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Health Tech Solution Veda Ranks No. 417 on the 2024 Inc. 5000

With Three-Year Revenue Growth of 1,066 Percent, Veda Ranks No. 417 Among America’s Fastest-Growing Private Companies

August 13, 2024 – Veda Data Solutions, healthcare’s leading AI provider data platform, was named No. 417 on the 2024 Inc. 5000 list revealed today.

Among software companies, Veda was ranked 47th and the Madison, Wis.-based company was the 4th highest-ranked company on the list from Wisconsin. This is Veda’s second consecutive year on the Inc. 5000 list. 

“At Veda, we are committed to improving the healthcare experience by creating the most accurate, curated provider data on the market and partnering with health plans and provider organizations to ensure their members have seamless access to appropriate care,” said Meghan Gaffney, CEO and co-founder of Veda. “Being named in the top 10 percent of high growth companies validates our solution and reflects the value our customers place on member satisfaction, patient access to care, and their commitment to delivering on Medicaid and Medicare requirements.”

The Inc. 5000 class of 2024 represents companies that have driven rapid revenue growth while navigating inflationary pressure, the rising costs of capital, and seemingly intractable hiring challenges. Among this year’s top 500 companies, the average median three-year revenue growth rate is 1,637 percent. In all, this year’s Inc. 5000 companies have added 874,458 jobs to the economy over the past three years. 

“Veda is committed to Health Equity, and creating the most accurate provider data is how we make good on that promise,” said Gaffney. “I am so proud of our customers and team members who ensure members have access to timely, high-quality care.”

For complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, location, and other criteria, go to www.inc.com/inc5000. All 5,000 companies are featured on Inc.com starting Tuesday, August 13, and the top 500 appear in the new issue of Inc. magazine, available on newsstands beginning Tuesday, August 20. 

“One of the greatest joys of my job is going through the Inc. 5000 list,” says Mike Hofman, who recently joined Inc. as editor-in-chief. “To see all of the intriguing and surprising ways that companies are transforming sectors, from health care and AI to apparel and pet food, is fascinating for me as a journalist and storyteller. Congratulations to this year’s honorees, as well, for growing their businesses fast despite the economic disruption we all faced over the past three years, from supply chain woes to inflation to changes in the workforce.” 

About Veda

Veda blends science and imagination to solve healthcare’s most complex data issues. Through human-in-the-loop Smart Automation, our solutions dramatically increase productivity, enable compliance, and empower healthcare businesses to focus on delivering care. Veda is simple to use and requires no technical skills or drastic system changes because we envision a future for healthcare where data isn’t a barrier—it’s an opportunity. To learn more about Veda, follow us on LinkedIn.

More about Inc. and the Inc. 5000 

Methodology 

Companies on the 2024 Inc. 5000 are ranked according to percentage revenue growth from 2020 to 2023. To qualify, companies must have been founded and generating revenue by March 31, 2020. They must be U.S.-based, privately held, for-profit, and independent—not subsidiaries or divisions of other companies—as of December 31, 2023. (Since then, some on the list may have gone public or been acquired.) The minimum revenue required for 2020 is $100,000; the minimum for 2023 is $2 million. As always, Inc. reserves the right to decline applicants for subjective reasons. Growth rates used to determine company rankings were calculated to four decimal places. 

About Inc. 

Inc. Business Media is the leading multimedia brand for entrepreneurs. Through its journalism, Inc. aims to inform, educate, and elevate the profile of our community: the risk-takers, the innovators, and the ultra-driven go-getters who are creating our future. Inc.’s award-winning work achieves a monthly brand footprint of more than 40 million across a variety of channels, including events, print, digital, video, podcasts, newsletters, and social media. Its proprietary Inc. 5000 list, produced every year since its launch as the Inc. 100 in 1982, analyzes company data to rank the fastest-growing privately held businesses in the United States. The recognition that comes with inclusion on this and other prestigious Inc. lists, such as Female Founders and Power Partners, gives the founders of top businesses the opportunity to engage with an exclusive community of their peers, and credibility that helps them drive sales and recruit talent. For more information, visit www.inc.com. 

Provider Data Accuracy Verified By Third-Party Audit

Independent Audit Says Veda’s AI Precision Exceeds 90%, Solving Ghost Networks and Payer Network Attestation Challenges

Veda is paving the way for improved data quality, transparency, and accountability in healthcare through continuous validation and testing of our AI-powered solutions. Our scientific rigor commits us to continuously testing our methodology and we believe all AI-powered data solutions should undergo an unbiased independent validation of their data. Learn about our approach to healthcare data challenges and the third-party study performed by Erdős Institute proving our data accuracy.

Provider Data Inaccuracy

Provider data management is inherently flawed. The information found in provider directories is often manually updated, the scope of required information keeps expanding and information changes often; practices move, physicians change practices, and contracts between practices and health plans expire. Multiple industry reports state between 20% and 30% of directory information changes annually

With provider data accuracy rates of 90+%, the study highlights the potential of automation and machine learning in achieving high levels of data accuracy

Reinforcing Commitment to Accountable AI-Powered Solutions in Healthcare

Inaccurate provider directories and networks full of “ghosts” (or unavailable providers) aren’t just frustrating to patients making appointments, they’re making waves among policymakers. The bipartisan Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, introduced by U.S. Senators and Representatives calls to eradicate ghost networks that are impacting patients nationwide and states across the U.S. have followed suit with their own proposed regulations.

Vectyr Curated Dataset

To prove our products and approach to provider directory accuracy are best-in-class, the Erdős Institute conducted a blind third-party audit of Veda’s Vectyr product.

Vectyr is Veda’s curated dataset that powers all our provider data products. With Vectyr’s continuously monitored and validated data, Veda customers can quickly find correct provider information with the confidence of Veda’s optimal accuracy. Many back-office workflows—like directory management, credentialing, and claims—need access to accurate, up-to-date provider information. Our Vectyr product curates data from over 300,000 sources including NPPES, DEA, and state licensing organizations. 

Why validate with impartial analysis?

As a leader in the industry, armed with proprietary solutions, we understand the key to solving complex healthcare problems lies in innovative technology. We’re taking the lead again, this time via rigorous third-party validation. By subjecting our technology to impartial analysis we’re taking a step forward in the evolution towards greater transparency.

Employing rigorous methodologies and independent sampling techniques, ensuring an unbiased assessment of provider directory accuracy? Sounds like our scientific approach to everything we do.

Additionally, having an independent institute like Erdős conduct the validation study safeguards against potential conflicts of interest and ensures the credibility and integrity of the findings.

Erdõs’ Method for Proving Accuracy

To gauge provider data accuracy, Erdős and Veda simulated a Centers for Medicare & Medicaid Services “secret shopper” audit. Callers attempted to make an appointment on behalf of a patient and collect information that would be necessary to do so: the phone number and location of the provider (which are typically major areas of inaccuracies). The audit provided a measure for the main appointment information and manual research was used to measure more detailed provider information.

To reduce bias in the CMS simulation, Erdős created a sample of NPIs for the measurement. The selection of the sample was aimed to be representative with respect to geographic categories of rural and urban and focused on stratified sampling by specialty. In the total sample, 184 NPIs were called. Of these 184 NPIs, 92 phone numbers and 118 locations could be assessed.

The call-based outcomes found phone and address accuracy are consistent at 90%. Moreover, Erdős found that additional Vectyr fields were also highly accurate. For example, the Vectyr database demonstrated accuracy levels of 99% for fields such as languages spoken. With provider data accuracy rates of 90+%, the study highlights the potential of automation and machine learning in achieving high levels of data accuracy.

Reinforcing Commitment to Accountable AI-Powered Solutions in Healthcare

With a commitment to accountable AI-powered solutions and five approved patents in the industry, we believe all healthcare data vendors need to think more rigorously about what “correct” data means. Attestation does not create quality data. Patients don’t need attested data, they need correct data. Therefore, data vendors must measure performance the same way patients do: making an appointment on the first try, with the correct information. We promise accuracy, and we deliver.

Veda First to Achieve Third-Party Data Validation from Erdős Institute, Reinforcing Commitment to Accountable AI-Powered Solutions in Healthcare

Independent Audit Says Veda’s AI Precision Exceeds 90%, Solving Ghost Networks and Payer Network Attestation Challenges

MAY 6, 2024 – MADISON, WI Veda, a leading health technology company specializing in provider data solutions, announced today that it has achieved third-party validation from the prestigious Erdős Institute, an independent organization of university PhDs advancing the fields of Data Science and Machine Learning.

Following a blind independent review of Veda’s AI-powered data curation engine—the backbone of its product stack—Erdős Institute researchers found highly accurate provider directory data with certain accuracy scores exceeding 90 percent for critical information like addresses, locations, and phone numbers.

By facilitating accurate provider directory data, as mandated by the No Surprises Act, validation of Veda’s proprietary curation and machine learning methodologies represents a pivotal milestone in Veda’s journey towards fostering greater transparency and accountability in payer data solutions.

“As skepticism surrounds AI tools in healthcare, validation from the Erdős Institute underscores Veda’s commitment to leading the market with ethical and reliable solutions,” said Meghan Gaffney, Co-Founder and CEO of Veda. “While outdated methods for maintaining accuracy and compliance continue to fail, Veda is proof positive that automation is an effective and necessary approach to supporting health plan members who rely on provider directories to find care.”

A rigorous analysis by Erdős not only demonstrates Veda’s commitment to AI excellence but also sheds light on the prevalent issue of ‘ghost networks,’ or inaccurate provider directories. Yale Law and Policy Review found between forty-five and fifty-two percent of provider directory listings had errors, with some individual plans having error rates as high as ninety-eight percent. 

Increased pressure on state and federal lawmakers to protect seniors from surprise medical bills and improve access to mental health treatment has spurred a wave of bipartisan legislation seeking to hold commercial and Medicare Advantage plans accountable. 

In a crowded marketplace of payer solutions, the independent validation from Erdős sets a new benchmark for accuracy and compliance.

“Our blinded study found that Veda’s data-driven automation is capable of producing accurate provider data quickly and efficiently,” said Roman Holowinsky, PhD, Managing Director of the Erdős Institute. “Automated, real-time provider datasets like Veda’s can greatly benefit the market and save users a lot of time over manual attestation or intervention.”

To access a copy of the whitepaper, please visit vedadata.com/case-studies/erdos-white-paper-vedas-ai-precision-exceeds-90.

About Erdős Institute:

The Erdős Institute is a multi-university collaboration focused on helping PhDs get jobs they love at every stage of their career. Founded in 2017, the Institute helps train and place a diverse pool of PhDs through boot camps, workshops, mini-courses, consulting opportunities, and direct employer connections. For more information, visit www.erdosinstitute.org

About Veda:Veda blends science and imagination to solve healthcare’s most complex data issues. Through human-in-the-loop Smart Automation, our solutions dramatically increase productivity, enable compliance and empower healthcare businesses to focus on delivering care. Veda is simple to use and requires no technical skills or drastic system changes, because we envision a future for healthcare where data isn’t a barrier—it’s an opportunity. To learn more about Veda, visit vedadata.com.

We promise accuracy, and we deliver.

Why It Took Language Processing For AI To Go Mainstream

Scientists and technologists have been using AI for decades. We’ve used it to do complicated calculations and run algorithms and equations that we couldn’t previously conceive of. Your favorite streaming services have been using it for years to recommend shows and movies. But looking at media coverage of the past year, you’d think that AI was just developed. Why is mainstream AI language processing now taking off?

In late 2022, did AI experience an onslaught of media attention that made it seem like it was a new functionality? Why are legislators and regulators now racing to regulate something that has been in existence for about the same length of time as the color TV?

Learning To Learn

Tools powered by AI have essentially learned to learn. The language models we’re all seeing now train themselves with two primary algorithms. First, they can look at any sentence in any context and try to predict the next one.

The other way that language models try to learn is by guessing words in a sentence if some words are randomly removed. These are examples of implicit supervised training, and it’s made possible because these tools use the entire corpus of the internet as training data. This is the actual breakthrough.The other way that language models try to learn is by guessing words in a sentence if some words are randomly removed. These are examples of implicit supervised training, and it’s made possible because these tools use the entire corpus of the internet as training data. This is the actual breakthrough.

Read Chief Science & Technology Officier Dr. Bob Lindner’s entire article on Mainstream AI Language Processing.


Rural healthcare challenges: How bad data deepens disparities

In rural healthcare, timely access to crucial mental healthcare and other specialized services presents a significant challenge. Over the last decade, numerous rural hospitals have shuttered, with more at risk of closure due to staffing shortages, declining reimbursement rates, diminished patient volume, and challenges attracting talent. The answer to the challenges in rural healthcare is to get more data.

With very few options for specialty and subspecialty providers, rural patients often endure long journeys for necessary care. According to a Pew Research Center report, the average drive to a hospital in a rural community is approximately 17 minutes, nearly 65 percent longer than the average drive time in urban areas. Such systemic failures not only exacerbate disparities but also challenge the very foundation of patient care.

A functioning rural health system relies on legions of specialty care doctors conducting outreach visits across vast geographic areas. In principle, this approach presents an efficient means to provide rural patients with access to specialty care, eliminating the need for extensive travel to major urban centers. However, the persistence of inaccurate data poses a significant barrier to achieving comprehensive access to specialty care in rural regions.

Discover Bob Lindner’s take on how bad data exacerbates rural healthcare challenges and impacts patients on Chief Healthcare Executive.

Connect with Dr. Bob Lindner on LinkedIn. Read more from Bob with Automation, Machine Learning, and the Universe: Q&A with Veda’s Chief Science and Technology Officer and Co-founder, Dr. Bob Lindner

Addressing Challenges in Rural Healthcare Data

HEALTHCARE BUSINESS TODAY — Specialty and subspecialty healthcare services are less likely to be available in rural areas and are less likely to include highly sophisticated or high-intensity care. This exacerbates problems for rural patients seeking specialized care who must travel significant distances for treatment.

It comes as no surprise a 2019 policy brief from the University of Minnesota Rural Health Research Center found that 64% of surveyed rural health clinic staff members reported difficulties finding specialists for patient referral.

A functioning rural health system relies on legions of specialty care doctors doing outreach visits across a wide geography. In theory, that’s an effective way to ensure that rural patients have access to specialty care without traveling to a major metro area. But, bad data is keeping us from achieving complete access to specialty care in rural areas and experts across industries are weighing in on the issue.

Read Chief Science & Technology Officier Dr. Bob Lindner’s entire article addressing rural healthcare data challenges.


Progress in healthcare data quality

Health tech companies have attempted to solve provider data inaccuracy problems with a number of products, platforms, and integrations. No solutions have been able to offer members the ability to easily book an appointment armed with accurate information.

While many solutions focus on gathering all data sources available to identify providers, most don’t have the ability to effectively clean up those databases. That’s where we comes in. Veda is leading efforts to eradicate rural healthcare data challenges in the U.S. Discover how our technology connects patients to the critical care they need while ensuring that individuals are not burdened with unexpected healthcare costs.

MedCity News: Healthcare Doesn’t Need More Big Tech

Healthcare Doesn’t Need More Big Tech; It Needs Specialized Tech. Byline by Dr. Bob Lindner in MedCity News.

It’s easy to oversimplify and say, “These big tech companies are now doing healthcare and they’re going to solve everything.” But the reality is that often, the solutions are not going to come from big tech.

READ FULL MEDCITY NEWS ARTICLE

Just like clinicians who specialize in an area of medicine, healthcare’s tech problems need specialized solutions. That’s because the industry doesn’t have a single general issue to solve, healthcare has many discrete issues to address.

To further complicate things, healthcare is not one industry but many industries under the same umbrella. Clinical care, devices, diagnostics, pharmaceuticals, hospitals, payers, and more each has its own unique challenges and opportunities that need to be addressed with unique solutions.

It’s easy to oversimplify and say, “These big tech companies are now doing healthcare and they’re going to solve everything.” But the reality is that often, the solutions are not going to come from big tech.

Our healthcare system is built on a series of complex requirements and regulations that conventional technology solutions aren’t built for. Patient data privacy, regulatory compliance, interoperability, and the sensitivity of medical information call for a specialized set of solutions. A solution for a payment issue isn’t the same as a solution for patient records or network construction, telehealth, provider data, or a condition-specific issue.

These individual problems are being addressed by legions of innovative people working in smaller, more focused organizations where they are experimenting, iterating, pivoting, and getting closer and closer to solutions to the issue they’re addressing. These teams are focusing on singular issues and solutions in a way that bigger, more general tech doesn’t.

To compound the issue, healthcare is an ever-changing industry and requires solution providers to be agile in order to keep up with emerging trends, new discoveries, new regulations, and shifts in patient and provider preferences. These smaller more specialized companies may not have the resources of large tech enterprises; however, they are inherently more adept at quickly iterating solutions, responding to changes, and adapting to evolving needs.

This is why specialized solutions and specialized tech providers are ultimately going to be the problem solvers.

Does this mean that big tech doesn’t have a place? Of course not. Big tech can do what big tech does best: identify, vet, and foster some of these solutions and ultimately scale the right ones.

But what about the funding? These entrepreneurial companies who are developing innovative tools are often start-ups and frequently raising capital at the same time they are building the solution.

A recent Pitchbook report covered by MedCity News included a mixed bag of news for these entrepreneurial companies in the medtech space. The report noted that venture capital funding to medtech appears to have bottomed out in the first quarter of this year and has been ticking slightly upward. That’s the good news. The troubling news is that this year’s medtech funding total may not reach the 2022 funding total of $13.5 billion and certainly won’t even approach the 2021 funding total of more than $19 billion.

In healthcare the stakes are high, and any tech solution needs to operate as a “mission-critical” part of the equation. Think NASA or car safety where there are no margins for error or experimentation like there are if we were building a ridesharing or shopping app. We’re dealing with people’s health and lives on a daily basis. The stakes should be treated as life or death because they are. And the solutions we deploy need to be more than adequate. They need to be infallible.

Connect with Dr. Bob Lindner on LinkedIn. Read more from Bob with Automation, Machine Learning, and the Universe: Q&A with Veda’s Chief Science and Technology Officer and Co-founder, Dr. Bob Lindner

Is Your Data Partner Ready for New AI Regulations?

How to Find the Right Provider Data Vendor Partnership

It seems that almost every week we see new vendor offerings within the provider data management ecosphere—each claiming to offer a revolutionary way of visualizing your data and making impactful improvements for healthcare. The provider data accuracy challenges that health plans and provider organizations face are vast, so it’s not surprising that new health tech companies are quick to capitalize. Caution: all health tech companies may not be keeping new and developing AI regulations in mind when developing their technology.

All health tech companies may not be keeping new and developing AI regulations in mind when developing their technology.

Looking at the Bigger Provider Data Picture

Quality provider data can help the healthcare industry tackle some of the biggest challenges health plans and provider networks face, like onboarding, credentialing, roster creation, and referrals. 

A commitment to improving your provider data can have great ROI potential and long-term impacts on your business and patient populations. But, with all the buzzwords and capability promises from the masses, how do you find the best vendor fit for your business needs?

Necessary Topics to Cover When Vetting Provider Data Vendors

To set you up for partnership success, here are discussion ideas for data vendor conversations:

  1. Find out the vendor’s practices for responsible data collection, storage, and validation. For example, does the vendor keep their data in the U.S.?
    Veda’s Take: You want to ensure any vendor interacting with critical data is not utilizing offshore, 3rd party data processing centers that can unnecessarily expose data and therefore, providers’ information. Consider this: If patient data is protected from offshore processing vendors via HIPAA and other regulations, shouldn’t the same protections be afforded to provider data? Veda offers comprehensive security and data protection and is HITRUST-certified.
  2. Understand the vendor’s business policies regarding AI. For example, how does an AI vendor utilize Language Learning Models? 
    Veda’s Take: Avoid risk by future-proofing your AI policies. Machine Learning can be a powerful tool, but should be approached thoughtfully and aligned with current and future U.S. legislative requirements such as President Biden’s executive order for the Development and Use of Artificial Intelligence. Warning: fewer companies comply with the proposed regulatory requirements than you may think.
  3. Ask about their reporting and measurement. How does the vendor define accurate data and measure it during and after delivery?
    Veda’s Take: Data can be compliant but inaccurate and unusable for health plan members who depend on the data to get care. Be prepared to discuss your business goals and thresholds for accuracy—consider going beyond meeting regulatory guidelines. We think healthcare data should truly be considered “accurate” if it meets a member’s needs when accessing care. 
  4. Discuss what is necessary for your business success. Can the vendor offer the necessary tools to reach your goals and eliminate what is unproven?
    Veda’s Take: Don’t be distracted by tools that may not deliver results or provide value for your goals. For example, APIs are often necessary to save time on automation. Therefore, many businesses focus on the ability to have an API connection and the API integration above even the results the product delivers. Or, in another example, the UX and the interface of a product can become a focal point above the actual functionality of the product. If you can’t trust the data and know how to interpret and use it, then connectivity and appearances don’t matter.
  5. Determine what happens first. Can a vendor partner prioritize your specific business requirements?
    Veda’s Take: All businesses have different objectives and these goals greatly impact priorities. Your vendor should clearly articulate what needs to happen first, upon implementation of the product, to realize immediate value and reach success. There is no one-size-fits-all solution when working with a provider data vendor. Before integration and during the initial conversations is the perfect time to establish an approach to prioritization within business rules. 
  6. Get familiar with the training process. What does the implementation, training, and delivery process look like for your AI data vendor?
    Veda’s Take: How a provider data vendor plans to work with you, and how they plan to train others in your organization, is key to partnership success. Beyond day-to-day use of the tools, how does the vendor recommend using the data and applying the findings? Who should be trained on what tasks? Clear and concise preparation will ready everyone in your organization.

Ensure any vendor interacting with critical data is not utilizing offshore, 3rd party data processing centers that can unnecessarily expose data and therefore, providers’ information.

Once you have a solid understanding of how a potential partner tackles the above objectives, only then can you capitalize on a business case for building a collaborative partnership with a provider data vendor.

Need more ideas on what to ask a potential provider data vendor? See Veda’s Six Questions to Ask Your Provider Data Vendor

Eradicating Ghost Networks from Provider Directories with Accuracy

The REAL Health Providers Act and Veda’s Accurate Data Approach

The bipartisan Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, introduced by U.S. Senators Michael Bennet (D-Colo.), Thom Tillis (R-N.C.), Ron Wyden (D-Ore.) calls to eradicate ghost networks that are impacting patients nationwide.

What are ghost networks?

A ghost network is a provider network that appears robust and full of available providers but actually contains bad data and thus, much more limited availability and unreachable providers. These “ghosts” are no longer practicing, not accepting new patients, are not in-network, or have errors in their contact information. 

Imagine using a “Find A Doctor” online tool to pick an in-network doctor in the specialty you seek, but when you call to book an appointment, you discover the provider is no longer practicing. That’s a ghost.

Despite the introduction of the bill, recent media coverage, and attention from the Senate Finance Committee, ghost networks are not a new phenomenon. A Yale Law & Policy Review completed in 2021 titled Laying Ghost Networks to Rest: Combatting Deceptive Health Plan Provider Directories declared “…these directories are deeply flawed.”

“ [Ghost networks are a] pervasive issue in the American health care system. A three-phase study of the accuracy of Medicare Advantage directories, which included over 15,000 providers, found that between forty-five and fifty-two percent of provider directory listings had errors, with some individual plans having error rates as high as ninety-eight percent.”

While behavioral health networks are often cited for inaccuracy and the mental health crisis in America has brought adequate network issues to light, inaccurate directories are a systemic issue prevalent across all provider types. All directories have “ghosts.” 

How do ghost networks inhibit care?

Besides adding to patient frustration, ghost networks prevent patients from accessing the care they need. Impactful stories, like this one from the Yale Law & Policy Review,  shed light on the millions of people dealing with the repercussions of inaccurate provider directories each year: 

“KC, who manages her brother’s mental health care, gave up on trying to find an in-network psychiatrist because calling potential providers was taking up so much of her time that it was more cost effective to pay out-of-network rates. “Ironically, I can’t imagine my brother or others in his situation being organized and effective enough to be able to make all these calls and keep track.” [Yale Law & Policy Review]

Additionally, ghost networks have inhibited care by leading to unexpected medical bills. “When Americans are purchasing and using their health insurance, they have the right to know whether their doctors are covered by that plan,” said Ron Wyden (D-Ore). “Too often, seniors and families get health care whiplash when they sign up for a plan only to find out that their preferred doctor is out-of-network, or it’s impossible to find a covered mental health care provider.”

How does the REAL Health Providers Act tackle the issue of ghost networks?

The legislation aims to combat the ghost network problem by, among other things, requiring Medicare Advantage (MA) health plans (beginning with plan year 2026) to verify their provider directory data every 90 days and, if necessary, update that information.

  • If a health plan cannot verify the data, the plan must indicate in its directory that the information may not be up to date.
  • A health plan must also remove a provider within 5 business days if the provider is no longer participating in the plan’s network.
  • If ​​a patient obtains care from an out-of-network provider that a health plan’s directory indicated was in-network at the time the appointment was made, the plan may only charge that patient in-network prices.

The legislation also requires MA health plans to analyze the accuracy of their provider data on an annual basis and submit a report to HHS/CMS with the results of that analysis. HHS/CMS will use this information to publish accuracy scores for each plan’s provider directory.

How does Veda banish ghost networks?

Veda has been at the forefront of efforts to eradicate “ghost networks” in the U.S. for years. Veda understands that progress on this front is essential to connect patients to the critical care they need and ensure that individuals are not burdened with unexpected healthcare costs.

Veda takes a one-two-punch approach to eradicating ghost networks. Veda leverages its patented technology and innovative solutions to first identify where the “ghosts” reside in provider directories and then fills in the gaps left behind once the ghosts have been removed. Using a mix of AI technology, smart automation, and machine learning, Veda’s provider data is proven accurate.

Find the Ghosts

Veda’s Quantym platform identifies the errors in a provider directory

High-volume audit solution that delivers comprehensive, real-time scoring of provider data quality to identify bad data and significantly improve provider directory accuracy

Fill the Gaps with Accurate Data

Veda’s Vectyr tool supplies accurate data to replace the bad data

The most up-to-date, comprehensive, and accurate source of data on healthcare providers, groups, and facilities on the market

Veda understands that ghost networks will not be eliminated by the manual attestation methods of the past.  Manual verification is labor-intensive, expensive, subject to human error and time and again, it’s proven ineffective. The fact is, “attested” data is frequently not “correct” or “accurate.”

Veda’s technology takes provider attestation out of the equation and, in doing so, can more accurately identify where ghost networks exist (by pointing out inaccuracies in the health plans’ provider directory data) and provide solutions to the ghost network problem (by filling in the gaps that are created when the bad data is removed).

It’s time to let technology like Veda’s solve the ghost network problem once and for all. Give your members the accurate information they need to make an appointment for care on their first try.  Contact Veda for a free data assessment.

Want to learn more about ghost networks? Watch a recording of Veda and Mathematica’s November 2, 2023, webinar,  Don’t Get Spooked by Health Care Data: Tackling Zombie Rates and Ghost Networks. Read a summary of the REAL Health Providers Act here.

Artificial Intelligence, ChatGPT, and the Relationship Between Humans and Machines

By: Dr. Bob Lindner, Chief Science & Technology Officer, Co-Founder

If the explosive launch of ChatGPT has taught us anything, it’s that there is a growing appetite for engaging with AI. According to a recent UBS study, the chatbot from OpenAI reached 100 million monthly active users in January— only two months after its launch. By comparison, it took TikTok about nine months to reach that milestone and Instagram two-and-a-half years.

While ChatGPT and the generative AI that powers it represent the latest advancements in AI and machine learning, the fact is that organizations and individuals have been trying to harness the power of AI for years. Some see it as the wave of the future. Others are scared of what it portends for the complicated relationships between humans and machines.

Many people are so afraid of being displaced by the automation that artificial intelligence brings that they overlook the benefits of this amazing technology. But the fear of “robots replacing humans” isn’t the only thing that gives people pause. There’s also concern that machines will make unacceptable errors. Of course, when people make the occasional mistake, we’re used to giving them the benefit of the doubt, but we struggle to do the same for machines because we don’t know how to contextualize their errors.

Why do we react so emotionally to AI? How can we shift our perspectives? And how can we actually score recommendations in AI systems? The hope is that with greater understanding, we can apply AI to more business settings and drive greater success.

Digging deeper into our fears and hesitations

Behaviorally, people tend to fear things we don’t understand or that seem out of our control. When it comes to risk, specifically, we struggle to comprehend how to assess it in an objective—rather than emotional—way.

For example, think about self-driving cars. The thought of a car without a driver makes many of us uneasy. Even though more than 75% of us will be in at least one major car accident during our driving lifetime, we’re afraid to put autonomous cars with this type of driving record on the road. While the probability of an accident is likely not higher than for a human driving a car, the combination of not knowing the exact percentage of risk and not being in control makes it harder to accept. We’re just not used to making our decisions based on probability; we are used to listening to our gut.

In order to process the data with a probabilistic AI system, we have to score it and set a threshold for “good” data; anything with a score below our threshold is discarded and anything higher is deemed an acceptable level of risk and included in the data set.

In my experience, the best way to get comfortable with objective assessment of risk is practice. Over time, it becomes more natural to look at the numbers as opposed to looking at our emotional response. Of course, understanding exactly how AI works helps too.

Understanding how to assess risk associated with AI

AI acts on two types of systems: deterministic and probabilistic. With a deterministic system, an outcome can be determined with relative certainty. This includes apps like Amazon, Doordash, and Venmo, which generate predictable types of data within a confined system. These are usually not considered “mission-critical,” and as a result, we’re willing to tolerate some level of inaccuracy in their algorithms. For example, when Netflix recommends a movie that doesn’t actually interest us, we don’t cancel our subscription to the service. We just look at the next recommendation in the queue or scan the top 10 titles of the week. We’re forgiving.

Probabilistic systems have built-in uncertainty. The exact output is not known. Think about the difficulty of forecasting the weather. It’s hard for us to understand the uncertainty of probabilistic systems and the stakes get even higher when we’re dealing with “mission critical” data, like we are in healthcare technology. In order to process the data with a probabilistic AI system, we have to score it and set a threshold for “good” data; anything with a score below our threshold is discarded and anything higher is deemed an acceptable level of risk and included in the data set.

The first step is to understand how these systems work, and the second is to set thresholds to score data that matches your risk tolerance.

Take a risk

With machine learning models, we are training a system to learn and adapt in order to improve—so it’s necessary to make assessments on an ongoing basis, rather than measuring an automation system’s performance once and only once. Because of that, it’s essential to have patience, as data can and will change, depending on many factors.

While risk makes people feel uncomfortable regardless of the setting, it’s time to address those fears and reluctance to move forward. Once we have tangible examples and parallels we often relate and tolerate it better.

As for ChatGPT and its generative AI brethren, the key will be for each person who engages with these tools to determine what level of risk they are willing to take. For most of us, a simple chat about something mundane or unimportant is likely acceptable. For some, the exchange of critical data or asking it to perform an important function will be a bridge too far. For now.

Dr. Bob Lindner is the Chief Science & Technology Officer and Co-Founder of Veda. More about Veda’s science and technology: Automation, Machine Learning, and the Universe: Q&A with Bob Lindner.

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