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

Episode Date: March 19, 2024

The healthcare sector just got hit with a cyberattack that could be the most significant in its history. Joseph Dworcan, VP of Product Strategy at Paradigm Senior Services joins us to discuss what happened, who's impacted, and how providers can better safeguard their data.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

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 equally important and exciting and interesting for all of you. So today I'm joined by Joseph Vorkin. 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. 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 do Paradigm more justice, but all things third-party payers, they know what they're doing. They're working with hundreds, thousands of agencies processing these claims and doing all of those things. So 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 also appreciate you jumping on last minute. I know you're a busy guy. You're actually on the road right now. You know, just 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 to talk about this specific topic. So just so everyone's aware today, we're going to talk about the change healthcare data breach. I'm sure you've read headlines, seen it in the news. That's what we're going to dive in to talk about today. What happened, you know, how things are going and what does it mean for healthcare providers and home care 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 you were doing before Paradigm, you know, how you got started at Paradigm.

And then, yeah, take a minute to introduce Paradigm as well. That would be great. Sure. I am the Vice President of Product Innovation Strategy at Paradigm. I've held many roles there. I was there from right from the beginning of Paradigm. And I started with when we were just, you know, piloting our product, working with some providers right at the beginning in the 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.

But, you know, I was always drawn to both the technology side, but also, you know, helping providers actually had 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. And, you know, as you mentioned, Paradigm, you know, a lot of we're known to be assist with third party billing, and working with third party payers. But it's interesting, because, in a sense, we're, while we do that absolutely as part of our mission, we are really here to remove the burden from providers when you're working with third-party payers. You know, there are so many aspects to this. You see this a lot with each of the pay lines in their own unique way. And, you know, to why I wrote this article

and kind of how I see it's close to where we are is that Paradigm uses technology like this, similar to Change Clearinghouse, in order to process the claims for the thousands of providers who we're working with. 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, owners can be prepared when this does happen. So 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 not able to run payroll. And that's where we really try to come in and make sure that we can get them back up on their feet and get things running smoothly again. That was perfect. Perfect segue into this topic. And later on in the conversation, we'll talk about like, you know,

Paradigm's role in this, how it's applicable, you know, how you influence providers and in a similar sense. So let's kind of dive in here and talk about high level overview. What happened? You know, there was this data breach,

you know, who, what, when, where, how? Like, let's just kind of start high level. What happened and when did this happen? Sure. So Change Clearinghouse is, well, I'll start off with the fact that Change is actually was purchased by United Health Group, which runs an arm called Optum. 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 clearinghouse, um, in order to be able to have what is probably either the largest or the second largest clearing house in the country, um, clearinghouse, meaning that they receive all transmissions between a provider

who's providing the care and a payer. And they could be serving them on just the payer side or on both sides. So what happened is there was a major data breach where a hacking group by the name of Alpha V, or also known as Black Hat, 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 changed slash united slash ops

and took down their services. A total of 111 services were taken down in order to preserve whatever they could. And at that point, consequently, they actually, at least it's reported that they may have paid a ransom in order to try and receive the data back. And that was an amount of, I believe, $22 million in Bitcoin. So that's still unconfirmed, but that's kind of where we are today. Awesome.

Yeah, that's a great overview. For anyone listening to this that hasn't heard, that was a perfect summary of what happened. So I want to kind of start in this direction, actually. Change, you mentioned, is owned by United, who also has this arm, which is Optum. 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. 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 from a provider's point of view um the provider is already mandated to work with United Healthcare you know on our Optum especially if they have a government contract on the Medicare Advantage space and the Medicaid space and even in the VA space.

And they're having to work with them on that end. And 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. And so there was a lot of pushback with 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 did go through. Now, why it 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, where, you know, we were discussing earlier that the number that I've been hearing is one in three medical records actually went through change on some level, which is pretty wild. Yeah. Okay. Okay. Yeah. That, yeah, we'll get into that a little bit more later on if you know like united's role optim's role etc so um going a little bit further after like what happened

what has changes response been you know like real time this happened we're 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 out. 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 for a lot of, not only for the pairs, because it also impacted them, they kind of went down and they said, Hey, there's nothing we can do. We're trying to protect you those who were using Change as a Clearinghouse, and many do, and we can go into that if you'd like.

But we had even had providers, I can tell you, who reached 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. And we were able to get them enrolled as a provider with the 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 her right away with the owner, was able to sit down

and right away within 24 hours, we had all their billing out the door. And we were 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 um but it was just she said she was on the verge of tears if you can imagine it was literally a question of a business going under um and so you know it was incredibly tough for both providers um and the pairs obviously, 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 do they respond?

They responded in a way which really accounted for the larger providers, however, not necessarily the smaller ones. 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 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? You just said, yeah, the funding option for smaller providers. What were the measures they took for the larger providers? So 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.

They had a more position of power because they were saying, hey, we're doing everything through you. We're using you already. And 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 really get to have a voice, unfortunately. And so that's where it really becomes challenging in that space. Okay. Okay. Yeah, that makes sense. 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 the provider point of view. And so for many providers, they'll integrate into their scheduling software, or they'll maybe upload something into changes at Clearinghouse and submit their claims that way. And as soon as that pipeline gets turned off, there's just no way for them to get their billing even to the payer 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 payer. If the payer is using change of the clearinghouse, the payer was never able to adjudicate and therefore

pay the claims. So that was just getting stuck at that end, if it even reached the payer. And then finally, even even the peers which did receive the claims some of them relied on changes 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 so um to your question in the case of, 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. Surprisingly, Optum of all the payers 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 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 back end side in their relationship with change as opposed to being their ability to adjudicate the claims. Okay. Okay. Do you have any sense of this is, you just explained it, you know, this is impacting

providers directly, but also impacting payers. So this question may be tricky, but any sense of how many home care providers were impacted like percentage wise? 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 space of how many were. I can tell you though, that we had a lot of providers who have reached out to us, owners who have reached out to us. And I couldn't quantify it exactly, but we've just seen a tremendous, you know, turn up where they kind of said, we just were stuck.

We need help. We can't, you know, we can't, we can't stay afloat. And we actually, for some, we were able to, we had some financial backing, which we were able to set up for them to really carry them over until those payments do come in, 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, their funding, their finances, you know, look very different than that of most home care agencies.

They don't have a lot of cash in reserve. So, you know, this hits home care very differently. And the margins are so thin, you know, there's not a cash flow is so, you know, differently structured than in healthcare. 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. Isn't that right? Yeah, absolutely. 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. And I'll say that from Change's point of view, they kind of said, you know, it only impacted maybe 8% of providers or something along those lines. Although that number is a bit skewed because for some providers, it could be their entire business or they could have had an alternative, but maybe didn't have the ability to set that up, you know, in an appropriate way. Yeah, I think that that makes sense. And, you know, like I was mentioning, if I'm understanding right, you know, it affects

providers directly, but then also the payers that are sourcing, you know, those providers. And that's where maybe that distinction is, could be massive is, 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. 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, additional lanes that they cover? Well, as a clearinghouse as a whole, 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 Ei electronic data interchange and that's where the information is transferred in a computer readable format and is transmitted and it

typically will arrive at a clearinghouse and say the provider sent 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. So if you imagine it's like a washing machine, then 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 is applicable when we talk about like data and data management and how your data is 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, 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. Meaning if you don't have the know-how of being able to say, okay, you know, this is a unique case, this is a unique payer, or there's a new requirement. I'll give you an example that just came up where the state of Indiana

is now requiring in 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, or where it's collected and placed in their clearinghouse, but accept it. But it's not something which is generally produced. And so it could become very difficult to track all those nuances which exist. And it also depends 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 um so in the case of indiana we right away we were able to build something out and you know we've we've been building the mandate actually just started at the beginning of this month so you know we've been able to include that in there but it's not it's not easy for someone it's just the technology'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, you know, carry it through. Is it the clearinghouse that makes those adjustments? You know, state of Indiana all of a sudden is collecting, you know,

X new data points. Is it the clearinghouse that decides that or there's also like, you know, government state regulations that are influencing this as well? Great question. So it starts really, sometimes it starts from a mandate, maybe they're not meeting all of their EBV 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 mandate it down the chain. However, if you were to submit a claim without it, no one would stop the claim from coming in. 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. Yeah. So quick, you know, shameless plug for a paradigm, staying on top of these types of regulations changes. They're relatively frequent. You know, 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, you know, 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 like maybe once a year, once every five years? So, yeah, I was going to say,

you know, 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 you know super regularly but it is happening and sometimes you know there may be even you 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. 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 you know the you know the president has even mentioned it um in in the state of the union and a number 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 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. And sometimes they could just be hard to track or just difficult to implement. Yeah, absolutely. I want to talk about the world where, you know, like the world without paradigm

for a minute where a provider has a relationship with someone like change, know it's like provider to clearinghouse which to my understanding exists is it 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 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 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 know, the scheduling software does support it, which typically it won't necessarily have multiple configurations, because you kind of just want to say, hey, Bill, and then it will go to your clearinghouse, you know, simplicity over, 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 just say, hey, I want to create the account and then it kind of does that. 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 have payers that then use change, that 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.

So, or sometimes even worse, it actually just gets lost and you didn't even know that it got lost. So that can also occur. So yeah, when the payer 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 but however the the at the end of the day you know for a lot of the providers it was just sitting there on their end 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, the anxiety in those moments of not knowing, and no one really has the answers and not being able to control the outcomes. Yeah, absolutely. And I've seen, I've seen, it's, 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. 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 what's unique about from day one, I'll tell you, 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 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 payer. So we'll say, okay, and sometimes even more than two. So we'll say, okay, we can 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 payer'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 method. And in an OSC case scenario, of course, we can always mail the claims or give physical claims to the payers. So those are all options. And I'll take it further that

where we're kind of going with this 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 net relationship, especially because I feel like this is such an important piece of the healthcare industry. 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 do you think home care providers were thinking in that context of, 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 an interesting story that also came up recently now with the breach. We got a call from a provider and they said to us, hey, you know, we really, 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 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. So it's multiple invoices and it's multiple. They said, 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 need to find a way to get it out. And so when they came to us, we got a similar reaction where they just, you know, they said, 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 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. And I believe this was actually a scenario where we said, hey, if for whatever reason, the payment didn't come through in time 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 scenarios like this. But what advice would you give to providers? Is that the best backup method, is being familiar with the payer portal, knowing how to submit claims there? Or like, is that the best backup method is being familiar with the payer portal, knowing how to submit claims there?

Or like, is that the best alternative? Or are there other alternatives that you think providers should like 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 the payer is always, always make sure that you have your portal set up with them and keep those credentials handy. I've unfortunately also seen

situations where providers have maybe, you know, one of their employees have set it up for them. The owner never actually accessed the portal 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? Can you make sure you have your setup, your access to the portal? And they'll say, oh, I don't know, someone else set it up and they're no longer with us. And so 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, yes, the next most important after sending electronically would be to be able to do it through the portal. Other, yes, the next most important after sending electronically would be to be able to do it through the portal. Other options are, of course, to just make sure that you have backup of your information, you know, 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.

But yes, from a transmission point of view to the pair, always make sure you have those credentials handy and have all options open. 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 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 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 i 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, 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 the 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, we 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. 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 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 that's something to be aware of, you know, it could be from your email vendor, it could be, you know, through and it 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. 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, it has to be a lot of 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 cybersecurity 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 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 to their data and their information. It's happening so frequently. People are getting smarter, getting better. Obviously they're, you know, primarily attacking like 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 people and scenarios that escalate massively and impact, you know, major organizations. Yeah, absolutely. And I'll add one more important aspect to this, which is, it's not so much a cybersecurity 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, you know, what would you call it? Hidden areas of your business, which you're not necessarily familiar with. 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, just having backup plans in place, you know, home care is relatively fragile, you know, margins are really thin. And like we talked about, there's not a lot of cash flow, you know, on hand all the time. And so I think this conversation is just warranting like have plan B's have plan C, 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, for owners to be kind of broadening their mind to like the possibilities and how things can, you know, go awry 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, was this preventable? Is this preventable? Do we foresee this happening more in the future? I'll be honest. I don't think, you know, it's kind of like in general, in the security world, they say nothing is really preventable, right? You could just try and, you know, just keep, you put up as many obstacles as you can to try and make it not worth the attackers while. 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 of 2023. So it wasn't that they were under watch, 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 this attack. And, you know, we were in the scenario today. 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 Optima or United will really have done everything they could have to prevent this. Because the catastrophic aspects of this is very, very concerning. And so I hope they've done everything that they can up until now. And we can only hope that this is making everyone think harder, longer about cybersecurity. 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, you know, as it pertains to the future. Absolutely. Couldn't agree more. I do want to talk a little bit more about paradigm. I feel like it fits in really nicely into this conversation. I want 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 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, I don't know how you

bucket or organize what you do, but kind of give more detail about what you all do that helps home care providers? Sure. So, you know, I kind of shared earlier and I want to try and share some examples maybe which would be of help. But what we're really here to do is to ensure the success of the providers who we work with. 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 have different elements of what we do. 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 payer or rather even think about it from expand your business. We'll find the most opportune payers for you, which number one, will work with the services that you're providing, will give you fair reimbursements and obviously strong reimbursements where it makes sense for the kind of care and maybe 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 the appropriate 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 that payer further. So the idea is very simply that we just remove all those obstacles. And I'll share one of our earliest Medicaid providers, which we worked with, who was based in Texas. And in Texas, there are unique EVV requirements that actually just recently changed at the end of last year. But prior to that, they were working with a system called Vesta. And 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 EVV.

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 and payroll and billing were also occurring there. So you have these three separate systems where there was just no way to make sense of, you know, are we getting paid what they're actually providing? Are they getting paid properly a fair wage or are they not? And it was just complete disarray. And we sat down with the provider. We 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 and is accurate to what the actual EBB data showed. And I'll add additional interesting parameter to it that is within texas 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 build for three of those hours if you build for three hours but you had four hours in your EVV, you're not going to get paid. They have to be identical. It has to be four hours in the EVV, 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 billed appropriately, all of a sudden they were able to double their business and they scaled their business up because they said, we can take on more caregivers, we can take on more clients because we have the ability to scale this and we have the insight to know that what we're billing, what we're paying is all fitting within what is mandated by the payers. So that's really, we'll take it all the way to the finish line. And that's kind of where, you know, I think the power of working with, you know, someone

or an organization, and I really feel this close to my heart that what we're doing is not just about, you know, billing and payroll. 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. I really feel that if not, and you're distracted from the care that you need to be providing, you're just worrying about the paperwork and the logging and all that, it takes away at the bootloose at the end of the day from the client themselves. And we would never want that.

And so we really want to remove all those obstacles, 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 that we really want to remove those obstacles and those pain points to ensure that we can take it to the finish line. I'll add to this piece of that, that what we've also been able to develop because we're working with so many different payers are these excellent relationships and points of contact within the payer organizations. And so we've been able to, you know, trigger them to mass reload, you know, numerous times we found issues on the payer's end, where, you know,

their adjudication system was just off target and was denying claims. We brought it to their attention, they were 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 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, 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. It's not necessarily just that. It's, you know, making sure the owners, the operators of this home care business is 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 they that people can focus on the people? I think that's, you know, the mission of technology and home care is to help the people focus on the people. And that's what we're all here for. And Paradigm does just that, you know, breaking it down, explaining it, doing it, assisting with it. There's so much that goes into it that you all are helping with. I wanted 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 you that or maybe bring new payers to you that you 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. Now, from an enrollment point of view, we have different opportunities which open up. 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 our reimbursement rates fair are they not and for the the the overall program has been very challenging to enter into however recently they just released like their cal aim

program which is you know far more robust has seems to have far better rates um 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. And I mean, the number of payers are technically in the hundreds when you start thinking about

the different programs that exist. And, you know, 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 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 get you, you know, a hundred other providers who are in the exact same scenario. And we want to apply that here for you. And we want to get you, you know, in order and we want to get you paid. It's really fulfilling. And it's, I appreciate it so much when, when we're able to do that. 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 tide lifts 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 that's what Paradigm is all about, sharing your expertise so graciously and openly. You're learning so much about these billing sources, these payers, and you're so willing to share that information. And I think that goes a long way. Just one other question maybe here to wrap up on, 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 really try to be, you know, agile and 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 care switch to to have a seamless integration to be able to um you know handle the information as it comes in and out but we handle from any of the the scheduling softwares we're able to receive information and also send it back um 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 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 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. So we're able to

forward that to you and notify you of those payments and also put them into your scheduling software, your billing and payroll system as needed. So really we try and offer all types, you know, for some providers, they say, I don't want another system to work with. And so we say, awesome, go for it, you know, 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, you know, 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. And I think that's what something

that is unique about Paradigm is that we like to feel like we're problem solvers. We would like to make sure that no matter what, the providers win. And 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. 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. Like Joseph just said, the thought that's coming to mind, if you need a shoulder to cry, if you need someone to empathize with, to talk through solutions, to problem solve with, brainstorm, you know, there's no one better than the team at Paradigm. So reach out to them if this isn't, if you're in this camp. Joseph, thank you so much. I know I've thrown kind of a lot your way and we 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. 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. We'll send out some of that information. So thanks everyone for being here and we'll look forward

to seeing you back again next week. That's a wrap. This podcast was made by the team at CareSwitch, the first AI-powered management software for home care agencies. If you want to automate away the menial of your day to day with AI so that you and your team can focus on giving great care, check us out at careswitch.com.