Vericred Offers Industry First Provider-Network **tification Service (Interview)

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Vericred Offers Industry First Provider-Network **tification Service (Interview)

Vericred Offers Industry First Provider-Network **tification Service (Interview)
When providers transition amongst coverage*networks, the results can be unexpected out-of-network bills to patients and an administrative burden on healthcare businesses managing coverage.*Representing an important step forward in*the trend towards increased transparency in healthcare, today, Vericred, based in New York City, is releasing a new offering in the form of*provider-network **tifications. Vericred, a healthcare data services company begun in 2014, made the an**uncement at this year’s AHIP Institute and EXPO event in New York City. The new capability provides value throughout “the lifecycle of a member’s enrollment in a health plan.” When members are looking for coverage, the Service can help identify which providers are in-network or help a member*find a plan for which their preferred provider*is already in-network. Once on a plan, **tifications can alert*members if their provider leaves the network and help find a new one before the next time they need medical assistance.

Members are **t the only ones who may benefit from the new service. HR and benefits administration systems, private and public exchanges, health and wellness apps, and health insurance carriers*are just some examples of *insurtech companies and services that may benefit from Vericred’s new service. Any organization*using the Service can register patients or members*and tie those individuals*to*a list of providers. Anytime there is a change in Vericred’s Provider-Network data, alerts are sent to the organization, which can then take action such as sending a push **tification or other alerts to individuals affected by the change.

“Patients, providers and plans all benefit from proactive Provider-Network alerts. Creating a smart **tification Service is a**ther step in our overarching mission to drive in**vation in healthcare through data,” said Michael W. Levin, CEO of Vericred in*a published an**uncement.

Medgadget had a chance to get a few more thoughts from Michael on the new service.



Medgadget, Mike Batista:*What are the pain points creating a need for Provider-Network **tifications and how did Vericred identify them?

Michael W. Levin:*There is substantial churn in*provider networks meaning that with great frequency providers join while others will leave.*When a healthcare provider leaves a health plan’s network, patients who have been seeing that provider under the coverage of their plan are*likely to be surprised the next time they*visit that*doctor. Imagine getting to the pediatrician with a sick child only to find out that the is doctor ** longer accepting your*insurance. The choices are grim: find a new doctor, which takes time or leads to an ER visit, or pay out-of-network costs which can be devastating. This*problem is endemic throughout the industry.

Vericred identified the problem as a result of its work with provider-networks and speaking with clients who use Vericred’s data to power*“provider-centric search.”*Provider-centric search is the ability to enter your preferred doctors and facilities as*part of your health plan search or shopping experience and*immediately see who’s in and who’s out of*each plan. What we heard from our clients was*“what*happens if the doctor drops out of the network mid-plan year?”*While we can**t affect whether or **t a doctor joins or*leaves a network, we can bring*transparency to the changes in these networks. And thus, the development of Provider-Network **tifications.

Importantly, these **tifications can be delivered to the individual through the platform from which they purchased the insurance as well as*through apps that help them make better use of their insurance or benefits. That may be a*public exchange, a digital broker, or an employer benefits administration system. Our goal is to make our solution as*ubiquitous as*the problem so that never again is someone surprised about whether or **t their doctor takes their insurance.



Medgadget:*There are a number of businesses and tech**logies that can take advantage of this new data. Can you summarize the benefits to patients, providers, payers, and employers as a result of the new **tification capability?

Levin:*By proactively **tifying individuals that their preferred providers ** longer*accept their insurance, the element of surprise is eliminated, benefiting all parties. With alerts, the*individual can find a new provider*before an emergent need leaves them with few good options.***tifications can also be used to alert an individual when a provider they identify*enters*their plan’s*network. This would come into play if an individual enrolled in a plan that didn’t cover one or more of their doctors (perhaps for cost reasons) and later that doctor joins the network. Wouldn’t it be great to get a text or an email*saying*“Dr. Jones just joined your plan’s network”? In the absence of alerts that*individual would likely **t revisit the doctor’s participation in the network and therefore **t get the*benefit of k**wing that she can **w go to that doctor.

Providers don’t have the awkward exchange with their patient indicating that they ***longer accept that insurance. Payers create a better member*experience by eliminating surprise and they can reduce costs*through*avoidance of the administrative burden of*dealing with a member who is*surprised and*upset, and higher costs when ERs are used as a fallback. For employers, **tifications are a feature that leads to a better employee benefit*experience.




Medgadget:*Vericred’s new offering takes an important step forward towards more provider network transparency. What is a**ther*challenge with transparency in healthcare that still concerns you today? Is anything being done to address that challenge?

Levin:*Transparency around the cost of healthcare services and ***** remains elusive. With more*individuals being covered by high*deductible health plans, there is a need to understand healthcare costs and be able to make informed decisions*around cost, quality and availability. Good work is being done in this area through all payer-claims databases, but using such*databases is like trying to see intro a*room through a pinhole in the door.



Link: Vericred…

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