Episode 87: Payer Price Transparency with Rafiq Ahmed

No Surprises Act
https://www.cms.gov/nosurprises

https://www.serifhealth.com/

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Transcript

Jonathan: 0:30

My guest today is Rafiq Ahmed. Rafiq is the co founder and CEO of Serif Health. Serif is one of the first digital health companies ingesting and extracting the newly available price transparency data from machine readable files published by health plans to offer price intelligence products and analytics to healthcare organizations nationwide. Before starting Serif Health, Rafiq worked as a consultant at Bain Company and held a variety of leadership roles in finance, strategy, and operations. From working as a general manager at the Hotel booking app startup Hotel Tonight tonight, to working as a teacher and university guidance counselor at the Aga Khan Academy in Mombasa, Kenya. Rafiq is based in Los Angeles, but originally from Atlanta, and a devoted fan of all Atlanta sports teams, good and bad. Rafiq, welcome to the pod, dude.

Rafiq Ahmed: 1:14

Yes. Thank you, Jonathan. Excited to be here.

Jonathan: 1:16

am super excited to have you here. You know, it's really cool. Maybe we'll get a chance to talk at some point about our shared East Africa experience. You were in Kenya some, some years after I was in Tanzania. Um, I don't know that we're going to get to speaking Swahili on the pod. I think we're both probably pretty rusty, but let's start with, um, what have been some profound changes or I should say evolution, in healthcare price transparency. So tell me about there's some. recent regulations around healthcare price transparency that have passed. What were those regulations intended to do? And why are they important to our healthcare system?

Rafiq Ahmed: 1:51

Yeah, definitely. So one of the most exciting things I think in healthcare over the last several years has been pretty much the bipartisan support for price transparency in healthcare. No matter where you are on the political spectrum, healthcare prices have been going through the roof and that's a pain that the American consumer, the American patient has been feeling for the last several decades. And so this is something that. The recent price transparency regulations have really intended to focus on. And so the starting point of this was in 2020 with, some of the initial transparency and coverage regulations passed by health and human services. And so this started with hospitals in 2021, having to start publishing both their standard charge master rates, cash pay rates. And, reimbursement rates from insurance companies on their hospital websites. And so that started in January of 2021. And then the other piece of that is that they were supposed to provide cost estimation tools for patients to go on the hospital websites, put in one of potentially 300 shoppable procedures that they may get from the hospital and be able to get a general estimate of that cost. And so that was the starting point of some of those regulations. And then in 2022, starting on July 1st, this is where the price transparency data really exploded. And so those same regulations that went into effect for hospitals got put into effect for health plans as well. And so as of July of 2022, health plans had to post what are called machine readable files, which are just large files that are published on their websites. typically in a nested kind of JSON format, where they're displaying all of the reimbursement rates that they're providing to any in network provider. And this goes much beyond the hospital data because the hospital's just focused on kind of the 5, 000 hospitals or so that are in the U. S. In the case of health plans, they're including hospitals, outpatient providers, facilities, anyone that's in network. And then another piece of that, Information is it's not just for medical procedures, reimbursements, it's medical devices, it's drug infusions, a wide array of other procedures and health care, reimbursable services and products that are found in this data. And so those were sort of the 2 big pieces of the transparency and coverage regulations that went into effect. And then there were a bunch of other ADD-ons that went in as well. And so one of the biggest other pieces was the No Surprises Act that got passed in 2021, uh, started to be enforced in 2022. And with that, one of the biggest piece of that was, the focus on balance billing and stopping surprise bills. And so now there are more regulations around balance billing linked to price transparency, to limit the overall impact and frequency of balance billing. And then also, um, allowing customers or patients when they go to a specific provider to be able to get what's called a good faith estimate of the cost of their care within 24 hours. And so all of these. Sort of regulations have been passed over the last few years to really try to start tackling some of the issues of cost in the healthcare system.

Jonathan: 5:07

I'm fascinated on a few levels here, Rafiq. One is, I'd love to get from you a link to where ABA providers could read up on this, no surprise billing. And I think the vast majority of the six, 7, 000 ABA organizations out there probably have no idea that this passed, right? So there are some very specific guidelines around the good faith estimates and, and quoting back, what it will cost. So I'll include that link in the show notes.

Rafiq Ahmed: 5:30

Yeah,

Jonathan: 5:30

Second, um, gosh, I, I tell you what in this hyper partisan day and age, any legislation that garners bipartisan support, we should stand up and pay attention to. So I'm glad you highlighted that this gets support across both sides of the aisles. Uh, you know, but the other thing that comes to my mind is, um, usually price transparency in open free markets works because consumers then have a choice of where they're going to put their dollars. Now, consumers certainly have out of pocket. Um, maxes and, and other things who abide by, but isn't there a sort of principal agent problem here where if the vast, especially in ABA, right, these are expensive services, 50, 000, 100, 000 over the course of the year. where if your insurance is paying for most of it, how much as a consumer. Like, do you care what that pricing is? Or has Congress found and through these regulations that consumers are paying more attention and are voting with their feet on, which hospital or which, doctor's actually gonna, uh, come out cheaper.

Rafiq Ahmed: 6:29

Yeah, no, I think you're highlighting one of the biggest challenges that we still have around making price transparency actionable and effective. And that is very much, how do you get one consumers to care about kind of the total cost of care? So one thing that I would say is an obstacle right now is that these files Sort of give the total reimbursement rate. So that means it's the patient's contribution as well as the rest of the reimbursement that goes to the provider for let's say, any given ABA therapy, uh, code. And so I think the challenge right now is, now this data is available in its totality. But the question is how do you get. As you mentioned, consumers and patients to actually choose what might be lower cost, what might be lower cost care, or to even think differently about their out of pocket spend. And so I think there's a couple ways to think about how this might drive the overall cost curve down. One is that it's not just the patient that cares about this overall reimbursement. One big agent in this, for price transparency is the employer themselves who are, funding health plans for their employees. And so those employers really care about the total cost of spend. So we've seen a lot of uptick in employers choosing to narrow their networks or focus on specific Low cost, high quality providers for certain services so that they may recommend ABA therapy providers in a specific area for their employees. And so that's where we see a lot of the focus around total cost. And then I think the second piece is going to be the consumer, because right now, I think, The data is becoming available, but now more tools need to be built on top of it. And that's a little bit of where Serif Health comes in is that we're trying to enable companies to incorporate the total cost of care or the patient out of pocket spend into their own websites, products, services, so that patients can actually understand the cost of their care. And then. Not necessarily choose the cheapest option, but choose the option that's best for them. But you'll at least know who might be a more expensive provider that costs more out of your deductible versus who might be a cheaper provider that's going to cost less out of your

Jonathan: 8:36

Well, this is the entire point of highest value care, right? It's not just cheapest. It's best outcomes for the price you're paying. And so we've talked a lot on this pod about the importance of getting value based care, right. So ABA providers, if you are not looking at your clinical outcomes data, if you're not looking at thinking population health and comparing across, um, the, the kiddos you serve, start doing that now. But Rafiq, let me ask you I've been steeped, I've been in the field for, gosh, 11, close to 12 years now. And I've been steeped in this idea of like, there's no collusion. every single one of the hundreds of insurance contracts that like, my organization Ascend had, they explicitly prohibit sharing information, including on that for the purpose of restraining trade. But you know, this set of regulations. Kind of up ends that in my mind, am I thinking about that right in the right way? Or how has it evolved that ABA providers can share rate information with others now that it is such public knowledge?

Rafiq Ahmed: 9:31

Yeah, no, this is a really interesting piece. basically within the transparency and coverage rule, within what was the Consolidated Appropriations Act when it came out, there was specific language around eliminating the gag clauses. that health plans had in place in their contracts with employers and providers. But one thing that we've seen is people are still, because of all of the language in their existing contracts. People are still very skittish about sharing this data, so we haven't really seen, I would say, providers openly sharing this information, but the part of the gag clauses that we've seen removed recently is very much employers and health plans being able to share more cost and quality information with providers, with employees, in getting that information flow back and forth. so while these laws do supersede those gag clauses that exist in these insurance contracts, I think there's still a little bit of this transition period where people are more willing to share that data without fearing, uh, potential consequences. But it is something where the data is more open and available. And so we know it's similar to, I would say. looking at prices at a gas station, you're able to see all of the prices at a gas station, but, you know, maybe the gas station owners aren't all, sharing their prices with each other openly, but you can easily find that information and then use that, um, kind of more strategically.

Jonathan: 10:54

That's super fascinating. So just to be clear for listeners, go buy your insurance contract, right? especially as clarifications around elimination of some or all of the gag clauses comes out. But, you know, one thing you could do is when you get to a renegotiation point where your insurance contract is coming up, you could say, Hey, Get rid of this gag clause, right? Because, it gets superseded. Well, I mean, let me ask a really basic question, Rafiq, is how would an ABA provider go about finding these rates online?

Rafiq Ahmed: 11:20

Yeah, so the interesting part is they're available online, but they're still really hard to use as an individual provider. And that's a lot of where we come in. So the way for an ABA provider to find these rates online is you can go to any health plan website. So if you're in network with, let's say, United Healthcare, that's why it's called United Healthcare. UnitedHealthcare has, a website that's transparency and coverage.uhc.com. And then they've basically published, thousands and thousands of URLs with networks that are linked to their fully insured networks, their self-insured networks that have all of this reimbursement rate data for all of their in-network providers. on the site and hosted, um, kind of hosted either externally or by each of the health plans themselves. However, they are in complex files that are JSON files that are big, large, and can crash. If you don't have a laptop with a ton of memory, it can definitely crash your laptop. If you try to open a single file that can be hundreds of gigabytes large. And so that's where. companies like ours and others in the space have come in to basically take and process this information and put it in a format that's easy to use if you are an ABA provider. So whether it's, as simple as an Excel spreadsheet with the rates for all of the ABA codes that you want to see, or if you want to see it in, a web app or portal in a nice dashboard or histogram format, we can do something like that. But I think one of the key pieces of the regulations was that this is a lot of data, so it's hard to put it into, you know, uncompressed formats. And so in these compressed formats, you have to be able to then uncompress it and then. Use analytics to be able to put it into a format that's easy for an ABA provider to use in a rate negotiation.

Jonathan: 13:07

Yeah. You showed me actually what some of these files looked like, and I'm not going to lie. It's like a dumpster fire. I would have no idea, how to go about that, but you know, as someone, I hate to admit this, but I have spent literally hundreds of hours over the course of my autism services career, trying to look for things as basic as like a Medicaid state rate and like, dude, that's so hard. So I guess that is to say, I'm not surprised that health plans have made this really hard to access. It's like, Hey, we're meeting the spirit of the law, but good luck, um, actually getting it. but to your point, this is why Sarif Health was founded, right? So to make rate information more transparent to healthcare providers. So tell me your origin story, dude.

Rafiq Ahmed: 13:42

Yeah, so we actually didn't start with Price Transparency at all. So we actually started as a cardiology company. So I was working with my college roommate, who's a cardiologist in the LA area. And at the start of COVID, he started seeing his heart failure patients via telehealth. And so I had recently left my job at Bain and was exploring a couple different startup ideas I was working on. And I w I was just giving him general advice on. What I thought would be an interesting heart failure business if he did it fully via telehealth, because it was a perfect population that, was tough to reach because they were elder Americans, in terms of technology, however, when he did reach them, Basically, controlling the cost of heart failure, which can have extremely high cost was all about medication management and being able to reach patients in time when their symptoms became exacerbated. And so, in our mind, that was actually a really great use of telehealth to be able to make this early intervention with heart failure patients. So we actually started working together at the end of 2020. on building out a heart failure business, built out our telehealth app, and then really started working on partnerships with Medicare Advantage and assisted living facilities in kind of the spring of 2021. But what happened then was a lot of our partnership discussions got pushed back because of the vaccine rollout for seniors. So as the vaccine rollout was happening, all of our potential business building and partnerships got pushed back to later in the year. And then we really had to think about like, okay, can we build this business in the time that we thought we had? And so on that front, my cardiology co founder, um, stepped back, went back to practice in cardiology because we couldn't really build the business in time, but I had recruited my current co founder, Matt, um, who was an engineer, uh, building kind of the EHR systems at one medical before working with us. and so we really thought what could we do now based on what we had already built? Did we have to stay in cardiology or could we do something entirely different? And what was interesting is both Matt and I were really interested in the price transparency data. He coming from one medical where he was dealing with kind of contracts and admin on that front and building tools. I had worked with, a lot of the financial reimbursement information when I was at Bain, looking at healthcare investments for our private equity business. And so the price transparency regulations were on our radar and we actually use some of that hospital data and early 2021 to share cardiology reimbursement rates for hospitals. with certain potential cardiology groups we wanted to work with in the L. A. area. And when we showed that data to them, everyone was shocked. No one knew where it came from. There was very little awareness. We're much deeper into that now, but there's still, not huge awareness that this data is available. And so once we saw that, we really started testing it out to say, okay, if. These new laws have passed, who really knows about this information? Can people start using it more widely and more effectively? And then that's where we really started to test out the idea of providing this information to providers, healthcare analytics companies, and others, and then really went down the path of building out a price transparency company. So it was a little bit more happenstance and luck that we knew about this. Regulation. We started using this data more for a different business, and then we realized when we had that chance to pivot that this was the business that we were more capable of building and we found super exciting given that, we couldn't really replace the cardiologist that we had just lost to continue, um, building a cardiology business and our backgrounds much more fit, if we didn't have a doctor, building a data business.

Jonathan: 17:25

This is like so fascinating because I think this is the one of the really hard things as an entrepreneur is knowing, hey, when do we double down on what we're doing? Because we're seeing product market fit and we're getting traction and things are going great versus when might we need to slightly tweak our direction versus in your case, like, how do we pivot entirely? Um, and so, I mean, it's phenomenal that you all have Have made that pivot. That is, that's a little bit of art and science and reading tea leaves. but let me ask brass tacks, in what use cases can Sarif health best help an ABA provider?

Rafiq Ahmed: 17:58

Yeah, absolutely. So I think if we think about the ABA providers, one thing that's super interesting and why we think the data is really compelling for an ABA provider is that most other specialties typically benchmark off of Medicare rates. And so given that the ABA therapy rates are not reimbursed by Medicare, there's a much smaller amount of existing benchmark information available. You've got. The Medicaid rates out there that are really difficult to find, but that's about it. And so what's really exciting is that one, you're able to access the market rates by payer in any given market you're in for ABA therapy codes and understand sort of the scope, of ABA therapy rates across the board. and so where that becomes useful, one is in contract negotiations. we can go and find actually the rates of. Any specific peers or any specific provider in a market as long as the payer is compliant, and most are, and we can find those rates down to the penny for any specific CPT code. and so that's one where you can actually look at a set of your peers. How do you compare use that in a rate negotiation with any given payer? The second is if we're looking at market entry or payer entry. If you're starting to expand your practice, how do the rates look in state A versus state B? Is Ohio better than Kentucky or Kentucky better than Ohio? If you're a practice in a neighboring state, we've seen that we've seen it used for investment decisions for organizations that are investing in ABA therapy companies or looking to acquire a partner and kind of build out their business. You're able to understand what the existing contract rate structure is and whether there's an opportunity to improve it or whether it's at the bottom of the market or top of the market. and then we've also seen opportunities on, uh, being able to use this for just general pricing strategy as a whole. And so it's something where You can actually choose this to potentially not be in network with certain payers over others. And so certain payers may be advantageous to be in network, others it may be advantageous to be out of network, depending on their specific dynamics. And so we, we've seen a lot of that on the provider side. And then the other piece that's also useful is that it's also been helpful overall to. build out a larger data strategy. And so understanding the overall sort of scope of rates in the market. And then what are the relationships between who's getting high rates and who's not getting high rates, whether that's geography based, whether that's size based, we've seen a lot of those relationships.

Jonathan: 20:26

Hmm. I was very fortunate to see a demo. You gave me the product. I think it was back in like June, 2020. I'll confess. I was blown away. I mean, there's been some time and attention that's gone into, not just being able to translate this really hard data, but represented in a way that's easy to see to your point, like by CPT code by state and by peer providers. But here's something I'm struggling with. I'll be honest, Rafiq. If one of the intentions of price transparency and this set of regulations is to lower the cost of prices over time in health care, yes, we can all agree like health care prices keep skyrocketing. A lot of reasons for that. But, um, so if it's intended to lower. The cost of care. However, now with this kind of transparency, ABA, and in fact, all healthcare providers have access to their peer rate info, like that should strengthen any given provider's hand in rate negotiation and potentially increase prices. So there's this like dichotomous effect here, but am I looking at that the right way? Help me out.

Rafiq Ahmed: 21:28

No, I think, that's kind of the short term versus long term tension, um, with price transparency. So if we're thinking about, I think, and it's also a micro macro, lens on price transparency. So the starting point of, if we're thinking about the individual ABA provider with this data in their hands. You can definitely use it to get a higher rate. And I think the way we think about it is not necessarily a higher rate, but a fair rate for, uh, or a market standard. So where we think the short term price transparency impact is that dispersion in the market should decrease. so right now what we're seeing in terms of whether it's ABA therapy rates, surgery rates, you know, any given procedure, we're seeing some providers on the high end, regardless of quality or size, or Maybe it's a little bit more size and market power, but regardless of quality, we're seeing huge ranges in people getting reimbursed an incredibly high amount versus others getting reimbursed at the bottom of the spectrum. And so in terms of how we think about that, we really think about enabling ABA providers to get a fair rate for what they're offering compared to their peers. But we also think at the same time, health plans have this information, employers have this information. And so we really think that the rates at the high end are going to come down. So if you're more of a smaller individual ABA provider or. we really think that you using price transparency can bring your rates up to more of a market standard, but at the high end, really what this brings about is maybe more of a strategy question around pricing is if you're able to offer and take a lower reimbursement rate, can you then drive more volume to your practice, understanding where you stack up against other ABA providers in an area? And so I think for us, I think the macro effect. Is going to be lower prices over time because some of those highest prices are going to come down, but we definitely think the low end is going to come up as well. So we think the median price over time will decline, and that variance will also decrease. And so that's where we think kind of the systemic impacts of price transparency will come

Jonathan: 23:31

I totally get that. So just to be super clear here, you have seen tremendous dispersion in rates in the ABA field that different providers get, even in given geographies. Is that right?

Rafiq Ahmed: 23:45

Absolutely. We've seen it. Yeah. It's been consistent across almost any. If you look at almost any given CPT code, whether it's an ABA code or any others, the numbers get extremely high once you go into surgical procedures where you can see, if you're looking at something like a knee replacement, you can see an ambulatory surgical center getting in the low thousands of dollars, and then you can see a hospital getting in the, 20, 30,$40,000 range. And so you can see like 10x differences there. On the ABA therapy codes, you're definitely seeing Less of that. I would say less of that absolute difference, but you're definitely seeing significant, you know, 50 percent or two X number, like at the high end numbers that are twice as much as those on the low end of those codes.

Jonathan: 24:30

That's crazy to me, but, but honestly, it's less crazy than like, what does a higher rate provider, have they justified getting their rates via clinical outcome data, access to treatment metrics, you name it versus a lower rate provider. And so I think an important takeaway here is, as you go into your next round of payer rate negotiation, ABA organizations, um, certainly you can use this benchmark data, uh, to justify your case, but most importantly. To carve that moat around your reimbursement rates, communicate why you're better and with

Rafiq Ahmed: 25:00

Yeah, absolutely.

Jonathan: 25:00

others, right?

Rafiq Ahmed: 25:02

Absolutely. I think that's where our goal, like if we're thinking about long term where we think using this price transperency data can go It's really to create more of a simplified, standardized contracting process. And so if we think about reimbursement rates overall, our sense is there should be sort of a fair standardized rate in the market. If you're an ABA therapy provider, providing your services, as you enter a network, there should really be, a starting rate or a median rate. That's a fair rate in the market. And then you really can develop higher rates. through your clinical outcomes through the value that you're bringing to your patients or the other key piece that can also help on the reimbursement side is if you're providing access in an area that's under resourced or understaffed. So if you're in an area with Low access to ABA therapy, then that's also a key reason that, a payer would need you in that specific area. So there are a couple different reasons, but we really think the starting point should be standardized and then really the defense and the moat around higher rates should really be those clinical outcomes.

Jonathan: 26:05

So true. In my experience, Rafiq, and I've negotiated dozens and dozens and dozens of these, rates. Um, the single biggest predictor of... An increase in rates comes down to the payers network adequacy. So if you're in downtown New York City and you've got like all kinds of different ABA providers, that's very different than if you're upstate in a really rural area. So I think that idea of access is important. All right. Well, this gets me excited, right? Because I think as a country, this is like a national security issue, right? We're going to go bankrupt as a country if we see this hockey stick, continued hockey stick, like growth and healthcare costs. So this, this feels really important. It's kind of hard to Tie the X's and O's ultimately to where it's going to end up, but it feels like a really important evolution in price transparency that ABA providers should be paying attention to. But let me ask you, what are your thoughts on like the top three things that the healthcare industry can do to bend the cost curve in healthcare just more generally?

Rafiq Ahmed: 27:02

Yeah, no, definitely. So I think the starting point, uh, I think almost if we think about price transparency, it's a really great starting point. It doesn't fully bend the cost curve, but I think understanding the cost of care so that you can overall bend the cost curve becomes really important. So it almost becomes a more of a foundational starting point for policy, patients, providers to really come together. Yeah. And, and figure out ways to ultimately bend that cost curve. But I think understanding the total cost of care and not being surprised by a balanced bill, having some predictability is very important as a starting point. So I do think price transparency and continuing to make it easier for patients to truly understand the cost of their care and providers to understand their reimbursements and have that predictability is step one. But I think like step two. What I think is really interesting and exciting, I do think this is where technology comes into play. I do think the new generative AI chat, GPT technologies being used in a way that really can curb a lot of administrative spend is gonna be a really big point on the cost curve, but without losing sight of empathy for the patient and The wisdom and the skill of the clinician. So I do think a lot of solutions are trying to. Take a lot of that out, but if you're really focused on where there are ways to supercharge the abilities of clinicians to practice, reduce administrative overhead, there's a lot of waste around complexity of billing and coding that should really just be simplified and the more that you can simplify it and not allow people to game the system, it kind of helps everything because like one of the biggest challenges in price transparency Is all the complexity around billing and coding modifiers that probably shouldn't exist and have been there for people who, to game the system and kind of extract as much value. So if. We can use technology, whether it's AI or other tools to simplify that process and reduce a lot of that administrative overhead in gaming of the system. I think that's a huge way to bend the cost curve. And then I think like ultimately being able to really think about combining pricing and unit pricing information we have with ultimately. exactly what we talked about, what is a more kind of standardized measure of quality and clinical outcomes because, I almost think of price transparency, a short term cost. We're thinking about that as the cost of an encounter, but really a lot of the costs in the system is. long term costs from whether it's someone ending up, you know, hospitalized because something wasn't found early enough, or a readmission to the hospital after a specific encounter. So being able to really marry cost and quality and having a much more, I would say, unified or standardized view of quality that we can link to some of the new information that we're understanding and getting with the price transparency regulations.

Jonathan: 29:55

Well said. I totally get that. You know, it's really interesting. I go back to my economics undergrad and, and background. And, there, there is in some quarters in our country, this perception that ABA has become a commoditized service, right? That is, there's no way to differentiate value and think about commodities, like, I don't know, gasoline, or here's a specific case study. Um, and the question is like, why do gas stations end up right next to each other? Like, why does that make any kind of free market economic sense? Well, you know, this, this idea that if you have a long beach, right? And you have an ice cream shop set up at one side of the beach, you have a different ice cream shop set up at the other side of the beach. Wow. What are people going to do? Ice cream is kind of a commodity and you're just going to go to whichever is closest. So one of those. Ice cream vendors is going to move a little bit closer to the middle and get a little bit more, but then the other ice cream vendor moves a little bit closer to the middle. And then, you know, after a bit, boom, they're right next to each other. Right? And so you then have to differentiate on quality, right? And maybe you become a cold stone and like everything that comes with that versus something else, but same thing with gas stations. Right? And I think I don't know, a Bucky's gas station experience who, who would have ever thought 20 years ago that there was an experience to be had at a gas station, but

Rafiq Ahmed: 31:04

No, or, or in Georgia, quick trip is the big one where everyone loves quick trips, coffee and food items, you know, at the gas

Jonathan: 31:10

Exactly. You're building this like customer experience. You're thinking about sort of the outcomes of your consumer's experience. And I think that is a phenomenal analog to ABA providers, right? If you don't want to be perceived as commodity and just get to commodity pricing, think about how, the outcomes that you're driving for your kiddos are differentially better than other ABA providers drive. Um, so I just, I like, I can't stress that enough for ABA providers.

Rafiq Ahmed: 31:40

no, absolutely. and I think that's where we really think price transparency kind of helps drive. Providers in that direction. it almost provides sort of the gateway where over time, our hope is that price transparency simplifies the contracting, process makes it easy to get sort of that gateway contract to get into the network, um, at a fair rate, but then it's really around that differentiation to build on that rate over time.

Jonathan: 32:05

A gateway contract, kind of like a gateway drug, right? I don't know, that's probably extending the analogy a little too far. Uh, Rafiq, what's one thing every ABA business owner should start doing and one thing to stop doing?

Rafiq Ahmed: 32:15

Yeah. So I think in terms of thinking about ABA owners, I think my sense is You know, there's probably a lot of things I don't understand about the full kind of gamut of responsibilities of an ABA owner. So maybe I'll focus on the start doing where I have a little bit more expertise, but I think really thinking about data strategy as an ABA owner is. a really, a strong step. So what we've seen a lot of is, piecemeal solutions in the past, potentially, looking at something sometimes, or I think if we're thinking about, contracting as example, a lot of ABA owners we've talked to only really think about their contract when it comes up for negotiation, they're not necessarily thinking about it. You know, between if they're, let's say it's a three year timeframe or an annual timeframe, they get the contract and then, until they go back for the next renewal, you're not really thinking about it. So really thinking about what is that unified data strategy? It's like, how do you understand pricing in your market? How can you understand how your quality or your outcomes may compare to others or what you're really thinking about and tracking that over time, because then you really, I think, can come to the table with any payer and then tell that story. And so I think we've been seeing, we've been doing a lot of work with behavioral health, providers broadly, ABA therapy and otherwise. And I think what we're seeing is some of the most successful ones have been integrating various sources of data, whether it's public data sources, whether it's, you know, research, whether it's claims data, but really using it to be able to really truly understand their patient base. And then bring out whether it's the services or pricing that they think can really, attract additional patients and serve their patients better and better.

Jonathan: 33:59

Right on. Well, Rafiq, where can people Find you online.

Rafiq Ahmed: 34:02

Yeah, so online, I'm mostly a lurker slash consumer of information on most online channels, whether it's Twitter or X or, um, TikTok and, and others. But, mostly I'll be on LinkedIn. Or, on the Serif Health blog. So, Serif Health is, uh, serfihealth.com. we have a blog on our site where we post a lot of our analysis and findings from using the price transparency data. A lot of that is related to behavioral health and ABA therapy. I'm also much more active on LinkedIn, than any of my other, kind of social media presences. And so, post a lot about kind of the latest updates. or comment on the latest updates with Serif Health and sort of price transparency, at large, on LinkedIn as

Jonathan: 34:44

Rock on. Well, go follow Rafiq and his team because I think this is profoundly important work that's happening in our field and across all of healthcare. so Rafiq, are you ready for the hot take questions?

Rafiq Ahmed: 34:55

Ooh, hot take questions. Okay, let's see. Let's see if I'm ready.

Jonathan: 34:59

All right. You're on your deathbed, sir. What's the one thing you want to be remembered for?

Rafiq Ahmed: 35:03

So, I think on, yeah, on my deathbed, I think it's definitely about personal interactions and being able for people to remember me as a kind person, someone with a sense of humor, someone who, you know, made people's day better by, hopefully, our interactions. So, I think those positive interactions is what I'd hope to be remembered by. But then I'll also take if, uh, if Serif Health can make a difference in the world. That would be just icing on the

Jonathan: 35:28

Nice doing well and doing good. Well, what's your most important self care practice?

Rafiq Ahmed: 35:33

So self care practice, um, I would like to say it would be, uh, trying to exercise daily. I try to get in something after the workday, but if I can't do that, I'm a big fan of getting a morning walk in early morning, like as early as possible. getting to sort of breathe in the sunlight. I think LA, we're blessed, uh, with pretty good weather here. So getting some of that early morning sunlight and sort of that peace and calm, at the beginning of the day is always, uh, something that I try to start the day off with.

Jonathan: 36:03

What's your favorite song and or music genre?

Rafiq Ahmed: 36:05

Ooh, okay. Song. So I think I'll have to take it back to my Atlanta roots. So I'm a big OutKast fan. So, uh, Bombs Over Baghdad, uh, I would say is still my favorite song. I think that it packs the most genres into one song. Out of almost anything I know. So it's hip hop, but it's a little bit gospel. It's a little bit pop, a little bit R and B. It's got a little bit of

Jonathan: 36:27

Old school, well done

Rafiq Ahmed: 36:30

some storytelling, some good storytelling in there. So yeah.

Jonathan: 36:32

What's one thing you tell your 18 year old self?

Rafiq Ahmed: 36:35

Okay. 18 year old self. So I think, I think for my 18 year old self, it would be, I think I followed this advice a little bit, but maybe even take it more, but don't be afraid to take risks, rejection is not that bad. I think after going through the fundraising process for Serif Health and getting. You know, 90 rejections to, every, acceptance from, a firm on fundraising and believing in the idea, you know, I can handle rejection much, much better. So I think don't be afraid of taking risks, take the leap, and, have fun while, while doing it.

Jonathan: 37:08

That's the definition of resilience, right? And you know, I, what's the Ted Lasso? My family and I just watched all three seasons of Ted Lasso together. It's so good. But what, like the happiest animal in the world is a goldfish. Because their memory is like 24 hours. So you just go on to the next opportunity.

Rafiq Ahmed: 37:25

absolutely.

Jonathan: 37:26

So you can only wear one style of footwear. What would it be?

Rafiq Ahmed: 37:29

Ooh, one style of footwear. Um, this is, this is an interesting one. I, I am a fan of style, so I think like for me the loafer is, is probably the most versatile, uh, footwear. It works for all occasions. If you need to go formal for a meeting, if it needs to be casual, it's good. And it's still pretty comfortable, maybe not as good as house slippers, which would be my number two. But, uh, I would say the loafer would be my versatile form of footwear.

Jonathan: 37:56

That is perfect. Well, Rafiq, thank you so much for coming on the pod and taking time to share your wisdom, dude. Keep kicking butt for our healthcare field.

Rafiq Ahmed: 38:02

Well, thank you, Jonathan. I really appreciate the opportunity and excited. This was my first podcast. So hopefully one of one of many more to

Jonathan: 38:10

You kicked it in the butt.

Rafiq Ahmed: 38:12

Thank you.