How leveraging geocoding and validation enhanced data accuracy and compliance

Curatus, co-founded by Mark Fabiano, his brother Cory, and Jarrod Mandozzi, operates within the healthcare technology sector. The company focuses on data curation and cleansing, hence the name, and data enrichment for health plans. They ingest vast amounts of data, which requires extensive mapping, normalization, and comparative interventions. The company uses advanced analytics to ensure compliance with government regulations and optimize revenue factors in healthcare insurance. Its mission is to “Improve outcomes for patients and health plans by connecting, relating, and curating accurate provider datasets in a timely, cheerful, and efficient manner.”

In the United States, 189 million Americans are enrolled in government-sponsored healthcare programs, including Medicare, Medicaid, and the Affordable Care Act. The payment models for these programs involve variable revenue factors based on risk, eligibility, and quality.

The Centers for Medicare & Medicaid Services (CMS) found that 45.1% of provider directory locations were inaccurate. Accurate data is crucial for health plans to manage these variables effectively. Thus, the opportunity for Curatus to help these payers face-off against significant challenges with bad data, largely coming from their own contracted network partners.

“What we knew was that health plans were contracting with 3-7 different vendors who were dealing with one aspect or another of their provider data,” said Mark Fabiano, CEO of Curatus. “The average duplicate rate was sitting at 1.8.”

For example, one health plan listed a single provider 333 times in its database when in reality, it was only one doctor. Such duplication and data inaccuracies created the opportunity for Mark, Cory, and Jarrod to bring a solution to market to clean and enrich healthcare provider data to ensure compliance, reduce costs, and optimize business process efficiencies.

Shirland Whipple, Vice President of Operations at Curatus, also expresses his concerns.

“When people do a doctor search, they’re looking for a primary care physician or specialist convenient to their home or office. We have to provide real-time information about all available healthcare providers. Providers no longer practicing in that area, not accepting new patients, or perhaps even under sanctions by one or more government entities must be excluded from a payer’s online directory. The insurance company must also immediately block any referrals or claims payments to those healthcare providers until such time that the sanctions are released.”

Mark Fabiano agreed, saying, “It’s against the law to pay a claim using federal dollars to a healthcare provider whose license has any sanction attached to it.” He elaborated by stating that “health plans can be fined for paying a claim to a provider who has been sanctioned by the Department of Justice, the State Medical Licensing Board, the Department of Health and Human Services, etc.” He emphasized that being able to provide timely and accurate data for their health plan clients was crucial for Curatus’s success.

Curatus switched to Smarty after being referred by a colleague. This individual had seen improvements in their own industry from implementing Smarty's address validation tools, so the consensus became, “Why not give Smarty a shot in helping Curatus?”

“We had a team of people looking at solving this problem,” said Shirland.

He went on to say that in doing a side-by-side comparison of sanctioned, state, and federal data, it made sense to make the switch from their current provider to Smarty.

KPIs for choosing Smarty:

Mark Fabiano drove it home when he said, “When we notified our former vendor of our intentions to switch, they offered to match Smarty’s rates, but we still elected to make the switch. Our interfaces with you guys have been much more user-friendly with much better automation, so there were more reasons than just pricing that we switched.”

Curatus integrated Smarty's US Rooftop Geocoding validation tools into their systems, pushing through large datasets to clean and verify addresses and secondary address information such as doctor suites and unit numbers.

This included federal and state data sources and sanctioned data to ensure compliance with regulations. They also used Smarty's geocoding capabilities to enhance their data with precise location information.

Since implementing Smarty solutions, Curatus has realized:

Curatus continues to leverage Smarty's tools to maintain and improve its data quality. It has expanded its use of Smarty's services, incorporating additional features such as alias address identification and enhanced geocoding.

They also look forward to the future with:

Curatus's partnership with Smarty has proven to be a game-changer, enabling them to clean up bad data, improve operational efficiency, and ensure compliance for their health plan and provider group clients with numerous federal and state regulations. The switch to Smarty hasn’t only optimized their revenue factors but also significantly enhanced the quality of their data, making Curatus a reliable and efficient player in the healthcare data management space.