If healthcare wants to have better outcomes, then it must embrace digitalization.
In this episode of Bite the Orange, Carm Huntress, founder and CEO of Credo, breaks down their mission to automate and digitize medical records while addressing the challenge of outdated methods like phone and fax. By accessing national networks, Credo Health retrieves patient data and employs machine learning technology, among others, to analyze and synthesize information for providers, aiming to make medical records actionable. Carm talks about how the company focuses on value-based and ambulatory primary care providers seeking to streamline record collection, reduce labor costs, and improve patient preparation. He also explains how Credo Health offers pilot programs and different levels of engagement, with the ultimate goal of creating complete longitudinal digital records for every patient.
Tune in and learn about Credo Health’s solution for value-based care in the digital era!
FULL EPISODE
BTO_Carm Huntress: Audio automatically transcribed by Sonix
BTO_Carm Huntress: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today we have a very special guest. I ... Carm Huntress, CEO of Credo Health. So welcome to the show today, Carm.
Carm Huntress:
Thanks so much for having me, Manny.
Emmanuel Fombu:
Thank you. ..., Carm, so tell us about yourself.
Carm Huntress:
Yeah, I'm a longtime tech entrepreneur, I started my career in the Boston area, and I'm most well-known in healthcare for my previous company, which was called RxRevu, it's now called Arrive Health. And Manny, you know that journey as well as anybody in that we started in about 2013 trying to bring real-time drug costs to doctors at the point of care, and I spent eight years running that company. We finally, we did pull it off after a lot of years of hard work, we raised about 35 million in venture, and we scaled services from all the major payers and PBMs to the point of care to give doctors real-time drug costs, and we scaled that up to about 300,000 doctors, 700 hospitals, and that was a labor of love. It was a real mission-driven company and a very hard thing to do because when I started it, there was no real concept of real-time cost, and people just paid whatever the pharmacist said they should pay when they reach the pharmacy counter. So I did that for a bunch of years, and then, in the last two years, I've started this company, Credo Health, which is really focused on automating and digitalizing medical records. Both the collection and digitalization of medical records, which is a huge problem in the US. So I'm excited here to be here and excited to talk about it.
Emmanuel Fombu:
Carm, yes, I know the RxRevu journey pretty well, and I think it's quite impressive the amount of time you spent there on of work and the team behind you in getting that done so, I can vouch for you, and I think we have a very solid team, and you have a very strong vision to make these things happen. So with that being said, your current challenge with Credo Health, I know being in healthcare, I think fax machines are things that are of the norm. Getting medical records is a massive challenge in general, right? If you go to any one particular doctor and you have your medical records just to get an get access to it is a massive challenge. Getting even getting tests done is another challenge, right, to get the results and everything else is pretty complicated. So what was the particular problem that you're trying to solve here that you spotted?
Carm Huntress:
It's bizarre that in 2023 we're sitting here talking about phone and fax. Most Americans outside of healthcare rarely ever even use a fax machine. I don't own one, they don't really exist, yet in healthcare, we fax about 9 billion pages a year of medical record data. And so you sit there, and you say, this is insane, that we're still doing this, and we're really doing a huge disservice to patients. And that was really my endeavor to say, hey, if we could get complete digital medical records to patients, would this be incredible? But really started to see this when I was at my last company of just the insaneness of trying to move records around, and interoperability was starting to form when I was working at RxRevu, and we did these really interesting integrations into electronic health records like Epic and Cerner. And I saw this sort of insane moving around this unstructured data and going, this makes no sense. How would a provider even dare take care of a patient with a large record to sort through all this stuff? And so Credo really came out of learning a lot about that, and especially what I think is we're in this decade of digitalization. We've got 80%, 90% penetration of electronic health records now, most people have some level of digital access, and we've got regulation coming out of the 21st Century Cures Act now two years ago saying, hey, let's create a national network of interoperability and move around records. Now a lot of people say, oh, this is going to be so easy and fantastic moving from phone and fax, and we mainly work with providers to do this, moving entire individual groups, clinics, nurses, and groups of clinicians from traditional phone and fax to a full digital infrastructure is a massive undertaking. Most of these organizations lack the engineering, the vision, and thus the time it takes to implement a digital solution here, and so we're really out there working a lot. We can talk about what type of organizations we're working with, but helping providers, especially, make this transition away from traditional manual phone and fax to full digital, complete digital medical records. We're pretty excited about it. I raised, we just briefly on the company, we raised 3.5 million last year, and we've had we've got a great set of initial clients that we're working with, mainly value-based providers, and we're really excited of the progress we've made since founding last year.
Emmanuel Fombu:
And Carm, I think it's quite impressive as well. When I went on your website, and I was looking at the solution they provide you, not only do you provide, you know, information providers, but you actually make that information actionable. In one case, I think I saw you ... The screenshot of the ... Rx piece right there, right? When someone comes in, and you say, hey, I noticed you are on a statin or something, and then you could actually save some money by actually ordering your, like doing delivery or something of your medication. So you actually make this information actionable. So, in general, so tell me how the product works. Is it only for providers? Is it only for patients? How does it work?
Carm Huntress:
Yeah, today, we're really focused on value-based care providers, and I'd say one of the things I think, Manny, one of my big discoveries in this is, hey, why don't we all have this portable medical record? Why aren't we all walking around every other industry? We have all of our data on our phone or access to it in the cloud. Why don't we have this for our medical record? This seems obvious. And I think one of the things I discovered was this sort of weird, perverse incentive. If I'm a fee-for-service provider, and let's say you just went and got a bunch of tests done a month ago, and you show up at my office, and I said, oh, I got my medical, I can go get my record, right? It might take a lot of work, a lot of effort, but I can get all my data. The doctor says, oh, let me just rerun all the tests. This is much better for me, right? I can charge you and your insurance company to redo everything, right? And so in a fee-for-service model, there isn't aligned incentives to say, hey, let's take the effort to just go get all your data. And what we started to see, and we were looking at different segments of the market that value-based care providers were sitting there saying, hey, I'm going to take a fixed amount of money for a patient, and we tend to work in Medicare Advantage. This is super valuable, right? If I want to know exactly what's going on with you, I want you to know your whole history. I want to know how best to treat you so you don't consume a lot of healthcare, right? I want to optimize your costs, and I don't want to rerun a bunch of tests. I want to know your history. And if you've already had the test done, why go, why spend the money to redo that lab or other type of test? And so we really got focused on value-based care providers. So what we do is we tend to work off, they have a schedule or a list of patients that are coming in the next month. They send that to us, and then we have both a team of people as well as digital services that go into what are known as the national networks, and so this is things like Care Quality, Commonwell, and eHealth Exchange. Our technology goes into those networks, takes your data as a patient, your demographic data, first name, last name, date of birth, that type of stuff, and we pull back all the data on you. And so, on average, today we have about a 74% success rate. We get 43 documents per patient. Now, we all, we tend to work in Medicare Advantage, so these are 65 and older people with pretty long medical histories. And then we pull all that data together, and then we also have a team that can still manual phone and fax, and that probably makes us a little bit more unique. We're not trying to be full digital. We get that the market is in transition, and we see a lot of really high-value data in still phone and faxing because you have a lot of these rural providers who might not be connected into the fully digital today. We pull that data together, and then we use both a lot of technology and now machine learning a bit with humans to actually analyze that data, all that data, and bring it together in a synthesized sort of report for a provider, and we mainly focus on diagnosis support. So can we, today our main models are focused on, can I abstract out of this huge hundreds or thousands of pages of documentation, exactly what are the patient's current conditions and existing conditions and then get that data to the provider to support that encounter? And we think this is an essential service to value-based care that really hasn't been delivered to the market today. So that's a little bit about what we've done, and we've had really fantastic results. We've dramatically impacted treatment. These patients are better taken care of. And ultimately, in Medicare Advantage, if you can risk adjust the patient better, that changes your premium and how much money you make off a patient because you better understand their conditions and therefore treat them better, but you do end up making more money. And so that's really where we've hit our sweet spot to work with these value-based care providers in Medicare Advantage. So I know that was a bit of a long answer, but that's our end-to-end solution today that we have in the market.
Emmanuel Fombu:
That's quite actually interesting. You mentioned getting data from these exchanges, which is quite interesting. So if I'm a Medicare Advantage patient and I live in New York, and I happen to retire in Florida, for example, where I changed doctors, does that throw things up, or am I able to have the app, for example, and carry my information with me? How does that work?
Carm Huntress:
Yeah, so today it's these national networks only allow for treatment use cases. So the first thing is you have to be seeing what your doctor for us to use, leverage these networks, and that's part of the reason why we work with providers today. There isn't an individual use case, and we can talk about why that hasn't happened yet. It will come in the coming years, but the focus today is provider-to-provider, and that's a great use case where I'm, I spend half the year in Florida, for instance, but all my medical record and all my providers are in New York. We have access, our network's about 85,000 providers now, different health institutions, different health systems, and we can pull from those. So it's, if you're going, if you're in New York and you're at a Hackensack and big systems like that, it's highly likely we have your data, and we have thousands and thousands of connections in New York alone to pull that data together. So if you're seeing a doctor down in Florida, we can support that use case and trying to get that all together. And it's pretty meaningful because one of the great, if you don't have these national networks, you're really stuck to a release of information the typical way you do it, where you fill out a form, you say, hey, here's my previous doctors, and then you hand that to the clinic staff, and they go and fax that off and get the data they get back. What we found in most of our research, Manny, was, the patient will say, oh, list your previous doctors because you don't know where they got care potentially. And they say, Oh, Doctor Smith, And you say, where's Doctor Smith? I don't know. I just know their name, Doctor Smith. And you say there's probably a thousand Doctor Smiths in the country. And this is the reality of it, where the patient can't even really remember, hey, was it, where did I get that care? And even for me, I try to think back. If you think back through your medical history, where was that clinic? I went and got that consult where, I remember the building, I remember the address. But God, if I had to phone and fax and not only find out who the doctor is and where their location is, but sometimes that record can be stored somewhere completely different, right? You can be working with a subsidiary of some big system where they're using Epic, for instance, and to get the record, it's up at the level at the mothership and not at this small clinic owned by this big health system. So there's a lot of fundamental challenges in, when you think about our current state of phone and faxing a lot of this data, it's really broken. And so national interoperability is allowing me for just to take demographic data, under a treatment use case where I'm seeing a doctor, and the doctor can just say, hey, I'm just going to take your demographic data, I'm going to hit the networks and get back as much data as I can on you. I will say, Manny, I've been really surprised at how good the, both, I wouldn't say the quality of the data is good yet, but the quantity of data is there. We can talk more about the unstructured nature of the data we get back, but the quantity is really starting to get there. Now, we still think there's missing pieces for most patients that we're not getting today, but we're really starting to see large amounts of data appear for these patients on the networks, which is pretty meaningful, and I think is going to really start to impact care, as we've already talked about.
Emmanuel Fombu:
Which is quite impressive. I think the first step is getting the data sets right. What you do with it is another part of it. But so, are you getting data from like birth, for example? Are you getting data for the last five years, ten years, six years? How far back can you go?
Carm Huntress:
As long as the record has been digitalized, we will see it. And there is data on the network plus ten years back, I think only about 20% of the data on the networks I saw a chart of this recently is ten years plus back. Now, Manny, this is the part where we get into the discussion about quality of the data. We literally see it for your healthcare people. We see every format you could imagine. We do see scanned PDFs, we see image, Tiff files or jpeg files of scanned documents, a lot of handwritten stuff. We see CCDAs, we see fire records, we see CCDAs embedded in fire records. We see HL7 records both V1 and VH2 HL7 records, and that could be one patient, right, where we have that whole history. And then you open up one of those documents, and inside of it is 50 to 100 pages, and there's this thing in the middle somewhere along that if you're scanning through those documents called the progress note, that goes seven pages of hand type stuff that is completely unstructured with a lot of acronyms and a lot of references to things that may not be totally clear. And this is where we're spending a huge amount of time because today we're focused on, can we identify the problems you have, What are the potential diagnoses or diagnoses you currently have? This becomes really an AI and machine learning problem, and we think we're on the forefront of some of this. We are testing both heuristic-based models as well as some of the new large language models that like OpenAI and others, but there are some specifically tuned to health, for healthcare that we've been testing. So we're really excited about, now that we've opened up the floodgates to the data, how do we make sense of it? And to our earlier conversation, actionable insights, right? That's the big, exciting thing that's going to come out of this, as I can now create personalized recommendations to you based on your medical history because we have now have access to this data. So that's what's really exciting about where we're headed and what we're seeing out of some of our initial work in this space.
Emmanuel Fombu:
I think it's perfectly timed. I think you are doing the right thing at the right time. I mentioned OpenAI, and I'm looking at that and looking like ChatGPT and all the different technologies that are coming out in that particular space. I think it's just fascinating when you're able to take all this information that you have right now, you're building a foundation, I think it's a good way to describe it. You're creating a solid foundation, and then you can apply these technologies on top of it. So right now, who are your ideal customers, and how do you go about, because I want anyone listening right now to this podcast ... exactly what you're doing. You have some technology, so you're looking at the ideal provider, how do they reach out to you? What's the ideal customer right now for your business?
Carm Huntress:
Yeah, yeah, I would. We've really focused on ambulatory primary care value-based care providers who have a lot of manualized, they might have decentralized or centralized teams phone and faxing, traditional getting records for patients that are coming in to see their providers, and we can just take over that whole process. Not only are we digitalizing this and supporting the treatment of the patients, but we're taking a lot of labor costs. Most of our, at least our surveying our clients, they're saying they spend about an hour of time doing phone and faxing, prepping a patient for a visit. If you think about all the forms and the phone and faxing and follow-up calls, it's about an hour of time. So we're also really supporting those value-based care organizations that are in the outpatient world that are doing ambulatory care, that care about value-based care, and are trying to best treat the patients with this. There's a lot of these providers in the US, and they're growing very fast, or they're taking delegated risks from providers, and we think we're essential solution around provider enablement and provider success in these markets like Medicare Advantage, where you see these managed service organizations trying to take on risk and support a population of patients that really could benefit from having the complete medical record and trying to appropriately prep them, going into that first encounter with the provider and making sure that they're ready for that visit and the provider understands their history.
Emmanuel Fombu:
And I can attest to the fact that many of our listeners actually fit that perfect demographic you just described and could work for Carm. I worked with Carm in the past, and I have no doubt about the capabilities of what he could deliver in this particular case. But with that being said, someone listening to this, that ideal customer, understand that you have three different pricing structures. You have a basic, corporate, and enterprise-level kind of piece in terms of how you price. So can you give us a brief overall version of this?
Carm Huntress:
Yeah, for sure. I will first say one of the best parts about our solution today is we do a lot of pilots actually, we do these all the time where we just come, we'll walk into a provider group, and we'll say, hey, give us 20 patients. Let us show us 20 patients that are on your upcoming schedule. Let us, our team come in and just do 20 patients, and let us show you the results, and that's one of the easiest ways to start working with us. So if you're a value-based care provider and you just want to try us out, you can just do 20 patients with us, and we'll show you the results. We'll show you the impact on both labor cost savings, as well as getting the patient appropriately ready for that first visit with all their diagnosis, all their problems, all organized and summarized for that first visit. We have different levels depending, we work with small groups that can be just a few centers all the way up to very large enterprise, hundreds of clinics. Probably our largest client is in probably 100 to 200 clinic size in terms of ambulatory footprint. So we have different levels of engagement depending on what they need, and ultimately, it really matters if they want us to fully take over the service, right, of getting records, not just do the digital, but we do manual. We're really tied into their scheduling, and we're supporting it. So it's really about a level of, are we doing this from manual to full digital and how much support we're giving you on pricing. But we're, our pricing is what's also great about our pricing is, we're pure transactional. So you just whenever you need us, you just send us patients, and we go get the data and get this together for you. So it's a very easy model for most providers to put into their operation and scale up as they scale up, because a lot of these value-based care providers are scaling very. We just saw what happened with Oak Street these few last weeks and CVS. That's a good example of a value-based care provider that's scaling very fast and needs these types of services.
Emmanuel Fombu:
Yes, which is quite, I think the pricing model actually works quite well. But if you're you're curious, you're not an early adopter kind of person, right? We want to test this out to make sure it looks like, there is a free version to run the pilot. And I'm confident once you try it, you will continue ... in the next category of things that should go forward. So now, with that being said, what are, so what is the road like ahead for you? What are the challenges, or what do you mean, what do you hope to accomplish in the next year?
Carm Huntress:
Yeah, look, I think I'd rather be lucky than good sometimes. I think it's about return on luck, and I think the real lucky thing that Credo has hit upon is we have this great use case in Medicare Advantage with value-based care providers where, we really spent last year collecting all this data on patients and then starting to summarize it. And Manny, I think the future is when we can use a lot of these new AI and ML models to fully structure records. My vision is where I can hand a provider and say, here's the patient's diagnosis, here's their labs, here's their imaging, here's their procedures, here's their medications, and you can track that over time, you can do comparisons in real time of any of that data, and it's perfectly well structured across your entire history. And I think the first company, I think it's a 0 to 1 moment, and hopefully, we're the first to achieve it in structuring that full digital longitudinal record on a patient. And I think the company that does it is going to open up so many interesting doorways, some of which we've just touched on about the things we can do now. Once I have your complete history in a digital format and I everything's structured, everything's tied back to a taxonomy, which I can understand. I can build personalized recommendations, and I can build AI tools around your data to help recommend what's the next best thing to do to improve your health, and how can I support you and your provider in that discussion of what's right for you and your treatment around your diagnosis and what you've tried and what you haven't tried. And that, for me, is really what Credo is onto, and I think the bigger mission we are, yeah, we're really focused on Medicare Advantage and finding diagnosis today, but the future for us is really in that complete longitudinal digital record for every patient. And my 2030 goal that I have with the team, is we do this for 100 million Americans by then, by 2030. So it's a pretty ambitious goal, but I think this is the future, and this is what's going to happen in the next decade. So that's our future and our big audacious goal, Manny, and I'm very excited to be on this together, and if anybody wants to learn more, it's CredoHealth.com.
Emmanuel Fombu:
Now, that's quite fascinating. I love the journey, and I love that mission. I think it's quite incredible, and I don't think there's anything better than that, right? Really understanding your patient, right? The patient getting like the best insights that could possibly have. And I love that goal that you're heading towards, and I hope every listener that fits the demographic you're going after, please reach out to Carm. Let's join this movement, let's help him achieve that goal. And it's better for all of us, I'm sure we'll all benefit from this one day in our lives, our family members will benefit from this. So once again, thank you for coming on the show, Carm. I hope to have you again sometime soon and to see how you're progressing with this. Thank you.
Carm Huntress:
Yeah, thanks, Manny. Thanks so much for having me.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Carm Huntress:
Carm Huntress is the Founder and CEO of Credo, the leader in automated patient medical record retrieval. He is an entrepreneur and strategic leader with over 20 years of experience in startups focused on consumer and enterprise technology. His first web development and hosting company, which he started while in high school, was eventually acquired in 2001. After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations. He was later asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Ventures start-up. After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high-end audio site in the world. He managed the transition of the core technology platform and team for growth. He moved to Denver, where he founded RxREVU, where he currently remains a strategic advisor. In January 2022, he founded Credo, where he and his company are working to radically simplify and update the current medical record and retrieval process to support patients receiving better overall care.
Things You’ll Learn:
About 9 billion pages of medical record data are faxed in healthcare annually.
Credo Health uses machine learning technology to analyze and synthesize medical record data, retrieving patient data from national networks such as Care Quality, Commonwell, and the eHealth Exchange.
The progress note is a specific section within a medical record that consists of approximately seven pages of hand-typed, unstructured content, often including acronyms and references that may be hard to understand.
Credo offers pilot programs for providers to try their services and evaluate the impact on labor cost savings and patient preparation.
Credo’s long-term goal is to create a complete longitudinal digital record for every patient, offering a comprehensive medical history overview.