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The Future of Healthcare: “We Must End The Endless Inefficiencies” with Kirk Heath CEO of Modio Health

Endless inefficiencies. The inefficiencies rampant throughout nearly every sector of the healthcare industry are staggering. And it’s been consistently this way for far too long. As a surgeon, I witnessed the waste in the OR firsthand. For example, even if a surgical instrument is unused in surgery, it’s still thrown out after the procedure. Or look […]

Endless inefficiencies. The inefficiencies rampant throughout nearly every sector of the healthcare industry are staggering. And it’s been consistently this way for far too long. As a surgeon, I witnessed the waste in the OR firsthand. For example, even if a surgical instrument is unused in surgery, it’s still thrown out after the procedure. Or look at physician credentialing, which is costly and time-consuming. Every year, medical practices could spend over $7,000 on each provider’s credentialing application. The average physician spends 43 minutes a day interacting with health plans instead of their patients while administrators spend 20 hours to credential every provider. Administrative tasks are so demanding that practices lose nearly $100,000 in staff wages every year. If you belong to a specialty group, that number goes up. Still, it’ll take 2–3 months before that new doctor can even start working…if everything goes smoothly. Additionally, hospitals pay doctors who aren’t working while they wait months for their credentials to be processed.


I had the pleasure to interview Kirk Heath, M.D., F.A.C.S. Kirk is CEO and Founder of Modio Health. Modio is a physician-owned and operated platform making credentialing and career management simple, transparent, and efficient for healthcare professionals. Kirk served as Medical Director of IT for Sentara Healthcare as it pioneered EMR implementation in a major health system. As a full-time general surgeon, he then founded a healthcare IT consulting and staffing firm, which combined practicing physicians with EMR implementations across the U.S. Kirk lives in Virginia Beach with his wife and three children.


Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path?

As a physician, I was seeing myself and my colleagues spending too much time on administrative tasks, bureaucracy and endless non-clinical tasks that took us away from why we started practicing medicine in the first place — to help people. We are constantly hearing about how the American healthcare system needs to be improved. Yet, patients continue to face endless challenges accessing quality care. Care is extremely costly, and endless inefficiencies result in $140 billion wasted yearly in the U.S.

Early in my career as a surgeon, these inefficiencies became very clear to me, and it was eye-opening. Particularly where physician credentialing was concerned. Credentialing — verifying and renewing medical licenses — is one of the most important and necessary procedures in healthcare to ensure patient safety — it’s the gatekeeper to healthcare. Physicians can’t practice medicine or get paid if they aren’t properly credentialed. Yet, it’s also one of the slowest to evolve and extremely complex. The processes for credentialing I saw in place were antiquated and even further slowing down our ability to help people.

As a result, I wanted to start a company that would use technology and innovation to address the challenges of provider management, creating a better experience for physicians, which as a result, creates a better experience for patients. As I saw it, there was no need for credentialing to continue being stuck in the past when there was so much innovation available that could streamline the process. From that, Modio Health was born.

Can you share the most interesting story that happened to you since you began leading your company?

What is most interesting to me is how little people in the healthcare field know, my physician colleagues included, about what really goes on behind the scenes to get a doctor in front of a patient. Every physician has a team of people around them filling out hundreds of pages of paperwork, chasing us for signatures, calling other organizations to verify info, faxing other institutions, and much more. Then these steps have to be repeated for every entity associated with that provider, including insurance companies, then again every two to three years. It costs more than $40,000 per full-time physician per year just to keep a provider working.

We meet with healthcare leaders and physicians all the time, and it is eye-opening for them, as it was for me initially, to see the level of orchestration required to keep things flowing.

Can you tell our readers a bit about why you are an authority in the healthcare field? (2–3 sentences)

In addition to practicing medicine for nearly two decades, for the past 10 years I’ve worked with healthcare systems and leaders, physicians, tech and data experts to define the pain points of physician credentialing and work to create solutions.

Looking at healthcare, it’s interesting being able to see both sides of the equation — as a surgeon and CEO of a tech company working to provide solutions to many of the issues facing physicians and ultimately, our patients. If physicians aren’t able to efficiently work and provide care, then patient care suffers.

What makes your company stand out? Can you share a story?

Physician credentialing is extremely complex and vitally important. It can be a challenging and lengthy process for providers and healthcare organizations to navigate, especially if they don’t have the right tools in place, which the majority do not. There is a maze of per-state, per-specialty, and per-hospital licensing requirements to work through in order to properly credential physicians.

My company is working to make this process easier, more efficient, and safer for healthcare organizations and providers so that they can easily determine which regulations to follow, ignore, fight, or work around.

For example, our web-based system, OneView, provides simple, centralized management for healthcare teams enabling hospital administrators, group practices, and individual providers to share and access provider data (known as the Universal Provider Record, or UPR). By easing the information transfer, OneView usage cuts credentialing times and reduces administrative effort, saving hours of work across all providers and administrators. Long, repetitive forms can even be auto-populated from the UPR and sent for electronic signature, eliminating redundant paperwork and snail mail.

To ensure that providers maintain their credentials, OneView uses integrations with state and federal agencies to automatically gather and store real-time, primary source information like NPI, DEA, license numbers, education, CAQH, OIG status, and more. Hospitals and practices can also easily monitor provider compliance and receive alerts for expiring items, thus avoiding disruptions in medical care. OneView is also scalable for all team sizes and practice types, and as a software service, requires no expensive IT upkeep.

Our work with Ventura Orthopedics based in Southern California is a great example of our technology put to work. They were facing big challenges with provider monitoring and lack of transparency so came to us looking for a credentialing solution for their team of providers. Relying on Excel spreadsheets created daily headaches monitoring license expirations and re-appointment dates for their 66 providers. Additionally, having various departments spread amongst five locations in Southern California meant a lack of awareness and knowledge around every day credentialing processes, along with payor timeline expectations. With their practice growing and provider count rising, navigating through dozens and dozens of Excel sheets with multiple tabs in each was becoming a daily nightmare. Without an easy way to track expiring licenses and board certifications or reappointment dates, the practice kept seeing inaccuracies and lack of consistency.

This is where Modio came in. Since implementing OneView, Ventura Orthopedics has seen significant improvements in their credentialing workflow. Every department has access to our system which has helped significantly in creating department transparency. They have also reduced the time it takes to process an application by half. OneView houses all of the data in one place, so they no longer have to keep referring back to dozens of excel spreadsheets.

This is one example of how Modio’s technology is innovating the credentialing space.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

We’re solving a problem that has plagued healthcare for decades by finally replacing the burden of manual processes with the benefits of automation. There is a lot of hype right now surrounding blockchain and its potential to fix many of healthcare’s big problems, especially around data management. Down the road, blockchain offers promise, but it’s not the right time. We’re nowhere near blockchain as a solution for healthcare’s woes.

Any organization that works with healthcare providers — pharmacies, hospital systems, insurance payers, and more — requires defined and verifiable data about them. Yet, these organizations face administrative nightmares as they navigate an archaic system, resulting in $140 billion wasted yearly in the U.S. State-by-state requirements never match up, providers are required to manually fill out applications, and state licensing boards insist on snail mailing their verifications.

It’s no surprise that credentialers constantly struggle to get accurate data about their providers to the right organizations. Even doctors spend 43 minutes each day with health plan paperwork instead of their patients. Clinics can pay over $7,000 in wages for each credentialing application, complicated by clerical errors that grind credentialing to a halt, double the usual 60-day wait times, and interrupt patient care. The conditions healthcare administrators work in are just as bad — it’s common to see practice managers handling their providers’ credentials with no better tools than Excel on Windows 95 and a stack of Post-it notes.

If American healthcare wants to survive the 21st century, medical credentialing must adapt to technology and adopt a streamlined, cost-efficient process instead, which is exactly what our solution supports.

Are you working on any exciting new projects now? How do you think that will help people?

We’re excited about our Carbon® technology, which allows our team and clients to automate the verification process. Carbon directly communicates with almost any source of data, such as a licensing board. A PDF of the primary source (PSV) document may be captured, if needed, and then stored within the individual provider record, all with a single click. In addition, any updated data from the source will be automatically pulled into the platform.

We’re working to make manual verification a thing of the past, where it belongs. Carbon makes this possible.

What are your “5 Things I Wish Someone Told Me Before I Started” and why? (Please share a story or example for each.)

Choose your team wisely. There is nothing simple about launching a startup. Especially in healthcare. The initial team members are likely as much partners in business as they are employees. It’s essential that equity is distributed appropriately and that these conversations are clear and discussed thoroughly from the beginning. This helps prevent any complicated situations down the road as the company grows. Additionally, there has been explosive growth of new startups in health technology; however, many have also failed. I think a challenge is that talented entrepreneurs who have the skills to create sophisticated technologies do not necessarily have insight into the complexities and idiosyncrasies of healthcare. Startups can benefit by including people that have a deep understanding of healthcare. Someone who lives and breathes the workflow of a healthcare organization and who can work closely with technologists to build a product that’s going to be an asset to this complex industry.

Foresight is key. Have the foresight to understand time and people and how they change as the company grows and scales. Balancing urgency and patience in a startup environment is hard. Taking a longer-term view of what the next two or three years could look like helps me avoid “reacting” too quickly to the latest opportunity or crisis that pops up.

Work with clients who can grow with you. One of the only certainties about healthcare is that the landscape is constantly changing and transitioning. Likely your product will as well. It’s helpful to choose clients who can scale with you. Your success is tied together. If our technology helps a medical practice run more efficiently and scale, then we’re right there scaling along with them.

Know your audience. There is an art to raising funds. It’s critical that your audience is clearly defined within your product before pitching VCs. In the beginning, we were all over the place until we narrowed down the specific vertical inside healthcare. It’s such a large sector, there’s no such thing as just selling in to “healthcare” when there are so many different care settings, specialties, and business models.

The difficulty of the journey. Truer words were never spoken. Launching a company, establishing a career in medicine, none are easy paths. But being a surgeon, you have six days on/six days off. As a CEO of a startup, there are no days off. Work-life balance doesn’t exist. At least for a while. You’re wearing many different hats — you’re taking out the trash, responding to emails, raising money, helping employees. It’s a hard journey and so much better with helpers. Bring in people who know what you don’t. You can’t do it all.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the U.S. healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly?

Endless inefficiencies. The inefficiencies rampant throughout nearly every sector of the healthcare industry are staggering. And it’s been consistently this way for far too long. As a surgeon, I witnessed the waste in the OR firsthand. For example, even if a surgical instrument is unused in surgery, it’s still thrown out after the procedure. Or look at physician credentialing, which is costly and time-consuming. Every year, medical practices could spend over $7,000 on each provider’s credentialing application. The average physician spends 43 minutes a day interacting with health plans instead of their patients while administrators spend 20 hours to credential every provider. Administrative tasks are so demanding that practices lose nearly $100,000 in staff wages every year. If you belong to a specialty group, that number goes up. Still, it’ll take 2–3 months before that new doctor can even start working…if everything goes smoothly. Additionally, hospitals pay doctors who aren’t working while they wait months for their credentials to be processed.

Poor access to care and many people lacking coverage. There’s growing recognition that our country’s healthcare issues begin far outside the hospital. We’re not doing a good job addressing the social determinants of health that are skyrocketing our healthcare costs: clean water, healthy food, warm places to sleep, education, stress, financial instability, and mental health. So many of our nation’s health issues are tied to the larger health factors and chronic disease.

Lack of interoperability. Every health system, hospital down to individual departments, works in silos and believes their processes are unique. This leads to a lack of standardization and communication. No one is talking to each other, so you have systems that operate on their own islands, resulting in redundant processes, redundant costs, a loss of information, and so forth. We need our own healthcare system to collaborate, communicate, and share more.

You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall U.S. healthcare system? Please share a story or example for each.

  • Access, access, access. Patients need better access to care! Insurance coverage for everyone.
  • Quality outcomes. Switching from the model of fee for service to a payment system in healthcare tied to incentivizing on patient outcomes.
  • Transparent pricing models, so patients and payers know what healthcare really costs and can make informed decisions.
  • Data is powerful. It can inform providers, reduce costs, and improve patient outcomes. However, in order to be impactful it needs to be used and shared. It’s time to put data to work. Working with data partners you trust is key to ensure privacy.
  • A lot of these are major, national issues needing industry and government regulation. One area we feel we can affect quickly is administrative waste (a $100B+ problem!). Establishing a national credentialing database for physicians and nurses — as opposed to how it is now, which is fragmented, state by state — having a national database for credentialing would be a game changer.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities, and leaders do to help?

We need a shift in thinking — healthcare as a right, not a privilege. High infant mortality (among similar nations), living shorter lives with lifespan actually decreasing, and highest costs with less insured. We’re seeing this conversation on the political stage now as we head into the 2020 election. Getting involved as a voter, pushing candidates to take action is a crucial thing everyone can do to help improve healthcare.

There also needs to be more technological innovation. Providers and administrators need to abolish the fax machine and the Excel spreadsheet in their processes. Modernize, find software tools and new processes — such as what Modio does — to reduce wasted time and cost.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I enjoy Guy Raz’s podcast “How I Built This” on NPR. He has engaging conversations with the world’s best companies and their founders. The podcast “The Knowledge Project” also shares insightful perspectives on life and success from various leaders. Startup Health is a relatively new magazine that I’m digging into, as well as the long-standing staples, Medscape and JAMA.

I just finished reading Procedure, which is a great new book series about remaking medicine that profiles physicians, founders, researchers, and nurses who are all working toward a better healthcare future.

How can our readers follow you on social media?

Connect with me on LinkedIn | Modio Health LinkedIn & Twitter.

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