John Marron is president and CEO of InMediata of Charlotte, NC.
Tell me about yourself and the company.
I’m president and CEO of InMediata. I’m a health IT veteran, for lack of better words. I have 20+ years of experience in what’s called provider connectivity, EDI, some of those similar terms.
I’m very fortunate to have worked both on the payer side — for a large, national healthcare company here on the East Coast — and on the provider side as well. I’ve worked for software and services vendors.
The company has two divisions. One is in Puerto Rico. I won’t talk much about that today, but InMediata’s division there that serves a little bit of everything — clearinghouse, practice management system, and EHR.
For the US business, we’re focused on payments and payment analytics. We’re positioning our company for today’s real-world problems of fee-for-service payments and helping providers who are moving claims and remits electronically who are having a terrible time reconciling payments, having a challenge on patient responsibility, and are trying to understand where their money is.
This is a new business. There’s nobody out there doing exactly what we’re doing. Lot of clearinghouses out there, a lot of practice management systems, probably a lot of EMR vendors. Most of them become partners for us. We think we are one of the innovative companies who are looking at the payment side of it and focusing on how to reconcile payments, remits, and deposits, which are the banking side of the business.
More than anything else, we’re trying to bridge the gap between healthcare payments from payers, healthcare payments from patients, and the banking side of it in bringing deposits to the equation.
Is it unusual for a revenue cycle management services firm to go all the way to the bank?
Most of them go almost all the way to the bank. Revenue cycle is a pretty broad term. Banking is, as the old expression says, the last mile of cable. They’ll deal with the deposit side of it solely. They’ll deal with the insurance company payment side of it solely. But there are not many people bringing it all together.
You’ll see on our website that there are a lot of large provider groups. That’s our target audience here, groups who look at their back office process and find that they have accountants and CPAs going to banking portals and websites to try to help their organization reconcile where the money is at a certain point in time. I got a check, I got remit from a payer, I have to make sure that the money I was expecting is reconciled in the bank and I’m ready to run my business.
A lot of companies are going around it, but not a lot are tying it all together. We think that innovation in integration is one of the key points for us.
How much inefficiency is left in provider’s revenue cycle management?
We think it’s largely automated on the front end. By that, I mean things like eligibility verification and claims submission. If you view that piece, and it’s an important part of the revenue cycle, it’s largely automated. A lot of the people who work with us at InMediata have spent their careers chasing that part of the business.
It’s largely manual and inefficient on the back end — payments, reconciliation, and payment analytics. Just truly understanding where the money is. We think there’s a lot of room left in that business.
How is the market changing with high-deductible insurance plans increasing the need to collect patient responsibility upfront?
We’ve heard about that coming for a lot of years. I would say we’re probably about three-fourths of the way down that path as well. More patients that are walking into the doctor’s office have some form of high-deductible plans. MGMA published really astounding numbers about how much money is left on the table if you don’t collect while the patient is in the office.
That tells a part of what we’re trying to to bring to the table. We are looking for reconciling payments from payers and some patients — anything the doctor’s office has to handle. We think those challenges are all workflow related. We’re trying to design our solutions around clicks matter, quick information, quick access to still-multiple disparate systems, and tying it to integration and workflow.
The challenge for a provider is knowing that a patient is likely coming in with a high-deductible plan, but not knowing much more about it. Trying to fit that into the workflow of seeing a patient, getting them through the healthcare system, and dealing with billing on the back end. It’s increasing, it’s problematic, and the things that solve it are workflow and integration.
What are the challenges involved with integrating those disparate systems?
They just don’t talk to each other. We’ve gone a long way of tying front-end processing standards. HIPAA did a great job bringing standards to the transactional flow. But when you get into the back office, you’re dealing with completely different systems that just don’t have the knowledge on how to talk to each other.
A lot of the payment people in the provider’s office are real good about accounts receivable, real good at managing what’s going on within the office. Of course, payers have their own adjudication systems — they can manage what’s going on in their own house. Banking has its own systems.
When that payment is made, that’s when they stop talking to each other. It sounds archaic, but we see situations where back office people are still going across multiple systems, entering data by hand manually in an attempt to reconcile an electronic payment, to an electronic remittance from a large insurance company, to maybe even an electronic payment from a patient site. That’s a lot of good digital information, but at that last end, that that last mile of cable, payment and banking are still not talking to each other.
Banks are heavy technology users. Have they made an effort to offer similar services from their end?
They have. Some banks, with what we’re doing, are becoming partners of ours. Our niche, something that we do really, really well, is that we think this business is about relationships and partners. A lot of what we’re trying to do it partner with the key companies that are involved. We know them. InMediata has had great relationships through the people that are here with us, with the practice management systems and billing companies within healthcare, and with the banks.
The challenge is the banks don’t always know the healthcare processing, and the healthcare software and vendors don’t always know the banking processing. That’s why I talked about that bridge earlier. Someone’s got to sit between the two and make that connection.
Banks are involved. They’re good partners with us. We can’t do anything without the transactions that are moving through the system. We think someone needs to be the conduit between the two and we think — it’s an old expression – that all healthcare is local. I’ll tell you, I’ve take it further and tell you that all healthcare is about relationships, and it’s about building trusted relationships.
That’s what our team brings. We understand the vendors involved in the healthcare side and now we’re getting an understanding of the banking transaction sets. We serve as that conduit between the two.
What business lessons did you learn in watching Gateway EDI sell itself to TriZetto, which was then acquired by Cognizant for $2.7 billion?
Culture matters. Gateway EDI is where I came from and is part of the equation. It was a company that talked every day about culture, about its people, about treating people well. An old expression says, “Happy employees will create happy customers and create a happy, healthy, and successful business.”
We’ve taken that to InMediata — that culture, believing in people, empowering your people, and creating accountability. Transparency of communication across your environment creates a really strong culture. We’re working on building that as well.
You heard me talk earlier about relationships. We think the culture of the employees that you have transcends to the customers that you’re serving and to the partners that you’re going to bring into the game. We think culture matters. We had a expression when I was there that says, “Culture eats strategy for breakfast, lunch, and dinner.” That’s what Gateway EDI was about. That’s what we helped merge into TriZetto. Of course, as you mentioned, Cognizant came in at the end.
We’re trying to rebuild that same culture at InMediata. We’re doing it people first. Happy employees making happy customers. We’re going to look for the same kind of partners, people that believe in employee-centric organizations, people that believe in innovation, and people that believe in satisfying and delighting the customer.
Where do you see the company in five years?
I’d like to be the Gateway EDI of healthcare payments and revenue cycle. We think we’re at the beginning of something that’s going to take us to an interesting place.
I’d like to see us helping move from fee-for-service to fee-for-value. We think that’s an obvious place the industry’s going. We’re trying to focus on what exists today and help us get to tomorrow. As payment models change, as quality initiatives continue to get pushed, as the payment landscape finally makes that change from fee-for-service to fee-for-value, we’d like to see InMediata right smack in the middle of all that.
For us, today’s challenges and opportunities exist around the fee-for-service model, around using those administrative transactions to help fuel the innovation for payment and payment reconciliation, and take that up to and past the fee-for-value model when quality really takes hold of the payment system and be there to help our customers get through what is, at this point, a rather intimidating change in the coming landscape.
Do you have any final thoughts?
We have a lot of experience in our company. If I had to give you an expression we use a lot, we’d say, "Words matter."
I was thinking about this interview and thinking to myself, "I want to make sure Tim knows about our company and about me and about our people." A series of words I jotted down on paper tells you about our company and our business. It’s people. It’s experience. It’s relationships. It’s innovation. It’s integration. It’s information. Just a set of words that I think are important. If I had to describe ourselves in just a few key words, that would be them.
We hear about another word called commodity. The old EDI clearinghouse business you mentioned, Gateway EDI — people will talk about how that business has become commoditized. We view it completely differently. We view it as opportunity. We view it as value. We think there’s plenty of areas to help, plenty other places to go.
InMediata thinks more about, why not? Why can’t we further that industry? Why can’t we find value where people see commodity? Why can’t we find opportunity vs. people see crisis? That all comes from a few words. People, experience, and relationships are key to the culture side, then innovation, integration, and information are the three I’s that we think are key to our business.