Retirement Concerns by Andy

Finding Reliable Local Healthcare Providers and Caregivers

• Andrew Barrett

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These sources provide information about finding doctors, but from two different perspectives: public assistance (NC Medicaid) and commercial data analysis (USA Doctor List).

How much do you know about topics like Medicaid Managed Care or large-scale healthcare provider databases? Also, what is your high-level goal for learning about the information presented in these sources?

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SPEAKER_01:

Welcome to the deep dive. Today we're tackling a really interesting stack of sources you sent us. And uh it presents this powerful, almost contradictory contrast, wouldn't you say?

SPEAKER_00:

Aaron Powell Absolutely. It's Stark. We're looking at two completely different ways the healthcare world is mapped out.

SPEAKER_01:

Yeah.

SPEAKER_00:

One is all about, you know, constrained consumer access.

SPEAKER_01:

Right, like finding a doctor within a specific system. And the other.

SPEAKER_00:

The other is about maximizing commercial intelligence, market growth, big data.

SPEAKER_01:

So yeah, we did streamline the stack a bit first. We set aside those my course box notes and the new notes stuff just to focus on the core documents you wanted us to prioritize.

SPEAKER_00:

Exactly. And our mission today, really, is to show you how the exact same thing a doctor, a healthcare provider, is tracked and well targeted in two fundamentally opposed ways, two different ecosystems.

SPEAKER_01:

It drives home that finding a doctor isn't just a simple search, is it? It's this huge data challenge. And it's solved completely differently depending on uh whether you're trying to get care.

SPEAKER_00:

Or whether you're trying to gain market insight for a business. It really depends if you need, say, a protective network for your own health, or if you need deep market intelligence.

SPEAKER_01:

One system seems highly regulated, access focused, constrained by these networks.

SPEAKER_00:

And the other, it's basically a free market approach built on synthesizing just billions of commercial data points.

SPEAKER_01:

Aaron Powell Okay, so let's unpack that constrained system first. The NC Medicaid sources you sent talk a lot about this big shift towards something called managed care.

SPEAKER_00:

Aaron Ross Powell Right. Managed care. Most people getting NC Medicaid now get services through specific health plans.

SPEAKER_01:

Aaron Powell And what exactly is a health plan in this context for for you listening? What does that structure actually mean?

SPEAKER_00:

Aaron Ross Powell Well the key word is coordination. It's not just an insurance card, it's a specific contracted group doctors, hospitals, other providers who've agreed to work together.

SPEAKER_01:

Okay.

SPEAKER_00:

That's the mechanism for delivering, well, pretty much everything physical health, behavioral health, prescriptions. The idea is efficiency, both administrative and clinical. But the trade-off is constraint.

SPEAKER_01:

Trevor Burrus Constraint, meaning the provider network. That seems critical.

SPEAKER_00:

Aaron Powell Absolutely critical. If you're in one of these health plans, you generally must get your care from a provider who's in that specific network, part of that group.

SPEAKER_01:

Aaron Powell And if you go outside that network You're likely looking at a much bigger bill.

SPEAKER_00:

The financial burden often falls back on you. So yeah, that network really defines your choices.

SPEAKER_01:

Aaron Powell The sources also mention some added services, right? Little extras.

SPEAKER_00:

Yeah, they do. Things like programs to help people quit smoking, little incentives like that. But honestly, navigating that network correctly, that's still the main structural priority for the user.

SPEAKER_01:

Aaron Ross Powell Right. And speaking of navigating, there's this central figure, the PCP, the primary care provider.

SPEAKER_00:

Trevor Burrus, Jr.

SPEAKER_01:

Who exactly fits that role and why are they so important? Almost like a gatekeeper in this managed care world.

SPEAKER_00:

So uh a PCP could be a doctor, sure, but it might also be a nurse practitioner or a physician assistant. Their job is really to be your guide, your coordinator. They manage your whole health picture, ongoing needs, chronic conditions, and crucially, they provide the referral if you need to see a specialist.

SPEAKER_01:

Ah, the referral. So without the PCP's okay, you can't just go see a specialist.

SPEAKER_00:

Generally, no. That's the managed part of managed care. Without that PCP sign-off, getting access to specialized care often just stops. It's a control mechanism.

SPEAKER_01:

So if I'm new to this, trying to find the right PCP within my assigned network i it sounds a bit daunting. What help is there?

SPEAKER_00:

Well, the state does provide tools. They try for transparency. There's the official NC Medicaid provider and health plan lookup tool, basically the map.

SPEAKER_01:

A map. Okay.

SPEAKER_00:

And they also publish resources like tips for choosing a primary care provider. They recognize that even within the network limits, picking the right PCP is a big deal for your health down the line.

SPEAKER_01:

Okay, but now we hit this big administrative wall you pointed out earlier. Something that shows how fragmented things still are. One major service is completely separate.

SPEAKER_00:

Yeah, the dental exception. This is so important for anyone actually using this system. Dental services are not offered through these main health plans.

SPEAKER_01:

Wow, really? So your teeth are just administratively separate from the rest of you.

SPEAKER_00:

Pretty much. If you need a dentist, you have to use a totally different pathway. There's a separate Medicaid dental provider's webpage, a whole separate search process.

SPEAKER_01:

That really highlights the complexity, even within a managed system.

SPEAKER_00:

It absolutely does. It's still complex for the person trying to get care.

SPEAKER_01:

Okay, so that's a critical detail. And if you listening hit a wall navigating all this, the sources do give contact info.

SPEAKER_00:

Yes, there's the NC Medicaid Contact Center number 888-245-0179. And they also mention the local division of social services directory as a resource.

SPEAKER_01:

Got it. So that covers the consumer side. Yeah. Regulated network constraints focused on coordination.

SPEAKER_00:

Exactly. Now ready to flip the coin.

SPEAKER_01:

Let's do it. If the consumer side is about navigating these walls, the commercial side seems to be about analyzing those same walls, using them as data points.

SPEAKER_00:

Uh-huh. The second set of sources dives into this huge market built around tracking the same doctors. But here, they're not just providers, they're units of data, units of influence.

SPEAKER_01:

Trevor Burrus, Jr.: Data sold as a product.

SPEAKER_00:

A very high value product, yes. And the scale is just staggering. We're talking about commercial databases with verified profiles on over 2.4 million U.S. doctors.

SPEAKER_01:

Aaron Powell 2.4 million.

SPEAKER_00:

And it goes up to over 2.6 million if you include nurses, physician assistants, other allied health professionals.

SPEAKER_01:

Aaron Powell That's incredible. But the real kicker for me anyway is the depth of that data. It's not just a name and address, right? How do they get so granular affiliations networks without, you know, breaking privacy rules?

SPEAKER_00:

Trevor Burrus That's the core of their business model synthesis. Each doctor's profile pulls information from uh 20 or more different sources, public data, private data feeds, and proprietary data they develop or acquire.

SPEAKER_01:

Aaron Powell 20 sources per doctor.

SPEAKER_00:

At least. And crucially, they're not tracking individual patient names. That's key. They track the aggregated behavior of the provider. It's fueled by processing billions of medical and prescription claims. Billions. Covering hundreds of millions of unique but anonymized patients. That claims data is the engine.

SPEAKER_01:

Okay, billions of claims. So that's the secret sauce. That lets them see things far beyond just specialty and location.

SPEAKER_00:

Oh, way beyond. We're talking about incredibly valuable commercial insights. Yeah. Like they're prescribing trends, what kinds of drugs or devices they tend to use, what technology they use in their practice, even their adoption rates for specific telehealth platforms, stuff like that.

SPEAKER_01:

That's incredibly detailed, actionable intelligence, as they say.

SPEAKER_00:

Exactly. It's what informs market strategy. And this data has to be fresh to be valuable, so it's updated constantly. The source mentioned daily updates on things like executive moves at hospitals, MA activity, mergers, and acquisitions, which totally change the provider landscape, even RFPs, requests for proposals, which signal spending plans, and con ins.

SPEAKER_01:

Right, stand-in certificates of need. Let's quickly break that down. Why is tracking a con so important for a company selling, say, medical devices?

SPEAKER_00:

Okay, so a certificate of need, a con, is basically formal permission from the state that a hospital or clinic needs before making a major capital expenditure.

SPEAKER_01:

Aaron Powell Like building a new wing or buying a really expensive MRI machine.

SPEAKER_00:

Aaron Powell Exactly that kind of thing. Opening a new surgery center. So if you're tracking those con applications and the RFPs that follow, you know exactly where healthcare systems are planning to spend big money and when.

SPEAKER_01:

Ah, I see. It gives businesses a roadmap for future sales. It lets them target their efforts before the purchase even happens.

SPEAKER_00:

Aaron Powell Precisely. It's predictive market intelligence, helps them get ahead of the competition.

SPEAKER_01:

Aaron Powell So this commercial data isn't about finding a family doctor for yourself. It's about identifying these big market trends based on procedures, diagnoses, prescribing patterns.

SPEAKER_00:

Right. And using that to segment the entire physician market, mapping out their potential addressable market with almost surgical precision. It's all about optimizing strategy.

SPEAKER_01:

Aaron Powell Finding the right doctors to talk to, basically, the ones who influence purchasing or prescribing.

SPEAKER_00:

Exactly. It's about finding, connecting, and having, as they put it, high-quality conversations with the specific physicians who can drive their business. Right. There was that testimonial quote.

SPEAKER_01:

Oh, yeah. The quote It helps us to target accounts and carry out our operating plan. The business has grown significantly YoY year over year.

SPEAKER_00:

Aaron Powell doesn't get much clearer than that. It's about targeting. It's about growth.

SPEAKER_01:

Wow. Okay, so putting these two systems side by side is well, it's quite the contrast. We started with NC Medicaid using data to build these constrained networks, ensure basic care coordination through that PCP gatekeeper, regulated, access focused. And we end up here with this massive commercial system, taking the very behavioral data generated inside those regulative networks, the claims, the referrals, the procedures, using that data to fuel a multi-billion dollar intelligence economy that targets the exact same doctors, but based on their commercial utility, their prescribing habits, their tech use.

SPEAKER_00:

So it seems like the very rules designed to manage care and maybe protect patients, they simultaneously create these incredibly valuable, trackable data points for commercial exploitation. It's almost paradoxical.

SPEAKER_01:

Yeah. It feels like the friction between these two goals, patient access versus commercial intelligence, that tension really defines a huge part of American healthcare today.

SPEAKER_00:

I think that's right. Yeah. You really can't understand the complexity of one side without seeing the sheer power and scope of the other. Aaron Powell, Jr.

SPEAKER_01:

It makes you realize when you go to your PCP, the one you maybe had to carefully select from that constrained list.

SPEAKER_00:

Yeah. That same provider is also being profiled by 20 plus commercial sources, analyzed for their technology use, targeted based on every prescription they write, every procedure code they log.

SPEAKER_01:

It definitely puts a new spin on just choosing a doctor from a list.

SPEAKER_00:

It certainly does. And you know, that kind of leads us to the final thought we wanted to leave you with after diving into all this.

SPEAKER_01:

Okay, what should we be mulling over?

SPEAKER_00:

Well, think about this. If these commercial companies have such incredibly detailed daily proprietary data on doctor behavior prescribing, tech adoption, everything pulled from billions of claims, what might that imply for the future of patient choice within those regulated health plan networks?

SPEAKER_01:

You mean could that commercial data start influencing the care recommendations we get?

SPEAKER_00:

Could it? Will those deep commercial insights eventually find their way back, maybe subtly, maybe not so subtly, to influencing the advice or the referrals you receive from your state approved network bound PCP? It's definitely something to think about.