems with provider data. And it's a little bit of a, you know, a pain point of mind or it works to me a little bit to constantly hear about, well, here's all the reasons why provider data is so complex. Here's all the reasons why it's so hard. Here's all the reasons why the incentives are misaligned. Got a lot of health plan execs that are hopefully listening to this right now. - Yeah. - If you're a health plan exec, what are the one or two changes that you're going to make to try to solve these problems? What are the solutions to this? - Yeah. - Let me answer your question in two ways. Part one is sort of like, why bet with a solution here and what's the reason for hope and belief that an effort like this can succeed and germinate across the industry. Part one, I would say, it's all the things that we talked about in terms of the incentives are now to the point where the strategic and the operational complexity of provider data is such a hindrance to what health plans need to do moving forward. The time is now. It actually is different this time in terms of economic reality of what plans are going through and what they're gonna have to do in the future. Two is the technology is there. Three is actually, you now have a regulatory regime that I think has been independent of what you think of it. This particular iteration of leadership kind of across the federal and state levels has been very pro-technology. And so there's a little bit of bet with in terms of kind of the momentum of where people are looking for solutions. So one, I think the environment is kind of fruitful for something to go forward here. What executives need to really think through is commitment and then the kind of what are we going to do when we run into the inevitable fits and starts of my little bugaboo as a health plan. I can't yield or I can't give on some of those things and what the trade-offs are. I do think it is incumbent on a shared national activity like this that brings in so many stakeholders together. You guys have thought through what it seems like is all the root causes of why things fail, the incentive problem, the transparency problem, the individual data quality and compliance issues. I do think it's really important for executives to understand the only way that these things are going to move forward is if folks can see that conceding on some of these small operational priorities in exchange for a much better system is ultimately going to benefit the entire strategy, the industry and the organization in a place where we all agree on what good looks like moving forward. So I do think if we had one message that I could say to big health plan executives out there is do not think of this and lose the forest for the trees when the operational concerns, when there's turnover, when there's fits and starts about the progress there. I think what kept previous initiatives moving forward and where we did see success was a group of visionary leaders really committing to something at the senior most level, funneling that down into the organization, providing guidance that it was a priority, providing funding when it's needed, and then ultimately continuing to believe in that bet, I think there's a real shot at this being kind of a game changer for the industry. - It's that momentum, relentlessly executed that you got to focus on, little rapid fire. - Yeah. - Best and worst career advice you've ever gotten. - Oh my God. One of the best pieces of career advice I think I've ever gotten is and it's going to sound a little shameless in self serving. No one besides you wants you to get a raise. You have to be your own strongest advocate and you have to take your career by the horns. I think just wanting to think through and saying, hey, know your worth and kind of advocating for that is a really important thing to do. - Because my boss, I'm gonna take that. - Yeah, I was just wishing that Michigan leave the room right now. - I have been texting Nick that you need to raise more along. - It does. - It's the biggest provider data door kind of, but you do have to be your own advocate. I love that one. - Yeah, and then this is always probably like, I'll get in trouble for saying this one. I do think it's just too simple to say follow your passion. I think success in a career comes from mixing with a hard assessment of what you're good at, what you like to do, and then ultimately where there's opportunity, I think following your passion is just a little one element of that. I think really thinking through a combination of, what are all the things that have to go in to make sure you're gonna be successful in terms of opportunity that you're not in control of. I think taking a holistic view of that, isn't it? Tyler, what's currently on your nightstand? - Oh, currently on my nightstand? Nothing. I'm going through a lot of like, - What? - No way. - What? - No way. - Exercise here. - That's a simplification. - Yeah, I used to be, I used to have, like I'm a very messy person, just in general, and so I'm trying to go through this like, decluttering phase of my desk at work, my nightstand, so the goal is to get all the knick knacks and all the crap out of it, and it's brought me a lot of peace recently. - Wow, that's a really nice analogy to be able to do it. (laughing) - Yeah, let's get rid of the knick knicks and provide a data and clean it up. Favorite football team, you alluded to it. - The Buffalo Bills. - Gosh, born and raised in Rochester. - No, I think that's all we got today. We appreciate your time. - No problem, guys, this was awesome. Yeah, one thing I would just say too is, I absolutely love and feel like we need more conversations, more spaces like this, whether it's events, whether it's podcasts, whether it's media channels, provider data and the community that's being gathered here, it's pretty niche, and it doesn't get hit on the national circuit nearly as much as it deserves to. And so I love that you guys are kind of taking what feels like a very worthy conversation but something that's very niche and making it more accessible for everybody. So great job. - I appreciate it. - I appreciate it, comment. I appreciate you being a friend to us, a friend to the program, and a friend to the industry. You're certainly a trailblazer in this industry. It's an honor to have you on the show. And thanks so much, Manaling, for the work with you. - Awesome. - Can't wait to see what you guys do. - Amen.