Physician credentialing sounds almost like a non-issue at first blush, a clean cut problem that a hospital or health systems can handle by dedicating one or maybe two staff members. That's what Mike Simmons might have thought if he'd been asked about credentialing before he attended Johns Hopkins University in Baltimore to get his master's in business, where he became immersed in healthcare and realized how much of an industry pain point credentialing really is.
"It is linked to a lot of different things, from the quality of data that is in provider directories, like inaccuracies and inconsistencies, all the way to revenue cycle management," Mr. Simmons says. "We know that the reimbursement rates to providers is decreasing, so everything that provider groups can do to optimize the revenue cycle becomes front and center."
Prior to seeking his MBA, Mr. Simmons worked in software development focusing on business process and optimization. His understanding of the importance of organizing data to fix a variety of problems helped form the foundation of CredSimple. Mr. Simmons spoke with Becker's Hospital Review about the downstream impacts of credentialing and what it's like to start a healthcare company amidst so much change.
Question: What sparked the idea for CredSimple?
Mike Simmons: It started out with a pain point that has been shared with a lot of different constituents — from physicians to executives and administrators. Everybody had in some shape or form very painful interactions with this thing we call credentialing. As I dug in to understand what the problem was — because it was quite often discussed in my MBA classes as a quintessential problem process within the industry — I found the problem starts with a pain point of credentialing, but moves into what practices see as a "white space" where they lack an intelligent way to manage data about doctors. And also it impacts a lot of the other businesses that are quite inefficient in the administrative parts of healthcare. That's what got me excited about this work.
Q: What is effective about CredSimple's solutions?
MS: What we see as the white space is in provider data managment, which really starts at the credentialing department. When a new doctor comes into a health plan or into a facility, that's where we first encounter provider data. The credentialing departments are pretty old school and they're not really thinking about this in terms of data, they're just thinking about it in terms of getting the provider processed. You are essentially left with an asset that is not being fully utilized within every one of these organizations. Our solution gives clients a really easy way to get through that credentialing process, but then on the back end, we're helping them to maintain their data with much more integrity so they can use it in more effective ways downstream. Our clients enjoy also see big improvements in provider data quality.
Q: What has it been like to found a healthcare startup?
MS: It was a big difference for me from what I did before — building a software and services business selling to all different types of companies. For me it's a really exciting time to be involved in healthcare. With health reform, the industry is being pushed into doing all kinds of new things and we see that with our client base. Our clients range from the provider side, adopting entirely new ways of delivering healthcare to their customers, all the way to very well established health plans that are figuring out new ways to reinvent themselves to offer better products to their consumers and keep up with competition. We're playing a small but important role in that and to me that's exciting and that's permeated the culture at CredSimple. It's exciting to have a front row seat.
Q: What is coming up this year for CredSimple?
MS: There are three things we're focused on. The first is scalability, we're always increasing and building on the work we've done over the last couple of years since we started, but increasing our capabilities of our team and technology to take on bigger clients and do more for our clients as healthcare reforms and new regulations are issued. Second, we think about credibility, that's a big topic around here, obviously. Being credible in this industry is critical and we're going to be announcing that we have been working closely with a major regulatory agency to obtain certification which is very exciting. Lastly, we're focused on consistency. Taking the things we've done well with our customers and being able to parlay those into new opportunities, those three things will continue to drive us into 2016.
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