Anshul Rathi: How & Why I Started Certify

I'm Anshul Rathi, founder and CEO of Certify. Today, I’m discussing how and why I started CertifyOS and why I believe it could help solve provider data management problems found throughout our healthcare systems today.

Finding the right doctor in your network is a struggle we go through every now and then. And that’s not just restricted to the patient side—on the other side, healthcare providers spend countless hours filling out lengthy credentialing applications simply in the hopes of becoming in-network. This is just a glimpse into the challenges all parties face due to fragmented provider data in the healthcare sector.

I thought of Certify during my time at Oscar Health as one of their first employees tasked with building their provider network management function. I spent six years there before taking the courageous step of founding Certify and working to disrupt provider data management in healthcare.

I did this because, during my tenure at Oscar, I realized that the buy-or-build decision was not making sense. I tried to find vendors who would solve my problems, but I found that most of the existing vendors were point solutions, primarily built for compliance and security. I wanted to create something that could ease the pain points of the industry, and Certify was the result of that endeavor.

I conceptualized the idea of Certify in 2018 but didn’t begin building it out until the peak of the pandemic. I had three things always in mind—an API first, data first, and automation first company. I wanted to build a single source of truth for provider data across the US healthcare industry. My vision of one API and one provider ID would result in frictionless provider data.

While working with Oscar Health, I met stakeholders in the healthcare industry, and I listened to countless stories that highlighted how outdated our data management and credentialing processes were. Filling out a 40-page application form just to join a healthcare network was an administrative nightmare. Lengthy applications did nothing but waste valuable time, coupled with a high chance of errors because of manual processes.

Given the interconnectedness of the process, mistakes lead to a butterfly effect of chaos—delays in credentialing providers, causing them to wait weeks or even months before they could start seeing patients.

Then I saw that with the credentialing delays, data went stale. By the time provider data was processed and entered into the system, it was often already outdated. It was obvious that the archaic provider data credentialing processes were having real-world consequences—potentially delaying or restricting a patient from receiving necessary care.

Along with that, managing multiple data sources while making sure data accuracy remains intact requires a great deal of resources. It was obvious that system inefficiencies not only wasted time and money but, more importantly, limited workflow optimization and restricted patient care delivery. I built Certify to address these issues directly.

My core philosophy was to ensure that Certify is:

• API-first. I wanted to eliminate the need for manual data entry. That’s why we use standardized APIs (Application Programming Interfaces) to connect with several data sources and channels. With everything automated, the data is collected and transferred electronically, eliminating human error.
• Data-first. Everything runs, survives and thrives on the quality of data. That’s why I wanted Certify to ensure that all the data in use is not only accurate but complete. To do that, I established connections with primary sources to verify provider data on a monthly basis. It was mandatory that we establish ourselves and our data as dependable—a resolute source of truth for the healthcare sector.
• Automation-first. By leveraging automation to streamline workflows and reduce administrative burden, we have been able to replace an archaic 40-page application form with a system that only requires six key data elements. This, in turn, enables providers to focus their energies on strategic projects instead of the rigorous credentialing processes.

How Certify Aims to Reduce Administrative Burden

The ultimate priority of providers is to offer high-quality patient care, and we save them time and effort by streamlining the credentialing process. This takes a workflow that has been historically commoditized by health plans and removes the manual efforts ultimately reducing cost.

On the other side of the healthcare ecosystem, health systems, as a whole, benefit from our credentialing process from a monetary standpoint as well. The fast credentialing process enables health systems to onboard new providers faster—delivering a potential increase in revenue as new providers are able to see patients sooner.

Moreover, cutting down the administrative burden and easing operations saves resources, making healthcare systems more efficient and enabling them to focus on critical areas, such as being ready for unprecedented demand, medical emergencies, and preventive care. Also, our centralized and accurate data management system eliminates the need for healthcare systems to maintain and manage multiple data sources.

How Certify Improves Patient Experiences and Outcomes

The phrase happy employees, happy clients always revolved inside my head. Job satisfaction is immensely crucial in healthcare because people trust other people with their well-being. By eliminating lengthy applications, we improve provider job satisfaction, thereby enabling clinicians to reclaim their time and give 100% to their patients—benefiting providers and creating a more positive and productive work environment.

Moreover, we take data accuracy and verification very seriously. To ensure that only qualified providers are included in our healthcare networks, we refresh our credentialing data sources regularly. This allows us to accurately reflect the live status of providers, covering both past and present behaviors.

We do this because we understand the anguish patients experience when seeking care. Our goal is to connect them with qualified healthcare professionals who have a clean track record, free of disciplinary actions or malpractice claims.

Moreover, the data infrastructure allows patients to find the right providers based on their specific needs easily. Healthcare thrives on relevance, and that’s why we ensure that you can search for doctors in your network who specialize in a particular condition and have access to accurate and up-to-date information.

We wanted to empower patients to make informed decisions about their healthcare, and I think Certify has done a pretty amazing job in making that a reality.

How Certify Addresses Challenges of Provider Shortages and Burnout

By reducing the administrative burden on the professionals through automation, we actually reduce clerical errors as well as burnout and exhaustion, enabling these professionals to focus on more important and strategic tasks such as direct patient care, research and innovation, and population health management.

Moreover, we created a centralized provider data bank that streamlines verification and reduces inefficiencies by housing detailed information on providers' credentials and history.

With information about providers’ education, training, licensing, certifications, affiliations, and malpractice history available on demand, we save an exceptional amount of time. This speeds up the onboarding process, and there are more professionals available to cater to the growing number of patients.

How Certify Overcomes Resistance to Change

The healthcare industry is known for its cautious approach to change, and rightfully so—we’re talking about people’s lives, and that means we can’t experiment with every new idea recklessly.

Given the inherent resistance to change in such a highly regulated and scrutinized industry, we have turned to live demos to showcase the power of the Certify platform and its ability to automate once archaic and manual processes.

We avoid generic sales pitches. Instead, we take a data-driven approach focused on solving real customer challenges—or what we call pain points. The representatives access a potential customer's network during the demos and use real-time examples to showcase how efficient the platform is.

For example, they might take a randomly chosen provider name and demonstrate how our system can retrieve all the necessary data in seconds—showcasing how we cut down lengthy manual processes in real-time. When potential customers are able to see that live, it leaves an impressive impact, building trust and confidence.

What Lies Ahead?

I dream of a healthcare industry where a single source of data exists for everyone involved. We are breaking barriers and helping the healthcare system to become 10 times more effective than how it currently operates.

We want to create a future where providers spend less time on paperwork and more time delivering care, where patients can easily find qualified providers, and where healthcare systems operate with greater efficiency.

To learn more about how we can address your specific needs, consider requesting a free demo or contacting Certify at sales@certifyos.com.