Solutions for Organizations Suffering from a Lack of Data Insights

^{By: Julie Gould}

Michael Simmons, CEO and founder of andros, explains how the use of technology, including his new solution, helps leverage data-enabled learnings and an AI-powered process that streamlines health care organizations’ entire infrastructure and helps reduce health care spend for all parties involved.

Can you discuss the new data platform that is aimed at digitally transforming the health care industry? 

The health care industry has historically been weighed down by regulations and slow to innovate. Today, many organizations within the space suffer from a lack of data insights and access to the digital tools that they need to streamline their infrastructure and provider network services. The complexities that come with navigating an intricate credentialing, compliance, and adequacy system are vital yet time-intensive primarily manual processes. The need to innovate these tasks has never been greater. 

andros is an industry-first, all-in-one solution that solves these problems that often threaten a health plan’s ability to function. andros provides health care organizations with in-depth access to data, automation, and novel market insights that traditional health care companies weren’t presented with before. As the only solution built for the needs of today’s health care companies, we set up health plans, independent physician associations, telehealth companies, and health care organizations that manage provider networks, for success by allowing them to efficiently fulfill network management requirements and build provider networks all in one place.

andros provides a streamlined and comprehensive approach to powering network development and network management lifecycles, which includes recruiting, contracting, credentialing, and directory management. In leveraging technology, data-enabled learnings, and AI-powered processes, andros provides a completely customizable and adaptable approach to these practices, makes them more efficient and user-friendly, and reduces errors to make networks agile, compliant, and competitive at every stage of their operation.  

What challenges do you hope to address with this platform?

Our vision when creating CredSimple was, and remains the same, to greatly reduce administrative costs in health care. We built the SaaS technology infrastructure to replace the large-scale dependency that health care administration had and still has on disconnected systems, siloed data, and manual business processes. We were the first platform to really tackle the network management experience through the cloud and innovate credentialing processes for our clients. With andros, we are continuing to push that boundary by providing a brand new SaaS platform, andros a* (a-star) that will redefine how health care professionals credential providers as well as build, expand, and manage complex provider networks. 

Without a digital tool like andros, the processes involved in network development and network management lifecycles for health care organizations (i.e. credentialing, recruiting, contracting, compliance monitoring, and directory management) are extremely cumbersome. For example, while traditional credentialing takes between 90-120 days, our androsCredentialing* solution can complete this process with a turnaround average time of seven days. One of our larger health plan clients has 2 people managing all of the credentialing work for the entire plan across the country.  We have encountered similar-sized organizations that have as many as 30 people doing the same work with far less results. 

Oftentimes there are miscommunications throughout a patient’s health care journey. How will this help the communication between health plans, providers, etc.? 

There are many aspects to patient care and overall population health and care coordination that span the relationship between a health plan, a patient/member, and the provider(s). Our role, by addressing provider networks and provider data management, is to put in place, optimize, and manage the most effective networks possible for our health plan client and in turn the patients. This really tends to be work that the patient is not aware of, other than they understand which providers are within their network and can be assured those providers are available, at the location identified, legally compliant and able to provide care, etc. 

One of the main issues health plans and providers cite as a key point of friction in their relationship is the credentialing processes and the long delay to complete that process. When a provider is in the credentialing process, it usually means they are already accepted in the network and have a contract with the plan to see their members. But because they are not yet credentialed, they are not allowed to provide care to those members because they have not been vetted and shown to be fully compliant. If the industry average is 90 days or more (and usually it is more - one top-20 sized payer stated their average is 140 days) that is a long time waiting to see members that require care.  

Providing a 5-year prediction, how do you think these initiatives are going to change the future of care? 

We would like to continue to use our comprehensive data, learnings from the platform and clients, and automation to drive the administrative costs in this area of health care down to a fraction of its current amount. If we do this well, and we will (have to have some confidence here), we will have pushed the platform into proactively gathering everything relevant to a provider, having them quickly determine if everything is accurate and us being able to move credentialing to an automated process taking a matter of hours or a day or two total. We believe there are then higher-level things to take care of with predictive AI to optimize networks and continue to modify the networks based on usage, quality, cost, population density and composition, and more.  

Is there anything else you would like to add? 

Thank you for the opportunity to talk about andros and the things we are doing to reduce the health care spend for all of us. 

Michael Simmons, CEO and Founder of andros (formerly CredSimple). He graduated from Johns Hopkins University’s Carey Business School in 2013 and founded CredSimple the same year. Prior to this, he worked at SAP America (NYSE: SAP) where he was recruited to the founding team of an intrapreneurial division and successfully launched a new line of business focused on software optimization and business process engineering for SAP’s largest enterprise clients.