Verifiable

So today, we’re chatting about Verifiable and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

We’re a company that aims to make healthcare services more accessible and affordable for individuals without insurance or with inadequate coverage. Our goal is to make sure they can see exactly what they’ll get while allowing them to shop for healthcare services online. We cover a wide range of specialties and services, including labs, surgeries, sick visits, and specialty care. Our platform serves both direct consumers and businesses. Various organizations can partner with us to offer subsidized access, such as providing discount codes, or even fully covering the cost of certain healthcare services. My role entails supervising our provider operations, which involves overseeing account managers’ relationships with healthcare providers, evaluating provider performance based on key metrics, and managing partnerships with organizations that utilize our marketplace in various ways.

How long have you been using Verifiable?

About three years.

What was the context that drove you to look for a solution like Verifiable?

Initially, we had started credentialing providers in a spreadsheet, but as we scaled up with national telehealth due to COVID, it became unmanageable. And credentialing is not a one-time thing. It’s an ongoing process to ensure that the providers on our platform meet and maintain a certain quality standard. Sometimes unexpected issues arise, like board actions or clinicians doing things that would make us no longer want to work with them. So our challenge was to scale the credentialing process while also maintaining the licensure information that we’d already obtained, which involved verifying primary sources for different specialties and credentials. It was really time-consuming to do this for each new provider we brought on board, and we’re adding new providers on a daily basis.

As you were evaluating solutions, what were your key requirements?

We were pretty flexible, since we used to do everything manually and now we would be relying on a vendor. Verifiable was really one of only two options, the other option being CredSimple, who are now called Andros. Based on my experience with Andros, anything that offered a better user experience than them was an obvious choice for me. As long as the user experience was simple and the migration from our manual process was easy, and as long as it wasn’t going to cost us a fortune, we were ready to adopt the new solution quickly.

How did Andros/CredSimple compare to Verifiable?

With Verifiable, we were able to customize the inputs we collect from providers to some extent. Because our credentialing process is simplified, we don’t need all the information that CredSimple collects. They collect everything from social security numbers to addresses, but all we really need is name, license number, and NPI. We then run this information through a few federal exclusion lists to make sure they meet our quality bar. We wanted to be able to handle this ourselves, instead of burdening the providers with it, which was a major pain point in my previous role. With Verifiable, we get immediate results, because they are integrated with primary sources. On the other hand, with CredSimple, you enter all the information and then wait up to a month, and we didn’t have the luxury of waiting that long. Verifiable also has a seamless notification system. If a license expires or the status changes, we receive automated alerts. This allows us to take action if needed and maintain accurate provider listings.

Do you know how the pricing compared?

I don’t have a great sense about that, as we didn’t even research the pricing for Andros. What I can say is that when we initially partnered with Verifiable, it was as they launched their product so we were able to secure competitive, attractive pricing. As the product capabilities have increased, so has pricing.

What was it about your experience with Andros that made you look for a different vendor?

The platform wasn’t very user-friendly. It was often confusing to track the status of a provider’s credentialing. I never really understood the re-credentialing schedule, either. However, with Verifiable, you can set the re-credentialing frequency to be daily, weekly, or monthly. It’s always clear where each licensed credentialing status is. Plus, in Verifiable, you can easily filter and pull reports based on specific criteria, which wasn’t possible in Andros. In Andros, it was just one feed, and you had to click around a lot.

Andros’s account manager and support team were also unhelpful. Instead of assisting us, they often hindered the process and made it harder to find answers. On the other hand, Verifiable is quick to fix issues or develop solutions if we encounter any problems. Initially, Verifiable didn’t have pagination, so it was frustrating to navigate through providers as our numbers increased. But Verifiable quickly added a search function, once they realized the inconvenience it caused. I think the main issue with Andros was that providers had to input their own information, including sensitive details like their social security number, and fill out unnecessary information that wasn’t relevant to our credentialing process, which I think they needed for mandatory background checks. If that’s necessary for your business, it’s a great feature, but there should be an option to toggle it on or off as needed.

How do you find the sales process with Verifiable?

The process was pretty straightforward. We didn’t have to negotiate much. We knew it was going to be a new cost for us, since we’d been doing it in-house. Despite that, the contract was compelling and Verifiable was very reasonable. They understood that we were in a growth phase, as they were. When we developed the contract, we took into consideration our projected exponential growth in provider volume. We made sure that the per-provider fee would not remain the same once we reached a certain threshold, and we included additional thresholds beyond that.

How was the setup process?

Onboarding took about a month. We started off with a test batch, which I really appreciated. Loading everyone in from a spreadsheet right away usually leads to headaches and a lot of quality assurance work. We gave them a spreadsheet with all our providers in a specific state, including their NPI and license numbers, and they entered all that information into the system. Then we just had to double-check everything. I remember a few cases where the providers entered the wrong credential type, causing the wrong provider to be pulled in, but the system caught that and flagged it for us, and we could quickly go in and find where the discrepancy was.

There was a lot of hand holding and close communication, probably more than they usually do, because we were one of their early partners. But we felt fully supported, and I had no concerns. It never felt like we were doing most of the work. If anything, they were probably doing more than us when it came to migrating from a spreadsheet to their system. At that time, we had around 200 providers, so it was a significant number, but not overwhelming.

Can you talk a little bit about your use case and workflow?

Sure. When a provider wants to join us, they have to sign up or register on our site. One of the first things we do is check their credentials. When they register, they need to fill out a form with their license numbers and the states they’re licensed in. We also ask them to disclose any previous or ongoing actions by licensing boards. This helps us decide if we want to work with them or not. Sometimes providers are not completely honest, or they may miss that question. Next, a member of our onboarding team or an account manager will add their name and NPI to Verifiable, including the licenses the provider wants to list. Verifiable will verify if each license is active and in good standing. If there are any issues, they will be flagged in a tracker. I review these findings to determine if we still want to work with that provider. Usually, if there is a finding on their license, we are not going to work with them. If it’s something minor like forgetting to pay a license fee or not completing all required credits, we might still consider working with them, but if they have a history of violence or inappropriate conduct with patients, we definitely won’t.

We also check if they are listed on the OIG list for federal exclusion. Once everything clears and there are no issues, they can proceed with the onboarding process. On an ongoing basis, we update the profiles of clinicians who obtain new licenses, renew their licenses, or choose not to renew. We used to work with telehealth waivers, but that was only temporary. Right now, we are not accepting any temporary licenses because managing and maintaining them is too difficult and too much of a risk.

To what degree is that process automated?

So basically, the automated part gathers all the necessary information from the primary source and puts it into the provider’s profile. This saves us from having to manually search each state’s license verification website. Additionally, the system automatically re-runs the licenses on a monthly basis and checks them against the NPI database to make sure they’re valid. It also checks them against exclusion lists.

But there’s also a manual aspect to this process. Sometimes we get the wrong license number or a typo, so we have to manually correct it. This is especially common with nurse practitioners who have multiple licenses, like being an RN and an NP. Creating the provider profile is another manual task. Ideally, I want to integrate this whole process into the provider registration flow. Instead of entering the information into a separate form and then transferring it into Verifiable, they would directly enter it into Verifiable within their own system. However, this requires engineering resources and comes with some cost considerations. It’s something we hope to accomplish by 2024, but it’s not our top priority right now. It’s more about optimizing the process and reducing manual work.

Are there any features of Verifiable that you aren’t using at this point?

Yeah, so on our platform, we don’t allow any controlled substances. So we’re not using the DEA integration. We’re also not using the NPDB integration, even though they really push that feature. Initially, we were planning to include it in our last contract, but then they told us they were unable to help us get access given our organization type. If they could somehow provide secondary access, that would really set them apart from Medallion and other similar players.

We don’t really create as comprehensive a profile as we could. We could include their address and other additional features or pieces of information. I’ve thought about this, and if they offered additional features that could turn Verifiable into a provider network management tool, we would definitely use it. I believe they, along with other credentialing players, have a unique opportunity to expand in that area. You could start pulling in lists based on different attributes and maybe even send blasts through the platform, essentially turning it into what most companies try to achieve with Salesforce but fail. But I would say we use it in a very basic form. Credentialing is more risk control for us, rather than reporting to anyone or meeting specific requirements.

What would you say are the strengths of Verifiable?

It’s very easy to use, and it’s quick. Most primary sources are verified immediately. It does exactly what we need it to, and I’m confident we can maintain credentialing. The filters are also user-friendly, allowing me to easily find providers with disciplinary actions, licenses expiring soon, or filter by provider status. Objectively, it’s very easy to use and serves its purpose well without unnecessary steps or clicking around in the portal when credentialing, re-credentialing, or confirming information.

How would you characterize the weaknesses of the platform?

The biggest weakness is its detection of changes in primary source data. What I mean is, we often receive notifications that something on a license has changed, but it might be that the only thing that changed was the footer that is created when the primary source reruns the certification, which is basically the date and time of the verification. It’s been really frustrating and caused a lot of headaches. I’ve mentioned this issue to them a few times.

Another problem is that if we archive a provider, which we do quite often because providers come and go or we might want to work with them in the future, the system still alerts us if their license expires. Archiving is supposed to disable all verification features, but it will still verify archived provider licenses. The issue is that it doesn’t clearly indicate that a license expiration is for an archived provider. So we end up wasting time checking it, only to realize it doesn’t matter because they’re archived.

On the integration side, each provider on our end is associated with the states they practice in, which determines where they appear and what information populates on their profile. It would be great if this integration was seamless, so when we remove a license from a provider profile in Verifiable because it’s expired or for any other reason, it would automatically be removed from our system as well. The current process requires multiple steps, and I worry that someone might forget to remove the license from our system due to human error. It’s not a major risk for us, but it does impact the provider, and it creates a terrible patient experience during the initial visit where patient location is verified and they are told they can’t see the provider because the provider isn’t licensed in that state.

Do you have integrations with Verifiable?

No. When a provider signs up with us, they complete a virtual form. At that point, we gather their license numbers, state information, name, and NPI to create their initial profile in Verifiable. Essentially, we transfer this information from one system to another. Once it’s in Verifiable, we enter it into our admin portal by clicking the relevant states. If we ever need to make changes to the states, such as adding or removing them, we do it in Verifiable first and then update our system accordingly.

Is this because they don’t provide the access that you need? Or is it that you haven’t been able to prioritize building against their APIs?

It’s the latter. Integrating would be great, but we have limited engineering resources. If we could integrate, we wouldn’t need to go through the initial step of transferring data from the form to Verifiable. And in that case, Verifiable would essentially just be a reflection of the active states shown on the profile. That piece would be less work. The real challenge lies in creating the profile and transferring the information that the provider has given us. It should go directly to Verifiable instead of going through the form.

Are there any off-the-shelf integrations that exist between Verifiable and any other products, or is it purely a standalone?

They do integrate with NPDB, and I think also Salesforce. However, we don’t currently utilize Salesforce in that manner, so integrating with it isn’t necessary for us. It might be more suitable for other models, though. As for other integrations, I’m not entirely sure. They do integrate with other federal exclusion lists, such as the DEA, and any additional databases you may require. If there are specific databases you want to pull from that they don’t currently integrate with, or if it’s a challenging primary source to integrate with, they may not have off-the-shelf customization options.

How do you feel about their support?

Really great. Over the past three years, we’ve worked with a number of different people. Initially, our account manager was their director of product, which turned out to be an amazing experience. Working closely with the person in charge of the product’s features and growth was really beneficial, since they had a solid understanding of how to effectively use the product. Whenever we had a problem, they could quickly provide us with the best solution, unlike a regular account manager.

Later on, they expanded their team and included customer success account managers. Our current account manager, though, isn’t as responsive as others have been. We recently had to raise some concerns because she wasn’t giving us clear timelines for bug fixes or feature requests. I get it, startups often face engineering resource constraints or have trouble adding things to their roadmap, but we’d prefer transparency, even if they can’t deliver right away, rather than them giving us vague and ambiguous responses. But they were very responsive and promptly addressed our concerns. They created a solid action plan, making it clear that they value our relationship and the relationships with their other customers. They genuinely want to ensure customer satisfaction. I think, now that they’ve grown and added more team members, unfortunately some of the account manager quality is lost. And my expectations were set quite high after originally working with the director of product.

Do you feel like you made the right decision with choosing Verifiable?

Yeah. Over the past three years, I’ve evaluated and re-evaluated all the different players in the market. There are new ones that have come up, like Medallion and CertifyOS, and even some non-healthcare specific ones for credentialing. But every time, I feel really confident in the Verifiable platform. I’ve also had a lot of conversations with other decision-makers in similar roles overseeing credentialing who have indicated that other platforms tend to over-promise and under-deliver, which hasn’t been my experience with Verifiable. When I look back at how credentialing used to be before Verifiable, it’s just amazing how seamless the process is now. Even if there are some bugs or issues that pop up, they’re always solvable and never cause any major problems.

Do you have a sense of how Verifiable compares to Medallion and CertifyOS, based on your evaluations?

Yeah, I would say Verifiable and Medallion are the most similar among the different players. They are both venture-backed startups and share similar development and founding stories. Their interfaces are also quite similar, with a couple of form fields to enter information. They pull in primary sources to verify credentials. I believe reputation plays a big role here. Once a company like us has more than 100 clinicians, the willingness to migrate becomes very low because the process is so cumbersome. Unless there is a massive price difference, it’s just not worth it. In my experience, Medallion has always been significantly more expensive than Verifiable, even after multiple contract renegotiations.

As for CertifyOS, I can’t speak to pricing because we never got that far in our discussions. But from what I’ve seen, it’s not as comprehensive in terms of functionality and the extent of credentialing possible on the platform.

Do you see any major growth areas for Verifiable?

Yeah, I think provider network management is a huge opportunity, since it’s such a gap in the healthcare startup ecosystem. Having managed provider panels for years, I can say it’s a major pain point. I’ve tried using various systems like Sheets, Smartsheet, and even Salesforce, but none of them really address provider network management effectively. They have all the necessary information, or at least the fields to capture it, but they fall short in execution.

I understand that there might be hesitation in diverting from a focused mission and roadmap, but I truly believe it’s a massive opportunity that shouldn’t be missed. If Verifiable doesn’t address it soon, someone else will, and then it will live in two different platforms, which is much less effective. It could also become a driving motivator for businesses to switch platforms.

If Medallion were to release a provider network management feature tomorrow, I would definitely be interested in exploring it further. I’d want to schedule another demo, discuss pricing, and see if it aligns with our needs. While I have a strong loyalty to Verifiable, having such a feature would be a game-changer for us in overseeing our provider panel right now.

Regarding provider network management, what are some of the specific functionalities or workflows you’d like the system to be able to handle?

Yeah, it’s kind of like supply management. It involves reporting and communications. The goal is to be able to identify and understand who makes up your provider panel and how they’re performing. Then you can communicate with them and take action based on that information. Instead of going through Tableau for a report, I can quickly see all the providers working in a specific specialty in a particular state. I can also send a message to all active providers who have seen a patient in the last three months. And if we have inactive providers, I can see how many there are and work on getting them back in the loop. So those are the ways I would communicate. I’d love to have a simple and efficient way to analyze and understand our supply, both on an ongoing basis and as needed.

Do you have any advice for folks who are going through the buying process for this type of solution right now?

I would suggest doing a trial, to the extent possible. Testing the product in real-life scenarios can be extremely beneficial, particularly when it comes to credentialing. It’s important to ensure that the product integrates smoothly into your existing workflow. Credentialing is a critical process for many, and it’s often oversimplified, with the assumption that you just enter information and it automatically pulls data from the primary source. However, there’s also the aspect of building out a comprehensive maintenance process.

So my recommendation is to pilot the product and also inquire about the company’s future plans for the next 6-12 months. The market is getting increasingly saturated, and it’s likely that one or even multiple players will strive to innovate further to differentiate themselves.