Serif Health

Today we’re going to be talking about Serif and how it’s being used at your company. Before we jump into that, could you give a brief overview of your company and your role there?

Sure. So we’re a behavioral health care company. We provide one-on-one and group psychotherapy in virtual, in-person, and hybrid care settings. We have brick-and-mortar clinics in California, Washington and Florida, and provide virtual services to all those areas.

My role is in business development and strategy and I’m a senior associate on the team. What that entails is going to whatever area of the business needs some decision made or process implemented, figuring it out, and then implementing what needs to be implemented. It also involves supporting your typical business development things, like payer and provider partnerships.

Can you tell me a little bit about your experience with Serif? What drove the need for it? When did you purchase it and how long have you been using it?

Sure. So the way that we started using Serif was because I had met one of the founders through Health Tech Nerds and heard about what he was working on.

From my previous role, I knew that price transparency was a newer thing and would have some serious implications for a payer partnerships team and health care providers in general. So I brought that to my manager, who is the director of biz dev and strategy, and said, “Hey, I heard about this company Serif. They are offering data sets from these price transparency files that payers are now required to produce. That could be something interesting for us.” And it kind of grew out of that.

The response was “Ok sure, let’s try it out with one payer and see what we can find.” So we started out just with one payer looking at data and were really impressed with the amount of information that’s available there (a payer’s entire portfolio of rates). This has turned into an ongoing relationship with Serif where we will request to get a set of more specific CPT codes and specific competitors from various payers that we’re evaluating or negotiating with.

Our engagement with Serif started in Q4 of last year, and we’ve worked with them on an ad hoc basis since then. We’ll send a request, get a bit of data, use it and then whenever we need the next batch, we reach out to them again.

If I’m understanding correctly, the basic use case here is benchmarking, right? For example, you’re going into a new market and trying to figure out what the standard rates are that various payers have negotiated with your competitor set.

I’d say that’s the primary use case. We’re looking at what these payers are reimbursing providers that look like us and evaluating whether we have a good chance of closing a high margin deal with them.

Another product that Serif offers is a portal where you can look at – for any CPT code, any provider taxonomy, any state – a graph of all of the contracted rates for payers where they have processed the files in that region.

With that data, it doesn’t tell you the rate for a specific provider, it’s anonymized. But you can see, for example, that Health Partners in Minnesota has some really high rates. So that might be something that we’re interested in double-clicking on and figuring out whether those rates were for companies with a lot of bargaining power, or for companies that look like us. So there’s that kind of use case as well – figuring out who and where we want to target and then getting into specifics of what rate we can reasonably get. That’s the benchmarking thing that you were talking about.

Got it. So in terms of the workflows that you’re using Serif for, is it primarily leveraging their portal to find geographies and payers that you might want to partner with? Do you also use the portal for benchmarking? Or was that the ad hoc request workflow you mentioned earlier?

Yeah, the benchmarking is more ad hoc. The way it works is that we send an email to one of the founders and say, “hey, we want to look at these five payers and these CPT codes.” I’ve been working with one of the founders. It’s been really great because he’s always willing to get on the phone and talk through things. Usually they’ll send us the data outputs over email. One time he sent it through our Serif portal. I think that’s something they’re building out. So I’d say email is the scrappy MVP version and eventually they’ll get it all into the portal. That’s my read on it, but I don’t know for sure.

Did you do any competitive analysis of other vendors that are in this space before going with Serif? Or was it more organic via the initial outreach over Health Tech Nerds you mentioned earlier?

Yeah, kind of both. For the first request we did with Serif, we didn’t look at other competitors. The situation was – we’re negotiating this payer right now, so let’s test it out and then look at the whole landscape later. So we did that one without looking at competitors.

Once we had more breathing room then we did more of a competitive analysis. We really only compared them to Turquoise. Turquoise’s rates were significantly more than what Serif had charged us and the turnaround time was longer than what we had experienced with Serif on that first pull. So it was an easy decision and not a very intensive comparison.

In terms of the actual Serif product, how would you broadly characterize your experience with it? What do you like? What are areas you wish were better?

I’d say that broadly, the portal looks really awesome. I think that it’s evolving and turning into a tool that will be really powerful. But it’s also evident that they are a fairly early stage startup, and they’re still in the process of building things. Like I said earlier, our request process and a lot of our outputs are just through email via Excel files. So the product is newer and being built out. And with that comes some bumps in the road and things that are unexpected. So it’s not at the caliber or quality you expect from a very well established team with a whole army of engineers to work on it.

But the level of customer service and support that we have received from Rafiq, the founder, has been really incredible and, at least in my experience for our use case, makes up for the lack of product sophistication. If there is an issue with the data output or it’s not usable exactly in the way that we expected, he’s good about working through that problem with us and ensuring that he’s going to get us the information as quickly and as well put together as he can.

For example, we requested data for a payer that uses an MBHO (managed behavioral health organization) to manage their behavioral health network. Rafiq was on the phone with the payer asking them to publish the rates. He will really go above and beyond for you. So that’s kind of the double-edged sword of working with a company at that stage.

Are there any areas where you think the product really shines? And are there any specific areas where you think it’s lacking today?

Yeah, in terms of the area where it really shines, I’d say it’s the portal. I don’t know how to classify this, but it’s a really great tool for getting a lay of the land of what payers in a given area are reimbursing for any given service code that you’re looking at. For example, if I want to see, for a 30-minute therapy session, what is the world of possibilities for payer reimbursement in Minnesota, there’s pretty good information on that.

On the other side, where I think that Serif has room to grow and improve as they mature would be timeliness. I think that because price transparency as a thing is so new and they’re so new, there are many roadblocks that they don’t know about or don’t anticipate until they run into them. So sometimes timelines will change and some things take longer than others. I’ve seen that improve as we’ve continued working with them, as they build out the product and understand these data files more. Turnaround time is quicker and they’re able to communicate anticipated roadblocks, so on and so forth. But that has definitely been the biggest challenge.

The turnaround time you’re referencing – is that on the email requests that you are submitting to them where they are coming back to you with a file of the information that you need?

Yeah, those are on the one-off specific data exports.

Could you go deeper on what specifically you’re getting in those data exports? What is the nature of the question you’re asking and what’s the specific data that’s coming back?

What we’re asking for is a subset of these payers’ machine readable price transparency files. We want every line of data that has a negotiated rate for the specific list of CPTs that we send. We also ask to have another specific set of competitors highlighted in that data. If those competitors don’t have contracted rates with the given payer, then we ask for additional providers to be named in the data. The data export includes codes, negotiated rates, taxonomy, the provider name (which is appended by Serif), and a few other data pieces from the payers file.

Are there any features in the product that you don’t use? Either because they don’t work the way you want them to or because they’re not applicable for your needs?

In the portal, there’s one feature I know of that we want to use at some point, but is still being built – their dashboard. The one that I can see, for example, is called “behavioral health rates dashboard” and I believe the intention is that you can select any organization, and the portal will show you all of their negotiated rates. Once that’s built out, it will be an incredibly powerful competitive intelligence tool. It’s not completely built out yet though, so we haven’t used it.

Is there any setup or onboarding process, or does it pretty much work straight out of the box?

The portal pretty much works straight out of the box. You’ve got to make an account and that’s pretty much it. On the data exports (the ad hoc requests), we had a few meetings with Rafiq and his technical cofounder to work through the process. I don’t know if that’s the case for everyone. The product has matured and grown a lot since that time.

In terms of the actual sales process itself, can you talk through what that looked like? How responsive they were on the sales side, what was the contracting process like, and any details on the pricing or pricing structure?

My experience was fairly informal and ad hoc. We had one contract to start where we did the one data export, and then after that, we went back and in an email said, “We really enjoyed working with you. We’d like to continue this relationship and set up another contract where we can have an ongoing request and fee structure.” That entailed a few phone calls where we talked through what the pricing structure, contract, and nature of our relationship would look like.

I can’t say with confidence if the pricing structure and contract that we have is standard for them, or if it was essentially, “hey, we have this customer and this is what they want so we’re going to do it.” It seemed fairly ad hoc in that way.

Based on how things are going so far do you anticipate you’re going to continue to use this product for the next one to two years?

Yeah, I think so. I think for our use case, Serif offers what we need and we’ve been really happy with the relationship we have with them. So I see it continuing.

Is there anything that could potentially push you away from continuing to use the product or cause you to go back to market and explore what else is out there?

Yeah, I think that if there was interest from executive leadership in our company to have a more formal application of price transparency that could cause us to reconsider. What that means exactly though, I’m not sure.

If we heard that other competitors were offering something similar at a lower rate that might push us to consider other solutions. But I think our rates with Serif are more than reasonable, so I wouldn’t see that happening.

It sounds like overall you’re quite satisfied with Serif. The initial product, while being early, is quality and they’re continuing to build it out rapidly. In the areas where you need more bespoke support, they’ve been quite responsive. The pricing sounds like it’s been reasonable. So overall, the synthesis seems to be that they’re really solid so far and that you’re likely to stick with them unless something significant changes on your end or you learn that there may be a better product or better pricing out there.

Yeah, that sounds right to me. For our team’s use case, they were super flexible on timing and structure and things like that. So what Serif offers works for us.

If larger, more sophisticated companies needed a price transparency service, my perspective wouldn’t be as relevant for them. So that’s something to caveat.

It sounded like Turquoise was significantly more expensive than Serif. Do you have a rough sense of how much more expensive they were?

I did at one point. It was something dramatic. Like a multiple of Serif. I couldn’t tell you with confidence exactly what it is. But for us, going with Serif was a no-brainer. I know that isn’t very concrete, but it was multiple times as expensive as Serif.

Is there anything that we haven’t covered that’s worth mentioning?

One thing I’ll add is to be aware that there are two products: the one-off data exports and the portal. For the portal, you don’t need any data sophistication to understand it. It has a very intuitive user interface. For the data exports, if you want to get the most out of them, you’ll need someone that has some degree of skill when it comes to data analysis. It’s a raw data file. Other than that, nothing really that I can think of.

Has the data quality been high? Are there any data issues that you’ve come across or have you generally found it to be pretty accurate in your experience?

It varies depending on the payer. Some payers have more complete data sets than others. And I would not say that’s a product of Serif’s capabilities, I’d say it’s more so based on the payer. Because price transparency laws are fairly new, some payers are not publishing all of their rates in the most complete, digestible way. So for some payers, we have high confidence that we’re getting all of the rates that exist in their portfolio. For other payers, not so much. But Serif is measuring how complete various payer data sets are. So that’s something that they can report back – how complete and reliable the data is.

Are there any learnings on the price transparency space in general, based on trying to use this data?

One thing that I’ve learned from using price transparency data in general is it’s really great for giving directional insights. But there are so many layers beneath and above raw rates that tell the whole story of what a payer is doing and what kind of opportunity you, as a different provider, might have with that payer, especially as value-based care and value-based pricing arrangements grow. So it’s a really powerful tool, but there’s a limitation in how confident you can be about the insights that you’re drawing from it.

Are you able to say more about that? Are there specific situations you’ve seen arise or stories that emerge as you’ve dug beyond the data that you’re getting?

We recently requested data from a payer and got back extremely high rates compared to average for some specific behavioral health codes. As we’ve been sharing those out to the rest of our team, we found it’s important to caveat that because these rates exist in the data, that does not mean that we can get those rates. That’s what I’m talking about when I said that the insights that you can draw from these rate files aren’t written in stone. You have to interpret them in the context of – is there a reason why this payer has a portfolio of rates that are higher than the market average? And then also just knowing that some payers are going to have other performance-based bonuses or risk-based contracts, and so the published fee for service rates won’t tell the whole story there.

When you go to the payers and you’re actually negotiating, are you able to cite the rates and say, “Hey, based on your price transparency data, I see that you’re paying competitor X this amount of money and we’d like to get a rate that’s similar to that”? Or does it have to be more disguised than that, so to speak?

It’s a strategic decision that’s up to whoever’s negotiating rates. I’m not sure that we have explicitly said in any conversation with the payer “Hey, we know you’re paying X competitor Y rate.” I mean, the information is publicly available. That’s what the price transparency legislation calls for. So I don’t think it would be out of the question to bring it up. It’s just a situation-by-situation decision.

Any other advice for someone who might be going through the process of trying to select one of these vendors?

Yes, I would say that when you’re comparing vendors, I would ask for a sample of exactly what you are going to get from each of the competitors. And not just for comparison, but also to understand what the product actually is and what kind of effort or investment you need to make to translate the data into whatever you’re actually looking for, whether it’s benchmarking or competitive insights. That’s the biggest thing.

One thing that we did with Serif is we asked them to send us a data export for our rates from a payer that we have contracts with, just to vet that they’re pulling the right information. So that’s another option in the data extract request world.