The Change Healthcare Data Breach and What it Means for Home Care Providers (Joseph Dworcan)

[ 00:00:06 ] All right, welcome to Home Care U a podcast by Careswitch. I'm Miriam Allred, your host. Thanks for being here, thanks for listening to the show. It's great to be back with everyone. We're going to jump right into things, I'm really excited for today's episode it's a little bit different than what you may be used to, the content, the topic, the guest a slight veer from our norm but uh, equally important and exciting and interesting for all of you. So today I'm joined by Joseph Dworcan, he's the VP of Product Strategy at Paradigm based in Miami, Florida. Most of you probably have heard of Paradigm at this point in time, um, their website's paradigmseniors.com. They are the third-party billing experts in the home care industry, that's how I think of them in a minute, I'll let Joseph you know do paradigm more justice, but um all things third-party payers,

[ 00:00:58 ] they know what they're doing. They're working with hundreds, you know thousands of agencies processing these claims and doing all of all of those things so uh really excited to have Joseph on the show today, thanks for being here. Thank you, Miriam, I appreciate the opportunity to speak to you. Yeah, likewise I uh also appreciate you jumping on last minute, I know you're a busy guy. You're actually on the road right now, uh you know that, for context, I read an article that Joseph wrote just a couple of weeks ago, and I thought, 'You know, I need to have him on the show.' So, um, just so everyone's aware, today we're going to talk about the change health care data breach. I'm sure you've read headlines, seen it in the news; that's what we're going to dive into, talk about today.

[ 00:01:41 ] What happened? You know, how things are going? And what does it mean for healthcare providers and homecare providers? You know, how does this impact all of us here? So, before we jump into it, Joseph, I want you to take just a couple of minutes and introduce yourself a little bit about your background. What I was doing before this, and then we'll talk about how I got started at Paradigm, and then yeah, take a minute to introduce Paradigm as well, that would be great, sure. Um, so yeah, as you said, um, I am the Vice President of Product Innovation Strategy at Paradigm. Um, I've held many roles that were actually there, um, from right from the beginning of Paradigm and um, I started with when we were just you know piloting our product and working with some.

[ 00:02:28 ] long-term care insurance space, moving to VA to Medicaid, and so my experience before this, I was doing some technology and it before Paradigm, and actually before that it Was in the real estate world, um, but you know I was always drawn to both the technology side and also you know helping providers. I actually had um a child who received home care for a long time, so I really felt a personal connection to this industry. So, it's amazing to be able to give back and to be a part of this, um, and you know as you mentioned, paradigm, you know, a lot of people are known to be assist with third-party billing and working with third-party payers.

[ 00:03:11 ] But, um, it's interesting because in a sense we're while we do that absolutely, as part of our mission, we are rarely here to remove the burden from providers when you're Working with third-party payers, you know there are so many aspects to this. Um, you see us a lot with each of the pair lines in their own unique way, and you know to why this I wrote this article and kind of how I see it's close to where we are is that paradigm uses um technology and like this similar to change clearinghouse in order to process the claims for the thousands of providers who we're working with. Um, and you know it just seemed essential that it was clearly understood by everyone because it may not be appreciated just how big an issue this is, and some of the concerns and the pitfalls of what's going on here, but also how they can be avoided to some degree or at least how you know.

[ 00:04:09 ] owners can be prepared when this does happen so um the bottom line is we know that providers need to bill and get paid we've seen unfortunately providers who are on the verge of losing their businesses just because they're you know not able to run payroll um and that's what we really try to get clear about a lot of kids figure out where they are and there are things we need to think about when working with them and we try to work within these conditions in order to reach those levels

[ 00:04:58 ] of what happened and when did this happen? Sure. So, um, change clearing house is, um, well, I'll start off with the fact that change is actually was purchased by United Health Group, um, which runs an arm called Optum. Um, and some people may know them from the VA space, but they are also just a services company, which, which, um, services pairs and they actually purchased Change Clearing House, um, in order to be able to have what is probably either the largest or the second largest clearing house in the country, um, clearing house, meaning that they receive all transmissions between a provider who's providing the care and a pair, and they could be serving them on just the pair side on both sides.

[ 00:05:48 ] So what happened is, is there was a major data breach where a hacking group, um, by the name of alpha V or also known as black hat. Um, and they, together with a network of providers seized about six terabytes of data, which is a tremendous amount of data and essentially locked down their system and then, um, change slash United slash Optum took down their services. The total of 111 services were taken down, um, in order to preserve whatever, they could. Um, and at that point, consequently, they actually, at least it's reported that they may have paid a, um, ransom in order to try and receive, get, receive the data back. And, um, that was an amount of $22 million in Bitcoin, so that's still unconfirmed, but that's kind of where we are today.

[ 00:06:41 ] Awesome. That's yeah, that's a great overview, you know, for anyone listening to this who, you know, hasn't heard - like that was, that was a perfect summary of what happened. So, um, I want to kind of start in this direction, actually change you mentioned is the acquisition of Optum owned by United, who also has this arm, which is Optum. Um, tell, tell us a little bit about, you know, that acquisition when that happened and maybe why that's applicable to this conversation. Yeah, absolutely. So, the acquisition took place in about 2022. Um, and it took a while to be finalized. Um, one of the challenges and why there was a lot of pushback is if you can imagine this was from a provider's point of view, um, the provider is already mandated to work with a United healthcare, you know, on our Optum, especially if they have a government contract in the Medicare advantage space and the Medicaid space, and even in the VA space, and they having that, they're having to work with them on that end.

[ 00:07:44 ] And now they're now purchasing the middleman, which is what a provider may be using on their end to submit claims. It started to feel very uncomfortable. Um, and so there was a lot of pushbacks. Pushback with that, the deal, and for many different reasons, and there's a lot to go into there, but essentially providers weren't comfortable with it. Regulators were not comfortable with it. However, the deal to go through now, why plays in over here is because of that, they consolidated so much of the processing into one system. So there was this one bottleneck or I wouldn't call it a bottleneck because it was functioning, but now it became a bottleneck in the case of this breach, uh, where, you know, um, we were discussing earlier, that the number that I've been hearing is one in three claims, one in three, um, um, transactions, medical records actually went through change on some level, which is pretty wild.

[ 00:08:40 ] Yeah. Okay. Okay. Yeah. That, yeah, we'll get into that a little bit more later on of, you know, like United's role, Optum's role, et cetera. So, um, going a little bit further after like what happened, what has changed his response been, you know, like real time this happened, um, and were what, maybe a month, almost a month later or just how, how have things unfolded after the breach? Yeah, I think we're this is about three weeks now, I believe it happened on February 21st. So, their response initially was just, they went dark, you know, they didn't give much reasoning. It was just like the systems are down due to a cybersecurity incident. And before a lot of, um, not only for the payers, because it also impacted them, they kind of went down and they said, hey, there's nothing we can do.

[ 00:09:29 ] We're trying to protect you. Um, which was the incredible move that they actually took action and didn't try and hide it. Um, however, on the flip side, at the end of the day, this had a tremendous impact on every part of the marketplace, um, because providers were unable, those who were using changes, the clearing house, um, and many doing, we can go into that if you'd like. But we had even had providers, I can reach out to us and said, you know, we were using change as a clearinghouse, we were sending all of our claims there. And we go a little bit further back, a particular provider reached out to us about two years ago. And they started working with paradigm because they wanted to engage with the VA.

[ 00:10:13 ] And we were able to get them enrolled as a provider with a VA and get them into the network. They started with their first client through our education department, which was awesome. And they consequently went and grew over the past two years to serve 200 veterans. And in this time, they actually, from that first client, they didn't end up working with Paradigm right away. However, they came to us now and they said, 'Hey, we're stuck, we have 200 clients, $200,000 worth of billing, we're not going to meet our payroll.' Our head of billing got on the phone with the right of way, with the owner was able to sit down and right away, within 24 hours, we had all their billing out the door.

[ 00:10:57 ] And we're able to already start receiving the payments as soon as they came in from the payer. And to the point that the owner was even offered our head of billing, her vacation home, which, but it was just, she was said she was on the verge of tears, if you can imagine, it was literally a question of a business going under. And so, you know, it was incredibly tough for both providers. And the payers obviously also, but it really impacted the smaller providers, because the bigger ones that we can talk about how the that and to your question of how they respond, they responded in a way which really accounted for the larger providers, however, not necessarily the smaller ones.

[ 00:11:42 ] And they offered even a funding program to the degree where they said that if you were submitting claims, and you were stopped for whatever reason, they would estimate the size of the claims, you were generally submitting, and they would be able to provide you with funding to cover that. But we, the feedback that we had received from a number of providers was that it really wasn't there, unfortunately, to the point where providers were not able to cover what they needed. And so, we're grateful that we were in a position to be able to help those providers as needed. But unfortunately, it just wasn't up to scratch. Just share the flip side of that coin. How did they support larger providers?

[ 00:12:22 ] You just said, yeah, the funding option, for smaller providers, what were the measures they took for the larger providers? So, they put in they put in some of these funding opportunities, and they were far more targeted to those because, you know, imagine a health system could say, you know, we're doing everything that they had a more position of power, because they were saying, hey, we're doing everything through you, we're using you already. Then so they're going to say, okay, no problem, we're going to float you until you get back in your feet. A smaller mom and pop, you don't have to have a voice, unfortunately. And so that's where it really becomes challenging in that space. Okay, okay. Yeah, that makes sense.

[ 00:13:01 ] So let's talk about, let's start kind of high level again, like, how does this impact like home care providers, there have been home care providers that are being impacted, if I understand right, through Optum, primarily, like indirectly through change, but through Optum, or tell me how home care providers are specifically being impacted by this that you've seen. Sure. So, there's a few possibilities. So, as I've mentioned, you could have on each side of a transaction, you can have a clearinghouse. So, depending on which pair it is, some pairs do use change as a clearinghouse. However, let's talk about it first from a provider point of view. And so, for many providers, they'll integrate into their scheduling software, or they'll maybe upload something into Change as a clearinghouse. And submit their claims that way.

[ 00:13:54 ] And as soon as that pipeline gets turned off, there's just no way for them to get their billing even to the pair in the first place. So, imagine that's just stuck with them as a confirmed schedule, but nothing more. The next phase of it is that let's assume that they actually get it to the pair, if the pair is using change as a clearinghouse, that the pair was never able to adjudicate and therefore pay the claims. So, there was just getting stuck at that end if it even reached the pair. And then finally, even the pairs which did receive the claims, some of them relied on Change's payment systems in order to give payments to the providers. Or they relied on them if they were representing government agencies to receive payments in some cases.

[ 00:14:40 ] So to your question, in the case of a VA, when someone has a direct VA contract, the VA on their side uses Change as a clearinghouse. So, they weren't able to receive claims at all. Surprising, Optum of all the pairs did not use change because they have a separate system, which is interesting. I guess they haven't merged the two yet, but they still had their older system they were using. So those never really stopped. However, TriWest, there were some delays. It's unconfirmed what the cause of the delays were, but it seemed to have been more on their backend side in their relationship with change, as opposed to being their ability to adjudicate ends were okay. Do you have any sense of you just explained it, this is impacting providers directly, but also impacting payers.

[ 00:15:34 ] So this question may be tricky, but any sense of how many home care providers were impacted percentagewise, I know that numbers may be broad, but any sense of maybe how many home care providers have been impacted by this? So I don't have the number specifically in the home care provider list, but like Scooter, of how many were um I can tell you though that we had a lot of providers who reached out to us owners who have reached out to us um and I couldn't quantify it exactly but we've just seen a tremendous you know turn up where they've kind of said we just were stuck we need help we can't you know we can't we

[ 00:16:13 ] can't stay afloat um and we actually for some we were able to um we had some financial um backing which we were able to set up for them to really carry them over until those payments do come in um you know because at the end of the day we need to make sure that every provider every owner is able to run their payroll they need to be able to run their business and not deal with these challenges because it's not a matter of if they rise it's a matter of when that's really incredible and you know to bring it to home care you know healthcare organizations you know they're funding their finances you know look very different than that of most home care agencies they don't have a lot.

[ 00:16:56 ] Of cash and reserve, so you know this hits home care very differently, and that the margins are so thin, you know there's not a cash flow is, so you know differently structured than in health care. And so, I think that's you know where this hits differently to use that phrase. And I think that's incredible that paradigm sounds like has stepped in and has quite literally been helping you know float some of these providers that have reached out to you, I, was that right? Yeah, absolutely um, and so I think going back to my earlier point about the fact that when you have a smaller provider who rarely feels it because they don't Have the extra funds on hand to carry them over, I think that's why it's been hitting this area of the industry so much, um, and I'll say that from Change's point of view they kind of said, you know it only impacted maybe eight percent of providers or something along those lines,

[ 00:17:50 ] although that number is a bit skewed because for some providers it could be their entire business, um, or they could have had an alternative but maybe didn't have the ability to set that up you know in the appropriate way, yeah I think that that makes sense and you know it like, if I'm understanding right, you know it affects Providers directly, but then also the payers that are sourcing you know those providers. That's where maybe that distinction is could be massive. If you know how many payers is this impacting and how many payers did those how many providers do those payers influence? And I think that number would be significantly higher, yeah, yeah, absolutely for sure. So, let's talk about the role of clearinghouses.

[ 00:18:32 ] I think that's kind of an important conversation to have as part of this. To make sure I understand change processes, claims for Medicaid. I think you said Medicaid waiver and VA is that correct? Those are like they hit All three of those lanes, and are there any other I guess addictions that you're talking about? I think there's a lot of additional lanes that they cover so um well as a clearinghouse as a whole if we if you want to go back a second we can talk about you know what firstly as you said what is a clearinghouse but even what transactions are going through there so there are I don't want to get too technical within this area but there are there's a standard called EDI (Electronic Data Interchange) and that's where um the information is transferred

[ 00:19:19 ] in a computer-readable format, and it typically will arrive At a clearinghouse, and say the providers end um and at that point it would do some checks and edits to make sure that the information was clear and it was as it needed to be by whatever even before it gets to whatever payer that it fitted the standards and then the next phase would be okay now does this fit the standards of the payer and you'd get a result from the payer's clearinghouse and then finally you would end up in the adjudication system, you imagine it's like a washing machine that it's starting off on your end but then it's going over to the next cycle and then eventually it comes out the other side yeah and I think this.

[ 00:19:59 ] is applicable when we talk about like data and data management, and how your data structured, and how you submit claims, like this is what you're talking about that data has to be so clean and to pass through this process, and then ultimately, to be approved. To be built for correct. Yeah, absolutely. And I'll tell you um, you know something that I've seen over the years which has been very eye-opening is that technology, you know as much as we love it and we rely on a day-to-day basis on its own in this area is unfortunately not enough, um, meaning if you don't have the know-how of being able to say, okay, you know this is a unique case this.

[ 00:20:40 ] is a unique payer or there's a new requirement I'll give you an example that just came up where um the state of Indiana is now requiring specifically the home care and the personal care space that if there are family caregivers it needs to be included on the actual claim which is submitted. You need to include a narrative which tells you who the caregiver was and their relationship to the patient and why is that so unique? It's because I don't know if any scheduling software or typically even a clearinghouse, which allows the narrative to be where it's collected and placed in their clearinghouse but accepted, but it's not. Something which is just a general practice, it's something that's part of the generally produced. And so, it could become very difficult to track all of those nuances which exist.

[ 00:21:26 ] And it could also be dependent on how a provider is credentialed. Sometimes they'll be identified within the EDI world, within that electronic data exchange world, in one way, maybe with an MPI, maybe without. So, it can be very interesting. And so, in the case of Indiana, we right away, we were able to build something out. And we've been building the mandate actually just out at the beginning of this month. So, we've been able to include that in there. But it's not easy for someone, it's just the technology to be able to handle that. You need to have the know-how and be able to actually carry it through. Is it the clearinghouse that makes those adjustments? State of Indiana all of a sudden is collecting X new data points.

[ 00:22:13 ] Is it the clearinghouse that decides that? Or there's also government, state regulations that are influencing that? Great question. So, it starts really, sometimes it starts from a mandate. Maybe they're not meeting all of their EVV requirements. And so maybe they're getting some crackdown, but it will usually start from that side of things. So, in this case, it was the department as a whole, which said, 'Hey, we need this in order to take place.' Then it goes to their EDI department to then mandates it down the chain. However, if you were to submit a claim without it, no one would stop the claim from coming. Again, it would just result in a denial when someone looks at that claim and tells you that, 'Hey, you didn't tell us who actually provided the care.' So, you may wait weeks or however long it takes them to adjudicate before you would actually be aware of something like that.

[ 00:23:04 ] Yeah. So, quick, shameless plug for Paradigm, staying on top of these types of regulation changes. They're relatively frequent. If you're a home care provider, you're putting out fires, you've got a lot going on. This is one more thing to keep track of. And then multiply that by two, three times if you have different service lines, if you're doing VA and Medicaid and private pay, just managing these nuances. Like you said, you start getting claim denials and then you don't get paid. It's really important to stay on top of, and it's really pretty intricate. And these changes happen frequently, correct? I mean, what would you say? How often do these types of change come about? Maybe in a specific state, are we talking? Maybe once a year, once every five years.

[ 00:23:51 ] So yeah, I was going to say, across the country, and so we're obviously tracking it across the board, so it feels overwhelming. But on the other side of it, as a local provider, it's not happening super regularly, but it is happening. And sometimes there may be even, you get a new author and it's from a new department that you haven't worked with before, but they have their own unique, and you just never know what's going to come your way. And so it happens, listen, they put out notices a few times a year, and they could just be at random also. Some of them in the pipeline for a while, and some of them were a quick realization, like, hey, we're spending too much here.

[ 00:24:27 ] And especially as the home care industry as a whole is getting a lot more focus for the good, and rates have gone up. And the president has even mentioned it in the State of the Union numerous times, and it's part of some of the larger bills. On the flip side is that there's a lot of scrutiny now. It's a lot of scrutiny now to say, okay, you know, what measures are in place to make sure that the care is happening as it needs to be? And so, because of that, these new mandates and these new requirements are coming about. And sometimes they could just be hard to track or just difficult to implement. Yeah, absolutely. I want to talk about the world without paradigm for a minute, where a provider has a relationship with someone like change.

[ 00:25:14 ] It's like provider to clearinghouse, which to my understanding exists. Is that common for a provider to like, A, have the relationship with the clearinghouse directly? And is it common or uncommon to have relationships with multiple clearinghouses? Or is it most common to just kind of have like that one-to-one relationship? Yes. So, it's very, very typical to only have the one clearinghouse being a provider, simply because number one, you don't want your staff to have to learn multiple systems. You know, there's dropout points which happen, even if you're able to transmit over to your clearinghouse, there are dropout points where, you know, maybe something needed to be adjusted or information was not entered correctly in the first place. So, it isn't able to go through your own clearinghouse.

[ 00:26:07 ] So you don't have to maintain, you know, those multiple systems. So usually, you just want to stick to the one. In addition to that, even if assuming, you know, the scheduling is software does support it, which typically it won't necessarily have multiple configurations because your kind of just want to say, 'hey, Bill,' and then it will go to your clearinghouse, you know, simplicity over the complexity, which gives you a more robust business. However, on the flip side, it makes it a little bit more challenging. So typically, yes, you would have a direct relationship. Sometimes it can be implemented through your scheduling software, meaning where you can say, 'hey, I want to create the account' and then it kind of does that.

[ 00:26:50 ] Although you would have an actual account with Change, which you could always access, and you would still need to maintain on that end. Okay. So then break down another scenario, which is, you know, I'm the provider. I have like maybe local payers and those payers work with change. That's another scenario, correct? Where, you know, I'm the provider and I don't have a relationship with change per se, but I'm my own employee. And I work with different payers that then use change. That is a play out, correct? Yes, absolutely. So, you could be doing everything right, and you can get everything over to the payer, or at least, you know, you've sent it from your end. But if there's no one to catch the ball on the flip side, you're just going to be, you know, it's going to be hovering in midair.

[ 00:27:41 ] So or sometimes even worse, it actually just gets lost, and you didn't even know that it got lost. So that can tell you a lot about the use of change. can also occur. So yeah, when the payee side is not, doesn't have a system which is operational, obviously that's tremendously problematic. And I will say to give credit here to change in this case, they actually did notify the clearing houses very quickly so that they would not transmit the claims and for them to go to no man's land. And however, at the end of the day, you know, for a lot of the providers, it was just sitting there on their end and there was nothing they could really do about that. And I can only imagine the frustration of that scenario specifically where you aren't even communicating with change directly, but your payers are, and they only know so much, you know, just, just the frustration and the anxiety in those moments of not knowing, and no one really has the answers and not being able to control the outcomes.

[ 00:28:39 ] Yeah, absolutely. And I I've seen, I've seen it's difficult to see, but sometimes I’ve seen these buckets just like grow and grow and grow and grow and grow. And you're like, oh my gosh, what is happening here? And there’s just nothing you can do. Yeah. Yeah. So, let's talk about the world with paradigm, you know, tell me how you all fit in here and how you can help providers in scenarios like this. Sure. So where, what's unique about From, from day one, I'll tell you. You know, we have multiple systems in place to ensure that there's redundancy and we can ensure that our systems and the systems of our providers are resilient. So we’ll always ensure that we don’t always have that. Sorry.

[ 00:29:33 ] We don't only have the opportunity to submit even via electronic data. And we'll always have a fallback or two options always available to us for every player. So, we'll say, 'okay'. And sometimes even more than two. So, we'll say, 'okay', we can make sure that we can send that electronically. If that is the fastest route, if that falls away, we have the ability to go into a peer's portal and submit it through there. If for whatever reason that's down, we may have contacts with the payer directly to be able to submit it an alternate, you know, method. And then in the last case scenario, of course, we can always mail the claims or, or give physical claims to the payers. So those are all options.

[ 00:30:12 ] And I'll take a, I'll take a, I'll take a look at further that where we're kind of going with us is, you know, and as you said, I've been traveling; we're looking at some of the latest technologies which are being used in the overall healthcare industry to transmit and in a more secure way and a more efficient way to have communication between providers and payers. And we really would love to bring those worlds together in a close-knit relationship, especially because I feel like this is such an important piece of the healthcare. Um, industry, um, and sometimes it's overlooked, but we really want to make sure that it's, it's accounted for over here. Before I ask some questions about kind of that latter point, you mentioned the, the ways in which you could do this, you know, if some of those relationships got breached or, you know, impacted, you mentioned kind of these other paths.

[ 00:31:05 ] Do you think home care providers were thinking in that context of, you know, if, if this happened, you know, if this happened, you know, if this happened, you know, if this happened, you know, if this happened, you know, if today I couldn't do, you know, process in this path, like they had backup plans or do you think that didn't really exist until maybe now? Great question. So, I'll tell you, um, an interesting story that, that also came up recently now with the breach. We, we got a call from a provider, um, and, um, they said to us, you know, we rarely were, we have also, I think it was a similar size about maybe, you know, 200 clients and they knew that there was a manual option to go to the, the payer portal and to be able to put in each of the claims, but they said, we can't be sitting there doing 200 clients multiplied by the past four weeks of billing.

[ 00:31:59 ] So it's multiple invoices and it's multiple. They said, we just, we're unable to do that. It's not sustainable. It's not scalable for sure, but even in the short term, we don't even know how long it's going to be. And we said, we just, we need to find a way to, to get it out. And so, when they came to us, um, we got a similar reaction where they just, you know, they said, I, the provider actually said to us, you know, I couldn't have done these 200 claims on my own or these 200 clients on my own. And we were able to get them out also within about 24 hours. Um, and just, you know, let them have that peace of mind to know that you don't have to be scared of not being able to hit your deadline.

[ 00:32:41 ] And I believe this was actually a scenario where we were able to get them out within about 24 hours. Um, and just, you know, we said, 'Hey, if for whatever reason, the payment didn't come through in time, um, for your payroll, let us know.' And we'll come up with a plan. We'll work together with you to come up with a plan to make sure that you can run your business and you can continue doing what you're doing. So, my question is obviously best-case scenario, you know, businesses can work with you directly, you know, in, in scenarios like this, but what advice would you give to providers? Like, is that the best backup method? Is being, is that the best backup method? Is being familiar with the payer portal, knowing how to submit claims there?

[ 00:33:17 ] Or like, is that the best alternative or are there other alternatives that you think providers should like to be aware of and be prepared to take on if need be? Yeah, great. Also, excellent question. So, I would say that absolutely the first thing you should always do when you engage with a payer is always, always make sure that you have your portal set up with them and keep those credentials handy. Um, I've unfortunately also seen situations where providers have maybe, you know, one of their employees have set it up for them and the owner never actually accessed the portal. Um, and they had never touched it. And then they will come, and we'll say to them, 'Hey, can we please get the access to the portal?

[ 00:33:59 ] Can you make sure you have your setup, your access to the portal?' And I'll say, 'Oh, I don't know, someone else set it up and they're no longer with us.' And so, um, we'll also help in that scenario to make sure that they get that access back. But at the end of the day, that is, I think the single most important, um, yes, the, the, the next most important after sending electronically would be to be able to do it through the portal. Um, other, other options are of course, to just make sure that you have backup of your information, you know, um, just as a whole, and you have a way to maybe do an export if you need to, to get your information out of your, whatever system it is that you're using.

[ 00:34:37 ] But yes, from a transmission point of view to the payer, always make sure you have those credentials handy. And you even said, you know, to the furthest extent, the paper option, you and I are both technology people, you know, vendors in this space and, you know, paper makes me cringe a little bit, but if it came down to it, you know, it's, it's important to have, you know, maybe some hard copies in your back pocket. Yeah. Or I would even add that at least the ability to produce those, you know, because as you said, we've become so used to electronic that, you know, for, if for some systems, there's just no way to produce an actual form.

[ 00:35:17 ] And so you just, or maybe there is, but you just don't know how to, so it's worth getting ahead of that and just knowing how to do it in case that something like this comes up, you have it clearly earmarked, and you know how you can handle these scenarios. A kind of off-the-cuff question for you, just as we're kind of in this, in this mindset right now, what, what would you advise providers to do right now to just like protect their data? You know, like start thinking, thinking smarter about like data accessibility, data security, like any just kind of like quick wins or quick like CTAs for providers right now to just consider, you know, if they're getting maybe a little complacent or haven't like checked in on this stuff in a while.

[ 00:35:56 ] What would you tell or advise providers to do in the short term to just feel more secure about their data and their information? Yeah. So, I mean, obviously I don't want to, I'm not a cybersecurity expert, but I can tell you what experts are saying that I've been hearing at least. So, from that point of view, firstly, I'll tell you, even from Paradigm's point of view, we actually started this a while back, we realized the importance of cybersecurity. And so, we were actually able to engage with one of the top companies in the world to assist us with ensuring that all of our systems were at the level that they needed to be. Because, you know, you can obviously only do so much, but you want to make sure you're doing the absolute most that you can.

[ 00:36:44 ] So we're talking about very practical things like secure passwords. I mean, just that's a very basic one, which oftentimes we just get so tired of, you know, having to enter in a long-winded password. So, there's some very strong tools out there which you can use. But I'll say this, and actually it's something that I heard just today from a representative from Microsoft. And they were saying that the monitoring system was something the monitoring saying to the group that you know for most or, I don't know if it's most or almost all cyber-attacks occur from third-party systems, so is that something to be aware of? You know, it could be from your email vendor, it could be you know through, and it oftentimes is where they collect information about an individual and then kind of communicate with them from there.

[ 00:37:35 ] And it could be from there, so of course just make sure you're working with trusted partners, you know, and just feel at ease about from a security point of view that what you're doing is as good as it can be. And outside of that, I mean, you just have to use common sense, I think that's the bottom line. Yeah, the thing that I was going to add on is there's a lot of cyber security training out there and I've been through my share of them and they're a little bit corny and funny and they seem like you said, like, common knowledge, and we live in a very tech-heavy world, you know. We're all entering.

[ 00:38:12 ] passwords like you said on a daily, you know, like almost minute basis on our cell phones but you know just making sure your team is aware of you know just the really common you know scenarios that they can come across where people are you know trying to you know weasel in weasel into their data and their information it's happening so frequently people are getting smarter getting better obviously they're you know primarily attacking like what's going on and what's going on and so I think that's a really large organizations like change but it starts with an individual you know at that company that you know it's like it really does come down to like the personal one-to One uh people, and scenarios that escalate massively and impact you know major organizations, yeah absolutely.

[ 00:38:56 ] And I'll add one more important aspect to this which is it's not so much a cyber security aspect but it's just understanding your business. So, imagine that if everything goes offline, you can continue running your business, meaning make sure that you don't have any um you know what you would call it... um hidden areas um of your business which you're not necessarily familiar with. Um, make sure you're able to continue down you know to run and do what you need to do to care for your patients but not have any blind Spots, yeah, like we talked about before, just having backup plans in place, you know. Home care is relatively fragile, you know. Margins are really thin, and like we talked about, it's not a lot of cash flow, you know, on hand all the time.

[ 00:39:43 ] And so I think this conversation is just warranting, like, have Plan B's, have Plan C's, go down these paths, be aware of, like, like you said, maybe the hidden areas of your business that are more vulnerable to you know circumstances like this. I think that's just a good call out, you know, for owners to be kind of broadening their mind to like the possibilities and how things can, you know, go awry realistically. And you know, you know really quickly in in situations like this and just how to, how to prevent it, you know that was one of the questions I wanted to ask you, like you know, was this preventable? Is this preventable? Do we foresee this happening more in the future? What are your thoughts?

[ 00:40:21 ] I'll be honest, I don't think um, you know, it's kind of like in general in the security world, um, they say nothing is really preventable, right? You could just try and um, you know, just keep you, keep you put up as many obstacles as you can to try and make it not worth the attackers' while um, but what's interesting over here is that the FBI actually took down The data servers of this hacking group, in particular, just in December 20,23 so it wasn't that they weren't under watch um or they were not rather under watch of the FBI. They were you know, and they were already there and yet they still were able to somehow perpetuate the threat of the FBI.

[ 00:41:07 ] attack um and you know we were in the scenario today um so I would say that I don't know if prevention was entirely possible, but I just hope that someone like an organization like Change or Optimal United will really have done everything they could have to prevent us because uh and the catastrophic aspects of this is very concerning. And so, I hope they've done everything that they can, um, up until now. Only hope that this is making everyone think harder, longer about cyber security, you know? I think that's a takeaway here is like you said, you know, we hope that they took all the measures they could but now, you know, we hope that everyone is really aware and has a heightened awareness for you know what can happen and how quickly things can escalate and that we're all just taking this very seriously, um.

[ 00:42:00 ] You know, as it pertains to the future. Absolutely couldn't agree more. I do want to talk a little bit more about the FBI and the FBI and the FBI and the FBI Paradigm, I feel like it fits in really nicely into this conversation, I'm wanting you to just share a little bit more about what you all do and how you all help providers. We're talking about topics that are very you know relevant to what you all do so um don't be bashful just give me you know a few, few minutes about what specifically you all do. I know there's like a few different areas of things you know from credentialing all the way down to the processing the claims but tell people you know I don't know how you bucket or organize what you do but kind of give more detail about what you all do, and I'll see you in the next one bye do that.

[ 00:42:37 ] Helps home care providers, sure. So um, you know I kind of shared earlier and um, I want to try and share some examples maybe which would be of help but um, what we're really here to do is to ensure the success of the providers who we work with, you know sometimes you know we could be seen as a billing company because that's the biggest, the most impactful function of what paradigm is doing but one of the premises that we live by is that we will have our providers back in every situation and we'll ensure that we can help them navigate the path in whichever way is possible so as you mentioned we, we have different elements of what We do Um, and starting from enrolling with new payers, so we want to make sure that there's as smooth a process from when you want to engage with a or rather even think about it - expand your business.

[ 00:43:33 ] We'll find the most opportune payers for which number one will work with the services that you're providing. We'll give you fair reimbursements and um, obviously strong reimbursements where it makes sense for the kind of care and maybe you're you utilize family caregivers and so therefore you don't mind if your margins are a little bit lower. So, we'll work with you to find appropriate uh payer lines that you could work with. But then, once you get into that, we even have an education department which will actually train you on receiving your first authorizations and engaging with you, and then we'll be able to help you with that payer further. And so, the idea is very simply that we just remove all those obstacles. I'll share um one of our earliest Medicaid providers ums which we worked with um who was based in Texas and in Texas there are unique EVB requirements.

[ 00:44:26 ] They actually just recently changed end of last year but um prior to that they were working with a system called Vesta and um this provider was working with their scheduling software. However, there was no allowed integrations between these systems, so if you can imagine you have caregivers who are clocking in and out of the Vesta EVB; the data was then going over to the state's mandate, State's Aggregator which was TMHP, and the scheduling was all occurring in the Scheduling Software, Payroll and Billing were also occurring there. So, you have these three separate systems where there was just no way to make sense of are we getting paid what they're actually providing? Are they getting paid properly, a fair wage or are they not?

[ 00:45:13 ] And it was just a complete disarray, and we sat down with the Provider, were able to say hey we can provide you with a clear report of all the systems and tell you exactly what needs to be updated if anything and we assist with that also to ensure that the payroll and the billing is clear and ready um and is accurate to what the actual EVV data is and so we're able to provide you with a clear report of all the systems and data showed and I’ll add additional um interesting parameter to it that that is within taxes specifically is that even if you are at a visit and you're say for example you clock in for four hours to a visit and um meantime you have you have only three hours left on the authorization so You say you know what we're just going to bill for three of those hours if you bill for three hours but you had four hours in your EVB, you're not going to get paid.

[ 00:46:07 ] They have to be identical, it has to be four hours in the EVB, four hours in the billing, and so we were seeing that with this particular provider that they were just they weren't getting paid, they weren't nothing was happening. And what happened right when we implemented the solution and we ensured that everything was in line and everything was getting built appropriately, all of a sudden, they were able to double their business and scale their business up because. They said, 'We can take on more caregivers; we can take on more clients. Um, because we have the ability to scale this where we can take on more clients and we can take on more clients and we can take on more clients. And we have the insight to know that what we're building, what we're paying is all fitting within um, what is mandated by the payers.

[ 00:46:44 ] So um, that's really, we will take it all the way to the finish line. And that's kind of where you know, I think the power of working with um, you know someone or an organization and I really feel this close to my heart that um, what we're doing is not just about you know billing and payroll, you know.' we're not just talking about you know we want all of our owners all of our providers who we work with to focus on the care that they're providing as I mentioned earlier I have a personal connection to that and I really feel that you know if you um if not and you're distracted from the care that you need to be providing and you're just worrying about the paperwork and the logging and all that it's really it takes away at who loses that at the end of the days from the client themselves and we would never want that and so we really want to remove all those obstacles and we really want to remove all those obstacles

[ 00:47:37 ] especially Understanding the fact that third-party payers are becoming so much bigger and so much more of a dependency of home care providers, particularly um, that what we've really want to remove those obstacles and those pain points to ensure that we can you know take it to the finish line, and I'll add to this, this piece of that, that what we've also been able to develop because we're working with so many different payer organizations, these excellent relationships and points of contact within the payer organizations, um, and so we've been able to, you know, trigger them to mass reload, you know, numerous times; we found issues on the payers' end where you. know their adjudication system.

[ 00:48:22 ] was just off target and was denying claims we brought it to their attention to be able to reprocess the claims which actually benefited not just the providers who worked with us but all the providers in the home care space and so that those are items which we continually work on and what we're implementing continue that is such fascinating data fields and I will just we try and make sure we have these active relationships with the payers to try and advocate on behalf of our providers. Wow. That was great. And really good examples that I think people can understand that it's so much more, you know, in my mind, I'm thinking like, what's the catch? You know, it sounds too good to be true, but I've seen it firsthand that you all go the extra mile. You know, it's not like you said, just billing and payroll.

[ 00:49:01 ] It's not necessarily just that. It's, you know, making sure the owners, the operators of this home care business are like, understand what's happening and why and how things work. And then, like you said, you know, the goal of us as technology companies is to offload all of these kind of manual, tedious processes so that they can focus on the care. You know, that's what home care is all about, is about the care and about the people. And how do we simplify and automate, you know, kind of the menial tasks so that people can focus on the people. I think that's, you know, the mission of technology in home care is to help the people focus on the people. And that's what we're all here for in Paradigm, does just that, you know, breaking it down, explaining it, doing it, assisting with it.

[ 00:49:46 ] There's so much that goes into it that you all are helping with. I want to maybe ask, maybe some of the common questions you get. Do you have coverage in all 50 states? I don't know, maybe approximately how many payers you all are working with. I imagine people ask me that, or maybe bring new players to me that I aren't working with yet. What does that territory kind of look like? Yeah, no, great questions. So, we do work in all 50 states. And in addition to that, we will, it depends obviously on the payer lines and what it is in particular, but we handle billing in all 50 states, period. To now from an enrollment point of view, we have different opportunities, which over time, we're going to be able to do more in the future. So, we're going to be able to open up.

[ 00:50:31 ] And I'll give you an example for in California. You know, Medicaid has been a very mixed bag of where is it worth going for providers, where is it not? Are reimbursement rates fair? Are they not? And the overall program has been very challenging to enter into. However, recently, they just released like their CalAIM program, which is, you know, far more robust, far better rates. And so, we've begun enrollment in that area now. So, before this, I may have told you, you know, we weren't handling enrollments. But the reason was very specifically that we couldn't encourage providers to go there because the reimbursement rates wouldn't have been worth their while unless they were in very specific locales. So that's kind of why. So, yes, we operate in all 50 states.

[ 00:51:24 ] And the I mean; the number of payers is technically in the hundreds when you think about the different programs that exist. And, you know, we – I appreciate it. And it excites me every day, you know, when I see that we're able to take the knowledge that we're learning from all these different programs and all different providers and in these areas, and we're able to say to a new provider, hey, we can really help you here, because we've seen, you know, 100 other providers who are in the exact same scenario. And we want to apply that here for you. And we want to, you know, in order, we want to get you paid. And it's really fulfilling. And it's I appreciate it so much when we're able to do that.

[ 00:52:08 ] Yeah, I love that, you know, maximizing opportunities for everyone, you know, as you all learn from providers, you in turn help more providers. And, you know, I'm like collaborative in nature, but I just appreciate that concept of we're, you know, we're all in it together. Yes, we have, you know, our competitors. But at the end of the day, we're all here to help as many people as possible. And when we, you know, raising tides lift all boats, when we all are doing our best and working together, we're quite literally able to help more people. And I think that's, you know, what paradigm is all about sharing your expertise. So, like graciously and openly, you know, you're learning so much about these, these billing sources, these payers, and you're so willing to share that information.

[ 00:52:50 ] And I think that goes a long way. Just one other question, maybe here to wrap up on what do what do businesses expect when they work with you? Do you all have, you know, a software or an interface that, you know, maybe interfaces with their AMS, you know, agency management system? Or, you know, when someone's using you all, do they have this experience where, you know, they're exporting and importing information, or they enter it all into your system? Or what is kind of maybe the technology piece of paradigm that owners can come to expect? Yeah, awesome. So, we rarely try to be, you know, agile and very agile. Very, very expandable in that sense that we'll work with providers from any type of background, you know, as you know, obviously, Miriam, we're developing together with Careswitch to have a seamless integration to be able to, you know, handle the information as it comes in and out.

[ 00:53:46 ] But we handle it from any of the scheduling software’s, we're able to receive information and also send it back. And while there may be different degrees of integration, we will always do the heavy lifting. So, we will always ensure that if there's reports that need to be pulled, we'll take care of those reports, and we'll make sure that they get processed, and everything will come back to your system as you need. And to your point, yes, we do. Absolutely. We have our own interface, where you're able to see all the claims or authorizations that you have. If there are renewals, which are coming up, we can help you to request the renewals. If there are payments that you want to track, we receive all the payments which come in, not the physical dollars, but we receive notice of the payments.

[ 00:54:35 ] So we're able to forward that to you and notify you of those payments and also put them into your scheduling software, you’re billing, and payroll system as needed. So really, we try and offer all types, for some providers, they say, hey, I don't want another system to work with. So, we say, awesome. Go for it. Stay where you are. We'll just take care of everything. You don't deal with anything outside of what you're used to working with. And for others, they say, I would love to see reporting and I'd love to see the symptoms. We have that all available. We know that not one size fits all. I think that's something that is unique about Paradigm, in that we like to feel like we're problem solvers.

[ 00:55:17 ] We would like to make sure that no matter what the providers want, they're able to do it. If they're not winning, then we're not doing our job and winning in the sense that they're able to do what they originally set out to do, and hopefully also be able to have a successful business and be able to take care of the people that they need to take care of. And I'll say this, I know we're closing up that if anyone is impacted by this and you feel like you're stuck and you feel like you have nowhere to go, or maybe you're just not getting any love or any help from the outside, feel free to reach out to us because we absolutely can help. And we're very creative.

[ 00:55:58 ] So even if it feels like you're in a unique scenario, we can try and help you navigate that and get you running as you need to be. Perfect place to wrap up and to end on. Paradigmseniors.com. If like Joseph just said, the thought that's coming to mind, if you need a shoulder to cry and if you need someone to empathize with, to talk through solutions, to problem solve with, brainstorm, there's no one better than the team at Paradigm. So, reach out to them. If this is in, if you're in this camp, Joseph, thank you so much. I know I've thrown kind of a lot your way and we've veered and kind of, you know, went a few different directions, but I appreciate you being nimble and speaking on the fly and speaking about such an important topic that affects all of healthcare and even, you know, us in home care and something that we need to be, you know, aware of in the future.

[ 00:56:45 ] And, you know, sometimes we have to learn the hard way, but I think we'll all be better, better off for what we've gone through. Yeah, listen. It's our hardest moments which shape us into becoming better. So hopefully this is one of those and we just have to learn how to grow and how to get better from here. Yeah, absolutely. Yeah. Thank you so much for being here again. Thanks for taking some time while you're on the road. We'll look forward to staying in touch as this continues to evolve. You know, we're finding out new information every day. I think this isn't the end of the story here as we find out more information. We'll stay in touch, and I recommend people reach out to Joseph on LinkedIn. He's active on there. This is where I found His article and the follow-up email will send out some of that information. So, thanks everyone, for being here, and we'll look forward to seeing you back again next week. Thank you, Miriam. Thanks, Joseph. Take care.