In this week’s special edition of “News You Can Use” on HealthcareNOWRadio I sat down with John Bou, President of Modio Health (a CHG company), to explore the company’s remarkable journey from a garage startup to a NASDAQ-listed pioneer in Edge AI.
Healthcare’s Worst Escape Room – The Credentialing Process
Healthcare’s Worst Escape Room
John Bou is the co-founder and President of Modio Health, a physician-founded platform, revolutionizing provider credentialing which is looking to modernize an inefficient and archaic system that plagues healthcare, especially doctors, across the country.
We discuss the current system, which requires up to 120 days to verify a provider’s qualifications, involving extensive paperwork, redundant information collection, and varying requirements across different states and institutions. This bureaucratic maze forces experienced physicians to repeatedly prove their credentials even when moving within the same healthcare network, creating unnecessary delays that ultimately impact patient care.
Modernizing an Inefficient System
Modio Health is tackling these challenges head-on by leveraging technology to create a streamlined, automated credentialing solution. The company aims to serve as a single source of truth for medical credentials, using data aggregation and automation to reduce administrative burdens and accelerate the verification process. As we discuss, this path to modernization isn’t without obstacles. Trust remains a significant barrier, as hospitals bear responsibility for credentialing errors and are naturally cautious about adopting new systems. The Centers for Medicare & Medicaid Services (CMS) is working to address this through the development of a National Provider Database, which could provide the regulatory framework needed to build confidence in automated credentialing solutions.
Modio’s Slicing Through the Bureaucratic Jungle
Looking ahead, the future of healthcare credentialing appears promising, with AI and continuous credentialing technologies expected to transform the landscape by 2025. John envisions a system where verification times could shrink from months to days or weeks, or even, as he puts it, be “continuous credentialing”. Importantly this is not a continuous imposition of the bureaucratic nightmare but rather the continuous availability or readiness of the physician to be able ot practice to the top of their license. This would allow providers to focus more on patient care rather than paperwork. These changes will unfold incrementally over the next 5-10 years. They promise to create a more efficient system that reduces costs, eliminates delays, and ultimately improves healthcare delivery across the United States.
Until next week, keep solving healthcare’s mysteries before they become your emergencies
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Raw Transcript
Nick van Terheyden
John, welcome to this special edition of News You Can Use. I’m your host. Dr, Nick and joining me today is John Bo He’s the president of Modio health. John, thanks for joining me today. Thank you. Great to be here. So as I do with all my guests, I like to get a little bit of context. Tell us briefly if you would your background and how you arrived at this point with this company. I know you’ve got an interesting background. You’ve created other things in the past, but, you know, tell us the relevant points and why this point here?
John Bou
Yeah, no. Thanks for Thanks for asking. And you’re right. I’ve been in the startup space for quite a while. For most of my career, actually got into the healthcare space, and somewhat of a roundabout way, I have a background in biomedical engineering, but really quickly found sort of my passion for product and technology. You know, I was always fascinated in how to apply technology to really big problems. I started in the education space, actually, which is very similar to healthcare, you know, big rules and regulations, but a really critical function in in our society, both training tools and technology around learning modules and these massive online open courses, and then moved into healthcare. Roughly 15 years ago. I actually started the EHR EMR space, which I’m sure you’re as a physician familiar with which is really growing during that time, was the Obama administration. They were pushing through the ACA, sort of the digitizing of records. Can I just
Nick van Terheyden
Meaningful Use right there
John Bou
so many that’s yet, you know that? Well, right? Yeah, we’re helping. We offered a free EHR. We’re trying to help smaller organizations get through meaningful use, exactly to get those incentives. And I joined, through common connection, my two other co founders, both physicians, into what we now call Modi help, which was to tackle this thing called credentialing, which I’m sure you’re also familiar with,
Nick van Terheyden
yeah, so I’m just going to say, sadly familiar with, can I say yes,
John Bou
you can. Yes you can. Absolutely. I think most
Nick van Terheyden
I before I get you to describe it, I’ve got to share with you my first intersection, which was actually outside of the US, and we had us physicians coming to the UK. We were trying to credential them. It was a much more nascent process, very simplistic, but it included me carrying fully mounted framed medical licenses from degree certificates and so forth, and flying from Glasgow to London, and then taking the tube to the General Medical Council to deliver these in hand by hand, and then return the same things, because there was obviously a fear of losing them. So I have real perspective on this, but if you would share the highlights of a little bit of the challenges, certainly that we see in this country. I mean, it’s explain what it is, because not everybody knows. We’ve got a sort of broader audience, and how you arrived at sort of focusing on this problem,
John Bou
yeah, sure. And maybe a brief overview of credentialing and what it is, I think because credentialing means you know slightly different things to different people, depending on who you talk to in the in the healthcare world, you know, overall, just you know, verifying that a provider is qualified to provide healthcare services to patients. You know, for hospitals, it means, you know, does this provider have the specific privileges to perform a surgery or as an ER doc. For you know, payers, it’s, you know, enrolling them into the program to cover their services. For pharmacies, it’s really just, you know, do you have a license, an active license, and qualifications to prescribe that specific medication? So it can be a little bit different, depending on who you talk to, but you’re right, in the US, it’s a pretty, pretty big problem. I think we spend over $4 trillion in the health care for on health care in the US. And they, they’ve done some studies, and I think, you know, roughly 25% of that is considered waste. It’s almost a billion dollars is considered waste. And at least, yeah, at least that might be, that might be a conservative optimistic number. And you look at the growth of providers, because there, there is a shortage of provider shortage, that the growth has been, you know, relatively flat, but you see the administration behind it. You. Has grown, you know, 20 or 30x to manage these providers and manage these hospitals. And one big piece of that is it’s credentialing. It’s super critical. Obviously, you want good providers, qualified providers, to be in front of patients, and this is a way for hospitals to get paid, but very inefficient, you know, like, you said, you know, it’s done by fax, by mail. You know, our, one of our founders, actually did it as a test, and like you, he had a stack of paperwork probably six inches high, asking for address, you know, 20 times for the for the same thing. So super inefficient. A lot of redundant information that is asked over and over again, and it makes it really difficult for physicians to work at other hospitals if they want to go across the street and work in the hospital, to go through that process sort of again. A lot of providers, obviously, are enrolled in multiple payers, sometimes 10 to 12 to 15, and they have to do that process every single time. So it’s pretty difficult. And it takes, you know, once a hospital or hires a provider, it can take anywhere from 90 to 120 days for them to actually start and start working there. So big sort of wait period. And this is, again, all all credentialing. That’s kind of the state. And why, sort of, we at Modio kind of tackle this like we saw a huge opportunity if we can apply technology, pull in data automatically, you know, ease the burden for administrators and providers potentially really make a difference, and get riders in front of patients
Nick van Terheyden
quicker. Yeah, and just to be sure that people understand this, you know, you describe the 90 to 120 days. This is not for somebody that’s just emerging from medical school. This could be, you know, a full on professor with extensive skills and experience who is in high demand. And there is a process that, as you describe, and I think in many instances, is still very much paper based. And importantly, I think one of the things that you missed in this, that I’m certainly aware of, is it, even if you go to a new place, even if you stay in the same place, you have to go through the same process again. Oh, and by the way, all the things that you submitted, sorry, we forgot. No, no, we don’t have no, you got to resubmit everything. Yes. I mean,
John Bou
no, great, great point that, yeah, the RE credentialing process, which, you know, sometimes one year, two years, and it depends on the payer as well. But you’re exactly right. Hey, we still need to get your medical certificate that you graduated from medical school, not that that has, school has or will change, but we still need that information again at this at the same place, so very difficult. And it is on paper. It’s it’s people using post it notes, Excel documents, as I mentioned before, fax and email, so incredibly, sort of archaic and old systems that we’re using. And just on your point of the physician experience, it may even be harder for physicians that have worked for 20 years that background, because there’s more information to gather, more documentation that needs to be put in place, versus a doctor coming right out of residency that really just has more of a clean slate. Just give me your license.
Nick van Terheyden
Somebody that has something on their resume but they decide not to credential for Whoa, oh, what happened there? Beep, beep. Back the truck,
John Bou
exactly. Oh, do you feel
Nick van Terheyden
some pain and agony in my voice
John Bou
as well? I
Nick van Terheyden
can see it. It is a true, truly shocking backdrop to healthcare that I think many people that access healthcare have no, I mean, literally zero. I think we just take on trust. I show up at a hospital, and there are certainly instances of failure, not something we’re going to focus on here, but they tend to be outliers. You know, the exception versus the rule. I think the process works, but extraordinarily inefficient. So here you come with an organization, obviously, two founders who, you know, probably sound a little bit like me, maybe not the accent, to be clear, but who, who might have the same scars to sort of show for some of this. And you’re clearly looking at it and saying, this is, this is fixable, right? But you’ve been at this for a while, and it’s, yes, still not fixed. So tell us how that journey is going, if you could.
John Bou
Yeah, yeah, great, great question. And it’s still not fixed. It is getting better. We are seeing, you know, through technology, through sort of this, as we. Move towards what we call a single source of truth, where, where there’s sort of data in one place, which is the ultimate goal, but we are seeing days sort of decrease to credential, but it is a very slow process. And, you know, big thing is, you know, hospitals are responsible if anything goes wrong. So there is sort of a lack of, a bit of a lack of trust in the system, right? I commit Hospital A i credential this physician. Am I going to trust the credential from another Exactly, exactly, because if anything goes wrong, you know, I will be putting the bill if we’re if we’re sued or held responsible for and you know, you did say it is allies, but you know, it does hit the news when you see a physician that does not have the credentials or is practicing and has multiple sort of sanctions and issues in other states. So I think a big part is just that trust within the system of, can I trust the data that you pulled, you know, even yesterday, which is, which is a big problem. And, you know, I think we have, are seeing larger organizations and governing bodies trying to move towards that sort of central provider database, so we have a single source of truth. But it does take, and will take, sort of both technology legislation to really get there. What I
Nick van Terheyden
love about doing this show is that, you know, it’s easy for me to rail into this, you know, having experienced it from one side, and you know, I have a very jaundice, biased view of it. But clearly what you’ve demonstrated here is that there’s there’s another side to that coin, that trust aspect. And you know, as we all know, trust is something that you you work hard to get, but you can lose very quickly, and at that point, it’s almost harder to get. And that issue of transfer of information, and you raise something that I think is extraordinarily important, and you know, let’s talk a little bit about that, that single source of truth is that Modio, and if so, how and why? Yeah,
John Bou
great, great question. And I think Modio can be a big part and engine to it. But I do believe, because there is that, what we call trust within the system, that needs to happen. We need the support of sort of large governing bodies, and you’re starting to see that happen. You’re starting to see that I think very recently, the CMS came out with some news that they were building what they’re calling a national provider, sort of database, right where they are pulling in data and creating a essentially Data Bank of providers that we know are verified that the data is good, that you can trust it. And I think you need that large governing body to sort of be behind it, to back it, so organizations can do it. I think you know for us, we are pulling in and pull in data from multiple different sources, automatic primary sources. So I think we are, can be part of the solutions, because then we can take data from the CMS from multiple different sources. We can aggregate it. We can know that it is, you know, CMS verified data. We can timestamp it and then feed that into, sort of our workflows and automation that credentials need to do their day to day tasks. I think, you know, I think a we aren’t going to be that single source of truth. There’s so many organization out organizations out there that that do this, do this well, and have that sort of stamp of approval and trust within the as a governing body. But I think we can be an engine that can can use, translate and get that data in front of our users very quickly and easily.
Nick van Terheyden
Yeah. So I think the combination of both the regulatory oversight, the you know, trust that encompasses the government sort of underpinning it, you know, if there’s an error in that data, then you know that’s attributable to one party, and you know, let’s hope they put in the appropriate controls to make sure it’s correct and so forth. What it sounds like is that Modio is really, you know, an an additive or supportive technology infrastructure. And I think, you know, intriguingly, and obviously everybody’s talking about AI, it would be, you know, implausible not to see this applied. How are you doing that? I mean, a lot of this is, as I said, I carried physical degrees. That’s not going into AI, but there must be a record of it. How are you approaching the AI aspect of that, and what’s it contributing?
John Bou
Yeah, great question. And. We get that quite a bit nowadays. I do think credentialing today will be, or in five years, will be, fundamentally different than than it is today. You know, credentialing is, it’s probably very it’s complicated, but it’s not complex, which is great for, for for AI and automation to hit. You know, you have a provider like yourself who wants to get credential at a hospital and cover payers in a certain state. So really, that’s a set of business rules that we’re following against a set of data. You know, hopefully this the single source of truth, you know, put into a specific format, so not really easily repeatable, something that automation can hit very easily. So the, you know, I think in, you know, five years, maybe faster. I know AI is moving so quickly. But it really can be that a organization can just say, I need to know if Dr Nick is, you know, here are some of the rules that I need. I need to know if Dr Nick is verified and qualified to work at my hospital, you know, yes or no, using AI and automation, because that data is already there, stored and pulled through automation. And then, you know, I need maybe these other two data points. And you know, it can almost be like a real time. I
Nick van Terheyden
was gonna say, is that a real time? You know, almost as you walk into the physician office, I can’t imagine a patient doing it, but, you know, ostensibly, a patient doing it, right?
John Bou
Yep, that is the goal. And I think what we’re trying to do, and, you know, our vision is what we’re calling it’s continuous credentialing, where this person is always,
Nick van Terheyden
I’m sorry, no, I know I’m a little bit hesitant, but I see where you’re going with it on on good principles, but
John Bou
yeah, yeah. I mean, it’s tough to get there, but I think we want, you know, a to not burden the physician continues. Credentialing doesn’t mean we’re always asking the provider for because that’s one of our goals, as well as like, let’s provide or do what they need to do, why they went into medicine, is to practice medicine and provide health care. So it’s, you know, what we would describe before is we have tools and technology to really pull this data when necessary. You know, when the credentialing re credentialing, that one or two years comes up, we can pull that data again, timestamp it through automation and knowing the business rules, and then, you know, yes, this provider, Dr Nick, is credentialed and ready to go. You know, maybe we need a signature or a specific piece of data, but it could reduce, you know, hopefully reduce that, you know, days or weeks, at least, versus versus months, which hopefully solves a lot of, a lot of problems.
Nick van Terheyden
So, I mean, I, I’ll be frank, that sounds exciting, obviously, you know, from a physician standpoint, because it is, it’s, it’s, it’s awful, wasted time, frustrating. I’m going to step into another mud bath for a second and talk about, you know, interstate issues, because that’s related, right? And it feels like this could be a solution, although, you know, ostensibly, the solution is medicine is the same in Florida as it is in California. But we don’t see it that way. Is there a scope to sort of facilitate that, albeit, there’s an economic driver that might prevent it, but from a technical standpoint, it sounds like you might be able to facilitate that. Think of telemedicine, where, you know, we cross boundaries very easily.
John Bou
Yeah. I mean, that definitely is a bit of a mud bath, as you as you said, and it’s interesting, you know, we might be in one state and 10 miles over, you’re unable to practice because it’s a it’s a different state. It requires a different license, which you know, causes, you know, many hurdles. It’s a little bit antiquated, backwards in that, in that regard. And a couple of things are happening on that front. There’s, there’s something called the IML, called the imlc, the interstate medical licensure compact, where, I think it’s roughly 30 states now which are putting together rules where it makes it much easier to practice in one state versus another. So there’s legislation. There is, you know, potentially some technology, but there are, sort of our economic hurdles. There are sort of state by state rules. You’re not going to solve that for Right, right? I remember, you know, when we first started, because we pull a lot of that state data automatically today, but when we first started to, you know, state by state was so different. One, you know, pretty advanced, had an API. Another, you know, you can pull data from. And then there were, I think there was one state in particular, you had to email them a request. I think they’d send you a physical CD in the mail with with the with the information. I think they’ve updated since then. But.
Nick van Terheyden
I’m just, you know, for those not watching in Technicolor, the this is Dr Nick shaking his head.
John Bou
So there, you know, really different rules, state by state, different and some states will license physicians much quickly than others. So it’s, it’s a little bit all over the board when they are providing essentially the same care across the board. And you know, obviously tele telehealth is, has and has run into those rules and regulations. I know there’s some regulatory rules that are that are easing that up, but you do see providers with 4050 state licenses because they want to practice, yeah,
Nick van Terheyden
oh, I huge. I’ve met them. Yep,
John Bou
it’s a huge cost, huge cost as well. You know, these these states. It is somewhat of revenue, revenue generator for these states.
Nick van Terheyden
So we didn’t talk about that. But I mean, it feels like this is also a cost saving, because if you can do it the one time versus multiple times, or, you know, there’s one providing entity that would allow for it that, you know, potentially reduces the cost,
John Bou
Yeah, huge, huge cost savings, not just for the application fees. That’s, you know, alone is fairly large. But then we talked about the administrator ratio to manage providers being being fairly large. You know, it’s, I believe the number is roughly $3,000 to manage every provider, and you have these games now, credentials that we work with that are solely built and created and managed to help support the credentialing process for providers. It is so difficult now to do today that you have teams of 510, 15 people just to manage this process. So, you know, you simplify that huge savings for hospitals which which are operating on razor thin margins already. You know, it’s not easy to run a hospital. So you know much. You know a large potential there as well.
Nick van Terheyden
So you you described a sort of a vision. I’m going to call it for about five years out. If you would wrap us up and share where you see this going and how you think this is all going to play out and improve over the next and it could be a shorter timeframe. I mean, that would be good too, but you know, you mentioned five years, that’s why I picked it. It could be any timeframe you’re you’re comfortable with.
John Bou
Yeah, I do think, you know, five to 10 years, we do see big fundamental changes. But, you know, I do. I think we get there in steps, which is why, you know, I love the name and mission of the podcast is sort of incremental changes. Because, you know, I do think small changes we’re making today are actually impactful and measurable. You know, we say the 90 220 day window to credential is happening today. But if you can shave off, you know, one two days at a time. I mean, you’re making sort of real impact. You’re getting physicians in front of patients earlier. You’re easing the burden on credentials. You’re getting them paid faster. You’re helping hospitals with their revenue and margins so small things like pulling in additional data automatically, or auto populating forms these sort of incremental changes can, you know, save maybe an hour a day a week, and hopefully we get to a place where, you know, where that vision comes to, where it is sort of real time. I know this sort of boggles the mind, but you know, continuous credentialing way where providers are ready to go once they are done with the process. It’s a quick one day, one week, even turnaround time.
Nick van Terheyden
Yeah, I’m just going to spin that continuous credentialing around and sort of explain it in a different way, because as I heard it, and, you know, obviously my biased ears heard it as, Oh, my God, that’s continuous paperwork. But what you actually meant by that was continuous readiness for the physician to practice, and that’s what continuous credentialing in this context means. And you know, obviously that’s financial for physicians because, you know, they’re precluded from earning income and doing the job that they signed up for, obviously, for all the ancillary services and everything around it. I think you know, rife for opportunity, opportunistic improvements, those incremental improvements that you described. I think you know, this is long been held over as I mean, it’s shocking to me how long this has sort of persisted and gotten worse. To be clear, I’ve seen that. I saw it over time. You know, truly exciting. I’ll be honest, I come into this conversation with a little bit of bias and, you know, some humor as well. Hope. Hopefully. But I think this is good news. I think it’s exciting. Unfortunately, as we do each and every time we run out of time for conversation, so it just remains for me to thank you for joining me on this special edition of news. You can use my thanks to modiohealth, and specifically to you. John boo, you can find out more about them@modiohealth.com John, thanks for joining me today. Thank you
