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With customers losing revenue due to claims audits and denials, MDaudit used ThoughtSpot to build a new set of analytics tools designed to help healthcare organizations better understand the reasoning behind audits and denials and subsequently retain and grow revenue.
Founded in 1993 and based in Wellesley, Mass., MDaudit -- formerly Hayes Management Consulting -- develops tools to increase earnings for healthcare providers by reducing compliance risk and improving efficiency.
ThoughtSpot, meanwhile, is an analytics vendor founded in 2012 and based in Mountain View, Calif. Its business intelligence platform enables customers to query and analyze data using natural language processing.
In addition, the vendor offers ThoughtSpot Everywhere, a tool that enables users to embed analytics assets within work applications.
In January 2020 -- just a couple of months before the onset of the COVID-19 pandemic -- MDaudit recognized a certain randomness to the way its customers mitigated compliance risk and exposure to claims denials.
Their internal audits -- and those of third parties, such as the U.S. government related to Medicare claims -- were somewhat arbitrary, according to Ritesh Ramesh, MDaudit's COO.
The firm's customers looked at samples, haphazardly selecting which claims to examine more closely, rather than identifying specific claims that were problematic and might lead to compliance violations or denials and result in lost revenue.
MDaudit determined that a more data-driven approach -- one that discovers and even predicts problematic claims -- would benefit its customer base.
"Healthcare was going through an interesting time," Ramesh said. "Compliance and revenue integrity were changing."
Two months after MDaudit first identified problems resulting from this approach to audits and compliance risk, the onset of the pandemic exacerbated pre-existing inefficiencies.
Suddenly, some organizations cut staff that wasn't directly involved in patient care. The retained compliance workers were remote, leading to less communication and collaboration.
As a result, "customers wanted to do more with less," Ramesh said.
MDaudit responded by targeting three methods for improvement: zeroing in on which claims to audit, understanding root causes for denials, and gaining insights into the patterns of external payers.
And once it targeted those three areas for improvement, MDaudit developed new analytics tools to better enable customers to take a more data-driven approach to auditing, predicting denials and learning the behavior of external payers.
When MDaudit decided to build a new set of analytics tools for its customers, it was not using a commercial development platform. Instead, it was developing SaaS analytics capabilities in-house with open source tools.
In-house development was an inefficient way for MDaudit to build analytics tools.
Ritesh RameshCOO, MDaudit
It needed to deploy a ready-made analytics platform -- which Ramesh felt could make development 10 times more efficient -- and use that platform as the basis for the new set of SaaS tools it would make available to its customers.
Ultimately, MDaudit chose ThoughtSpot as the engine for its analytics capabilities.
Ramesh, whose background is in analytics, was familiar with many of the well-known vendors before joining MDaudit as CTO in 2019. He wanted something different than what they were doing at the time.
He wanted a platform that would easily enable self-service analytics and saw that in ThoughtSpot's natural language search approach. In addition, ThoughtSpot offers a SaaS platform with embedded analytics capabilities, and that appealed to MDaudit.
"I knew all the traditional vendors in the space and knew what their weaknesses were, so I didn't bother to look at them," Ramesh said. "What intrigued me about ThoughtSpot was the whole idea of unlocking insights and putting it in the hands of users because we are a SaaS company and didn't want to highjack all the data and insights."
After trialing a one-month proof-of-concept and then selecting ThoughtSpot in January 2020, MDaudit built tools called Audit Insights and Revenue Optimizer over the next six months. Both can be embedded in users' workflows. After a brief testing period, the company launched the new features in August 2020.
The development process wasn't without occasional problems, according to Ramesh. He noted that MDaudit was one of the first ThoughtSpot customers to embed the vendor's analytics capabilities in a SaaS platform.
But when challenges arose, he said ThoughtSpot was responsive and worked closely with MDaudit to keep development moving toward completion.
Audit Insights is a decision intelligence tool that automatically surfaces which claims customers should audit themselves and why. It also shows the results -- revenue savings -- of those proactive audits.
Revenue Optimizer, meanwhile, enables its users to better understand the root causes for claims denials, including which healthcare providers submit the most claims that get denied.
"For them to understand where these denials are coming from, it's helping them find the needle in the haystack," Ramesh said. "We feel revenue retention, for healthcare organizations, is as critical as revenue growth. We're doubling down on revenue retention because revenue growth is hard to find."
He added that by embedding ThoughtSpot data visualizations and interactive dashboards -- called liveboards -- within the workflows of users, the vendor's analytics capabilities enable MDaudit's customers to more quickly go from insight to action.
"I'm a big fan of going from insights to actions to outcomes. And this is a beautiful way to close the loop rather than just giving insights to people," Ramesh said.
Since launching Audit Insights and Revenue Optimizer, MDaudit has found that many customers have started using the tools, according to Ramesh. He did not disclose what MDaudit charges customers for use of its SaaS tools.
In their first few months of general availability -- from August 2020 through December 2020 -- Audit Insights and Revenue Optimizer attracted about 50 customers. That number increased to 250 by yearend 2021 and now stands at about 500 as the end of 2022 approaches.
Of those 500 customers, Ramesh said that about 300 are active, using Audit Insights and Revenue Retention on a weekly basis.
Meanwhile, MDaudit's own revenues have increased about 25% this year. This came after its switch in 2020 to ThoughtSpot and subsequent development of new analytics tools for its customers.
Beyond MDaudit's own customer and revenue growth, the tools it developed have helped its users become more efficient, according to Ramesh. Many healthcare organizations have either cut staff or suffered from staff defections, but despite employing fewer people, they have been doing more work.
Ramesh said he's been told by customers that by unearthing which claims to audit -- rather than forcing auditors and analysts to manually sift through each claim to find those that might lead to denials -- workers are much more efficient than they were without data-driven tools.
"Today, a lot of healthcare organizations don't have a lot of manpower," Ramesh said. "Healthcare is going through staffing issues. Making [Audit Insights and Revenue Optimizer] self-service has helped."
Given the success of Audit Insights and Revenue Optimizer, MDaudit now plans to add new applications using ThoughtSpot.
Next, MDaudit intends to add tools that better enable customers to predict claims denials before they happen.
"Our vision in 2020 was to redefine the world of healthcare compliance and make it more data-driven," Ramesh said. "Three years into that mission, we have been very successful in using data to drive decision-making."