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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jonathan (00:30):
My guest today is Rafiq Ahmed.
Rafiq is the co founder and CEOof Serif Health.
Serif is one of the firstdigital health companies
ingesting and extracting thenewly available price
transparency data from machinereadable files published by
health plans to offer priceintelligence products and
analytics to healthcareorganizations nationwide.
Before starting Serif Health,Rafiq worked as a consultant at

(00:51):
Bain Company and held a varietyof leadership roles in finance,
strategy, and operations.
From working as a generalmanager at the Hotel booking app
startup Hotel Tonight tonight,to working as a teacher and
university guidance counselor atthe Aga Khan Academy in Mombasa,
Kenya.
Rafiq is based in Los Angeles,but originally from Atlanta, and
a devoted fan of all Atlantasports teams, good and bad.

(01:12):
Rafiq, welcome to the pod, dude.

Rafiq Ahmed (01:14):
Yes.
Thank you, Jonathan.
Excited to be here.

Jonathan (01:16):
am super excited to have you here.
You know, it's really cool.
Maybe we'll get a chance to talkat some point about our shared
East Africa experience.
You were in Kenya some, someyears after I was in Tanzania.
Um, I don't know that we'regoing to get to speaking Swahili
on the pod.
I think we're both probablypretty rusty, but let's start
with, um, what have been someprofound changes or I should say

(01:38):
evolution, in healthcare pricetransparency.
So tell me about there's some.
recent regulations aroundhealthcare price transparency
that have passed.
What were those regulationsintended to do?
And why are they important toour healthcare system?

Rafiq Ahmed (01:51):
Yeah, definitely.
So one of the most excitingthings I think in healthcare
over the last several years hasbeen pretty much the bipartisan
support for price transparencyin healthcare.
No matter where you are on thepolitical spectrum, healthcare
prices have been going throughthe roof and that's a pain that
the American consumer, theAmerican patient has been
feeling for the last severaldecades.

(02:13):
And so this is something that.
The recent price transparencyregulations have really intended
to focus on.
And so the starting point ofthis was in 2020 with, some of
the initial transparency andcoverage regulations passed by
health and human services.
And so this started withhospitals in 2021, having to

(02:34):
start publishing both theirstandard charge master rates,
cash pay rates.
And, reimbursement rates frominsurance companies on their
hospital websites.
And so that started in Januaryof 2021.
And then the other piece of thatis that they were supposed to
provide cost estimation toolsfor patients to go on the

(02:54):
hospital websites, put in one ofpotentially 300 shoppable
procedures that they may getfrom the hospital and be able to
get a general estimate of thatcost.
And so that was the startingpoint of some of those
regulations.
And then in 2022, starting onJuly 1st, this is where the
price transparency data reallyexploded.
And so those same regulationsthat went into effect for

(03:17):
hospitals got put into effectfor health plans as well.
And so as of July of 2022,health plans had to post what
are called machine readablefiles, which are just large
files that are published ontheir websites.
typically in a nested kind ofJSON format, where they're
displaying all of thereimbursement rates that they're

(03:37):
providing to any in networkprovider.
And this goes much beyond thehospital data because the
hospital's just focused on kindof 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

(03:58):
medical procedures,reimbursements, it's medical
devices, it's drug infusions, awide array of other procedures
and health care, reimbursableservices and products that are
found in this data.
And so those were sort of the 2big pieces of the transparency
and coverage regulations thatwent into effect.

(04:18):
And then there were a bunch ofother ADD-ons that went in as
well.
And so one of the biggest otherpieces was the No Surprises Act
that got passed in 2021, uh,started to be enforced in 2022.
And with that, one of thebiggest piece of that was, the
focus on balance billing andstopping surprise bills.
And so now there are moreregulations around balance

(04:40):
billing linked to pricetransparency, to limit the
overall impact and frequency ofbalance billing.
And then also, um, allowingcustomers or patients when they
go to a specific provider to beable to get what's called a good
faith estimate of the cost oftheir care within 24 hours.
And so all of these.
Sort of regulations have beenpassed over the last few years

(05:02):
to really try to start tacklingsome of the issues of cost in
the healthcare system.

Jonathan (05:07):
I'm fascinated on a few levels here, Rafiq.
One is, I'd love to get from youa link to where ABA providers
could read up on this, nosurprise billing.
And I think the vast majority ofthe six, 7, 000 ABA
organizations out there probablyhave no idea that this passed,
right?
So there are some very specificguidelines around the good faith
estimates and, and quoting back,what it will cost.
So I'll include that link in theshow notes.

Rafiq Ahmed (05:30):
Yeah,

Jonathan (05:30):
Second, um, gosh, I, I tell you what in this hyper
partisan day and age, anylegislation that garners
bipartisan support, we shouldstand up and pay attention to.
So I'm glad you highlighted thatthis gets support across both
sides of the aisles.
Uh, you know, but the otherthing that comes to my mind is,
um, usually price transparencyin open free markets works

(05:54):
because consumers then have achoice of where they're going to
put their dollars.
Now, consumers certainly haveout of pocket.
Um, maxes and, and other thingswho abide by, but isn't there a
sort of principal agent problemhere where if the vast,
especially in ABA, right, theseare expensive services, 50, 000,
100, 000 over the course of theyear.
where if your insurance ispaying for most of it, how much

(06:14):
as a consumer.
Like, do you care what thatpricing is?
Or has Congress found andthrough these regulations that
consumers are paying moreattention and are voting with
their feet on, which hospital orwhich, doctor's actually gonna,
uh, come out cheaper.

Rafiq Ahmed (06:29):
Yeah, no, I think you're highlighting one of the
biggest challenges that we stillhave around making price
transparency actionable andeffective.
And that is very much, how doyou get one consumers to care
about kind of the total cost ofcare?
So one thing that I would say isan obstacle right now is that
these files Sort of give thetotal reimbursement rate.
So that means it's the patient'scontribution as well as the rest

(06:53):
of the reimbursement that goesto the provider for let's say,
any given ABA therapy, uh, code.
And so I think the challengeright now is, now this data is
available in its totality.
But the question is how do youget.
As you mentioned, consumers andpatients to actually choose what
might be lower cost, what mightbe lower cost care, or to even

(07:15):
think differently about theirout of pocket spend.
And so I think there's a coupleways to think about how this
might drive the overall costcurve down.
One is that it's not just thepatient that cares about this
overall reimbursement.
One big agent in this, for pricetransparency is the employer
themselves who are, fundinghealth plans for their
employees.

(07:36):
And so those employers reallycare about the total cost of
spend.
So we've seen a lot of uptick inemployers choosing to narrow
their networks or focus onspecific Low cost, high quality
providers for certain servicesso that they may recommend ABA
therapy providers in a specificarea for their employees.
And so that's where we see a lotof the focus around total cost.

(07:59):
And then I think the secondpiece is going to be the
consumer, because right now, Ithink, The data is becoming
available, but now more toolsneed to be built on top of it.
And that's a little bit of whereSerif Health comes in is that
we're trying to enable companiesto incorporate the total cost of
care or the patient out ofpocket spend into their own
websites, products, services, sothat patients can actually

(08:22):
understand the cost of theircare.
And then.
Not necessarily choose thecheapest option, but choose the
option that's best for them.
But you'll at least know whomight be a more expensive
provider that costs more out ofyour deductible versus who might
be a cheaper provider that'sgoing to cost less out of your

Jonathan (08:36):
Well, this is the entire point of highest value
care, right?
It's not just cheapest.
It's best outcomes for the priceyou're paying.
And so we've talked a lot onthis pod about the importance of
getting value based care, right.
So ABA providers, if you are notlooking at your clinical
outcomes data, if you're notlooking at thinking population
health and comparing across, um,the, the kiddos you serve, start

(08:57):
doing that now.
But Rafiq, let me ask you I'vebeen steeped, I've been in the
field for, gosh, 11, close to 12years now.
And I've been steeped in thisidea of like, there's no
collusion.
every single one of the hundredsof insurance contracts that
like, my organization Ascendhad, they explicitly prohibit
sharing information, includingon that for the purpose of

(09:17):
restraining trade.
But you know, this set ofregulations.
Kind of up ends that in my mind,am I thinking about that right
in the right way?
Or how has it evolved that ABAproviders can share rate
information with others now thatit is such public knowledge?

Rafiq Ahmed (09:31):
Yeah, no, this is a really interesting piece.
basically within thetransparency and coverage rule,
within what was the ConsolidatedAppropriations Act when it came
out, there was specific languagearound eliminating the gag
clauses.
that health plans had in placein their contracts with
employers and providers.
But one thing that we've seen ispeople are still, because of all

(09:53):
of the language in theirexisting contracts.
People are still very skittishabout sharing this data, so we
haven't really seen, I wouldsay, providers openly sharing
this information, but the partof the gag clauses that we've
seen removed recently is verymuch employers and health plans
being able to share more costand quality information with
providers, with employees, ingetting that information flow

(10:17):
back and forth.
so while these laws do supersedethose gag clauses that exist in
these insurance contracts, Ithink there's still a little bit
of this transition period wherepeople are more willing to share
that data without fearing, uh,potential consequences.
But it is something where thedata is more open and available.
And so we know it's similar to,I would say.

(10:38):
looking at prices at a gasstation, 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 easilyfind that information and then
use that, um, kind of morestrategically.

Jonathan (10:54):
That's super fascinating.
So just to be clear forlisteners, go buy your insurance
contract, right?
especially as clarificationsaround elimination of some or
all of the gag clauses comesout.
But, you know, one thing youcould do is when you get to a
renegotiation point where yourinsurance contract is coming up,
you could say, Hey, Get rid ofthis gag clause, right?
Because, it gets superseded.
Well, I mean, let me ask areally basic question, Rafiq, is

(11:16):
how would an ABA provider goabout finding these rates
online?

Rafiq Ahmed (11:20):
Yeah, so the interesting part is they're
available online, but they'restill really hard to use as an
individual provider.
And that's a lot of where wecome in.
So the way for an ABA providerto find these rates online is
you can go to any health planwebsite.
So if you're in network with,let's say, United Healthcare,
that's why it's called UnitedHealthcare.
UnitedHealthcare has, a websitethat's transparency and

(11:41):
coverage.uhc.com.
And then they've basicallypublished, thousands and
thousands of URLs with networksthat are linked to their fully
insured networks, theirself-insured networks that have
all of this reimbursement ratedata for all of their in-network
providers.
on the site and hosted, um, kindof hosted either externally or

(12:02):
by each of the health plansthemselves.
However, they are in complexfiles that are JSON files that
are big, large, and can crash.
If you don't have a laptop witha ton of memory, it can
definitely crash your laptop.
If you try to open a single filethat can be hundreds of
gigabytes large.
And so that's where.
companies like ours and othersin the space have come in to

(12:24):
basically take and process thisinformation and put it in a
format that's easy to use if youare an ABA provider.
So whether it's, as simple as anExcel spreadsheet with the rates
for all of the ABA codes thatyou want to see, or if you want
to see it in, a web app orportal in a nice dashboard or
histogram format, we can dosomething like that.

(12:45):
But I think one of the keypieces of the regulations was
that this is a lot of data, soit's hard to put it into, you
know, uncompressed formats.
And so in these compressedformats, you have to be able to
then uncompress it and then.
Use analytics to be able to putit into a format that's easy for
an ABA provider to use in a ratenegotiation.

Jonathan (13:07):
Yeah.
You showed me actually what someof these files looked like, and
I'm not going to lie.
It's like a dumpster fire.
I would have no idea, how to goabout that, but you know, as
someone, I hate to admit this,but I have spent literally
hundreds of hours over thecourse of my autism services
career, trying to look forthings as basic as like a
Medicaid state rate and like,dude, that's so hard.
So I guess that is to say, I'mnot surprised that health plans

(13:28):
have made this really hard toaccess.
It's like, Hey, we're meetingthe spirit of the law, but good
luck, um, actually getting it.
but to your point, this is whySarif Health was founded, right?
So to make rate information moretransparent 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 acardiology company.
So I was working with my collegeroommate, who's a cardiologist
in the LA area.
And at the start of COVID, hestarted seeing his heart failure
patients via telehealth.
And so I had recently left myjob at Bain and was exploring a
couple different startup ideas Iwas working on.

(14:04):
And I w I was just giving himgeneral advice on.
What I thought would be aninteresting heart failure
business if he did it fully viatelehealth, because it was a
perfect population that, wastough to reach because they were
elder Americans, in terms oftechnology, however, when he did
reach them, Basically,controlling the cost of heart

(14:26):
failure, which can haveextremely high cost was all
about medication management andbeing able to reach patients in
time when their symptoms becameexacerbated.
And so, in our mind, that wasactually a really great use of
telehealth to be able to makethis early intervention with
heart failure patients.
So we actually started workingtogether at the end of 2020.
on building out a heart failurebusiness, built out our

(14:48):
telehealth app, and then reallystarted working on partnerships
with Medicare Advantage andassisted living facilities in
kind of the spring of 2021.
But what happened then was a lotof our partnership discussions
got pushed back because of thevaccine rollout for seniors.
So as the vaccine rollout washappening, all of our potential
business building andpartnerships got pushed back to

(15:09):
later in the year.
And then we really had to thinkabout like, okay, can we build
this business in the time thatwe thought we had?
And so on that front, mycardiology co founder, um,
stepped back, went back topractice in cardiology because
we couldn't really build thebusiness in time, but I had
recruited my current co founder,Matt, um, who was an engineer,
uh, building kind of the EHRsystems at one medical before

(15:32):
working with us.
and so we really thought whatcould we do now based on what we
had already built?
Did we have to stay incardiology or could we do
something entirely different?
And what was interesting is bothMatt and I were really
interested in the pricetransparency data.
He coming from one medical wherehe was dealing with kind of
contracts and admin on thatfront and building tools.

(15:54):
I had worked with, a lot of thefinancial reimbursement
information when I was at Bain,looking at healthcare
investments for our privateequity business.
And so the price transparencyregulations were on our radar
and we actually use some of thathospital data and early 2021 to
share cardiology reimbursementrates for hospitals.
with certain potentialcardiology groups we wanted to

(16:17):
work with in the L.
A.
area.
And when we showed that data tothem, 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 isavailable.
And so once we saw that, wereally started testing it out to
say, okay, if.
These new laws have passed, whoreally knows about this

(16:40):
information?
Can people start using it morewidely and more effectively?
And then that's where we reallystarted to test out the idea of
providing this information toproviders, healthcare analytics
companies, and others, and thenreally went down the path of
building out a pricetransparency company.
So it was a little bit morehappenstance and luck that we
knew about this.

(17:01):
Regulation.
We started using this data morefor a different business, and
then we realized when we hadthat chance to pivot that this
was the business that we weremore capable of building and we
found super exciting given that,we couldn't really replace the
cardiologist that we had justlost to continue, um, building a
cardiology business and ourbackgrounds much more fit, if we

(17:23):
didn't have a doctor, building adata business.

Jonathan (17:25):
This is like so fascinating because I think this
is the one of the really hardthings as an entrepreneur is
knowing, hey, when do we doubledown on what we're doing?
Because we're seeing productmarket fit and we're getting
traction and things are goinggreat versus when might we need
to slightly tweak our directionversus in your case, like, how
do we pivot entirely?
Um, and so, I mean, it'sphenomenal that you all have

(17:47):
Have made that pivot.
That is, that's a little bit ofart and science and reading tea
leaves.
but let me ask brass tacks, inwhat use cases can Sarif health
best help an ABA provider?

Rafiq Ahmed (17:58):
Yeah, absolutely.
So I think if we think about theABA providers, one thing that's
super interesting and why wethink the data is really
compelling for an ABA provideris that most other specialties
typically benchmark off ofMedicare rates.
And so given that the ABAtherapy rates are not reimbursed
by Medicare, there's a muchsmaller amount of existing

(18:18):
benchmark information available.
You've got.
The Medicaid rates out therethat are really difficult to
find, but that's about it.
And so what's really exciting isthat one, you're able to access
the market rates by payer in anygiven market you're in for ABA
therapy codes and understandsort of the scope, of ABA
therapy rates across the board.

(18:39):
and so where that becomesuseful, one is in contract
negotiations.
we can go and find actually therates of.
Any specific peers or anyspecific provider in a market as
long as the payer is compliant,and most are, and we can find
those rates down to the pennyfor any specific CPT code.
and so that's one where you canactually look at a set of your
peers.

(18:59):
How do you compare use that in arate negotiation with any given
payer?
The second is if we're lookingat market entry or payer entry.
If you're starting to expandyour practice, how do the rates
look in state A versus state B?
Is Ohio better than Kentucky orKentucky better than Ohio?
If you're a practice in aneighboring state, we've seen
that we've seen it used forinvestment decisions for

(19:22):
organizations that are investingin ABA therapy companies or
looking to acquire a partner andkind of build out their
business.
You're able to understand whatthe existing contract rate
structure is and whether there'san opportunity to improve it or
whether it's at the bottom ofthe market or top of the market.
and then we've also seenopportunities on, uh, being able
to use this for just generalpricing strategy as a whole.

(19:45):
And so it's something where Youcan actually choose this to
potentially not be in networkwith certain payers over others.
And so certain payers may beadvantageous to be in network,
others it may be advantageous tobe out of network, depending on
their specific dynamics.
And so we, we've seen a lot ofthat on the provider side.
And then the other piece that'salso useful is that it's also

(20:06):
been helpful overall to.
build out a larger datastrategy.
And so understanding the overallsort of scope of rates in the
market.
And then what are therelationships between who's
getting high rates and who's notgetting high rates, whether
that's geography based, whetherthat's size based, we've seen a
lot of those relationships.

Jonathan (20:26):
Hmm.
I was very fortunate to see ademo.
You gave me the product.
I think it was back in likeJune, 2020.
I'll confess.
I was blown away.
I mean, there's been some timeand attention that's gone into,
not just being able to translatethis really hard data, but
represented in a way that's easyto see to your point, like by
CPT code by state and by peerproviders.

(20:47):
But here's something I'mstruggling with.
I'll be honest, Rafiq.
If one of the intentions ofprice transparency and this set
of regulations is to lower thecost of prices over time in
health care, yes, we can allagree like health care prices
keep skyrocketing.
A lot of reasons for that.
But, um, so if it's intended tolower.
The cost of care.

(21:09):
However, now with this kind oftransparency, ABA, and in fact,
all healthcare providers haveaccess to their peer rate info,
like that should strengthen anygiven provider's hand in rate
negotiation and potentiallyincrease prices.
So there's this like dichotomouseffect 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, withprice transparency.
So if we're thinking about, Ithink, and it's also a micro
macro, lens on pricetransparency.
So the starting point of, ifwe're thinking about the
individual ABA provider withthis data in their hands.
You can definitely use it to geta higher rate.

(21:48):
And I think the way we thinkabout it is not necessarily a
higher rate, but a fair ratefor, uh, or a market standard.
So where we think the short termprice transparency impact is
that dispersion in the marketshould decrease.
so right now what we're seeingin terms of whether it's ABA
therapy rates, surgery rates,you know, any given procedure,
we're seeing some providers onthe high end, regardless of

(22:11):
quality or size, or Maybe it's alittle bit more size and market
power, but regardless ofquality, we're seeing huge
ranges in people gettingreimbursed an incredibly high
amount versus others gettingreimbursed at the bottom of the
spectrum.
And so in terms of how we thinkabout that, we really think
about enabling ABA providers toget a fair rate for what they're

(22:33):
offering compared to theirpeers.
But we also think at the sametime, health plans have this
information, employers have thisinformation.
And so we really think that therates at the high end are going
to come down.
So if you're more of a smallerindividual ABA provider or.
we really think that you usingprice transparency can bring
your rates up to more of amarket standard, but at the high

(22:55):
end, really what this bringsabout is maybe more of a
strategy question around pricingis if you're able to offer and
take a lower reimbursement rate,can you then drive more volume
to your practice, understandingwhere you stack up against other
ABA providers in an area?
And so I think for us, I thinkthe macro effect.

(23:15):
Is going to be lower prices overtime because some of those
highest prices are going to comedown, but we definitely think
the low end is going to come upas well.
So we think the median priceover time will decline, and that
variance will also decrease.
And so that's where we thinkkind 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 ABAfield 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 acrossalmost any.
If you look at almost any givenCPT code, whether it's an ABA
code or any others, the numbersget extremely high once you go
into surgical procedures whereyou can see, if you're looking
at something like a kneereplacement, you can see an
ambulatory surgical centergetting in the low thousands of
dollars, and then you can see ahospital getting in the, 20, 30,

(24:07):
$40,000 range.
And so you can see like 10xdifferences there.
On the ABA therapy codes, you'redefinitely seeing Less of that.
I would say less of thatabsolute difference, but you're
definitely seeing significant,you know, 50 percent or two X
number, like at the high endnumbers that are twice as much

(24:28):
as those on the low end of thosecodes.

Jonathan (24:30):
That's crazy to me, but, but honestly, it's less
crazy than like, what does ahigher rate provider, have they
justified getting their ratesvia clinical outcome data,
access to treatment metrics, youname it versus a lower rate
provider.
And so I think an importanttakeaway here is, as you go into
your next round of payer ratenegotiation, ABA organizations,

(24:50):
um, certainly you can use thisbenchmark data, uh, to justify
your case, but most importantly.
To carve that moat around yourreimbursement 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 usingthis price transperency data can
go It's really to create more ofa simplified, standardized
contracting process.
And so if we think aboutreimbursement rates overall, our
sense is there should be sort ofa fair standardized rate in the
market.
If you're an ABA therapyprovider, providing your

(25:24):
services, as you enter anetwork, there should really be,
a starting rate or a medianrate.
That's a fair rate in themarket.
And then you really can develophigher rates.
through your clinical outcomesthrough the value that you're
bringing to your patients or theother key piece that can also
help on the reimbursement sideis if you're providing access in
an area that's under resourcedor understaffed.

(25:46):
So if you're in an area with Lowaccess to ABA therapy, then
that's also a key reason that, apayer would need you in that
specific area.
So there are a couple differentreasons, but we really think the
starting point should bestandardized and then really the
defense and the moat aroundhigher rates should really be
those clinical outcomes.

Jonathan (26:05):
So true.
In my experience, Rafiq, andI've negotiated dozens and
dozens and dozens of these,rates.
Um, the single biggest predictorof...
An increase in rates comes downto the payers network adequacy.
So if you're in downtown NewYork City and you've got like
all kinds of different ABAproviders, that's very different
than if you're upstate in areally rural area.
So I think that idea of accessis important.

(26:28):
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 acountry if we see this hockey
stick, continued hockey stick,like growth and healthcare
costs.
So this, this feels reallyimportant.
It's kind of hard to Tie the X'sand O's ultimately to where it's
going to end up, but it feelslike a really important
evolution in price transparencythat ABA providers should be

(26:51):
paying attention to.
But let me ask you, what areyour thoughts on like the top
three things that the healthcareindustry can do to bend the cost
curve in healthcare just moregenerally?

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 areally great starting point.
It doesn't fully bend the costcurve, but I think understanding
the cost of care so that you canoverall bend the cost curve
becomes really important.
So it almost becomes a more of afoundational starting point for
policy, patients, providers toreally come together.

(27:25):
Yeah.
And, and figure out ways toultimately bend that cost curve.
But I think understanding thetotal cost of care and not being
surprised by a balanced bill,having some predictability is
very important as a startingpoint.
So I do think price transparencyand continuing to make it easier
for patients to truly understandthe cost of their care and

(27:46):
providers to understand theirreimbursements and have that
predictability is step one.
But I think like step two.
What I think is reallyinteresting and exciting, I do
think this is where technologycomes into play.
I do think the new generative AIchat, GPT technologies being
used in a way that really cancurb a lot of administrative

(28:07):
spend is gonna be a really bigpoint on the cost curve, but
without losing sight of empathyfor the patient and The wisdom
and the skill of the clinician.
So I do think a lot of solutionsare trying to.
Take a lot of that out, but ifyou're really focused on where
there are ways to superchargethe abilities of clinicians to
practice, reduce administrativeoverhead, there's a lot of waste

(28:31):
around complexity of billing andcoding that should really just
be simplified and the more thatyou can simplify it and not
allow people to game the system,it kind of helps everything
because like one of the biggestchallenges in price transparency
Is all the complexity aroundbilling and coding modifiers
that probably shouldn't existand have been there for people
who, to game the system and kindof extract as much value.

(28:53):
So if.
We can use technology, whetherit's AI or other tools to
simplify that process and reducea lot of that administrative
overhead in gaming of thesystem.
I think that's a huge way tobend the cost curve.
And then I think like ultimatelybeing able to really think about
combining pricing and unitpricing information we have with
ultimately.

(29:14):
exactly what we talked about,what is a more kind of
standardized measure of qualityand clinical outcomes because, I
almost think of pricetransparency, a short term cost.
We're thinking about that as thecost of an encounter, but really
a lot of the costs in the systemis.
long term costs from whetherit's someone ending up, you
know, hospitalized becausesomething wasn't found early

(29:36):
enough, or a readmission to thehospital after a specific
encounter.
So being able to really marrycost and quality and having a
much more, I would say, unifiedor standardized view of quality
that we can link to some of thenew information that we're
understanding and getting withthe price transparency
regulations.

Jonathan (29:55):
Well said.
I totally get that.
You know, it's reallyinteresting.
I go back to my economicsundergrad and, and background.
And, there, there is in somequarters in our country, this
perception that ABA has become acommoditized service, right?
That is, there's no way todifferentiate value and think
about commodities, like, I don'tknow, gasoline, or here's a
specific case study.
Um, and the question is like,why do gas stations end up right

(30:18):
next to each other?
Like, why does that make anykind of free market economic
sense?
Well, you know, this, this ideathat if you have a long beach,
right?
And you have an ice cream shopset up at one side of the beach,
you have a different ice creamshop set up at the other side of
the beach.
Wow.
What are people going to do?
Ice cream is kind of a commodityand you're just going to go to
whichever is closest.
So one of those.

(30:38):
Ice cream vendors is going tomove a little bit closer to the
middle and get a little bitmore, but then the other ice
cream vendor moves a little bitcloser to the middle.
And then, you know, after a bit,boom, they're right next to each
other.
Right?
And so you then have todifferentiate on quality, right?
And maybe you become a coldstone and like everything that
comes with that versus somethingelse, but same thing with gas
stations.
Right?
And I think I don't know, aBucky's gas station experience

(31:00):
who, who would have ever thought20 years ago that there was an
experience to be had at a gasstation, but

Rafiq Ahmed (31:04):
No, or, or in Georgia, quick trip is the big
one where everyone loves quicktrips, coffee and food items,
you know, at the gas

Jonathan (31:10):
Exactly.
You're building this likecustomer experience.
You're thinking about sort ofthe outcomes of your consumer's
experience.
And I think that is a phenomenalanalog to ABA providers, right?
If you don't want to beperceived as commodity and just
get to commodity pricing, thinkabout how, the outcomes that
you're driving for your kiddosare differentially better than

(31:33):
other ABA providers drive.
Um, so I just, I like, I can'tstress that enough for ABA
providers.

Rafiq Ahmed (31:40):
no, absolutely.
and I think that's where wereally think price transparency
kind of helps drive.
Providers in that direction.
it almost provides sort of thegateway where over time, our
hope is that price transparencysimplifies the contracting,
process makes it easy to getsort of that gateway contract to
get into the network, um, at afair rate, but then it's really

(32:01):
around that differentiation tobuild on that rate over time.

Jonathan (32:05):
A gateway contract, kind of like a gateway drug,
right?
I don't know, that's probablyextending the analogy a little
too far.
Uh, Rafiq, what's one thingevery ABA business owner should
start doing and one thing tostop doing?

Rafiq Ahmed (32:15):
Yeah.
So I think in terms of thinkingabout ABA owners, I think my
sense is You know, there'sprobably a lot of things I don't
understand about the full kindof gamut of responsibilities of
an ABA owner.
So maybe I'll focus on the startdoing where I have a little bit
more expertise, but I thinkreally thinking about data
strategy as an ABA owner is.

(32:36):
a really, a strong step.
So what we've seen a lot of is,piecemeal solutions in the past,
potentially, looking atsomething sometimes, or I think
if we're thinking about,contracting as example, a lot of
ABA owners we've talked to onlyreally think about their
contract when it comes up fornegotiation, they're not
necessarily thinking about it.

(32:56):
You know, between if they're,let's say it's a three year
timeframe or an annualtimeframe, they get the contract
and then, until they go back forthe next renewal, you're not
really thinking about it.
So really thinking about what isthat unified data strategy?
It's like, how do you understandpricing in your market?
How can you understand how yourquality or your outcomes may

(33:17):
compare to others or what you'rereally thinking about and
tracking that over time, becausethen you really, I think, can
come to the table with any payerand then tell that story.
And so I think we've beenseeing, we've been doing a lot
of work with behavioral health,providers broadly, ABA therapy
and otherwise.
And I think what we're seeing issome of the most successful ones

(33:38):
have been integrating varioussources of data, whether it's
public data sources, whetherit's, you know, research,
whether it's claims data, butreally using it to be able to
really truly understand theirpatient base.
And then bring out whether it'sthe services or pricing that
they think can really, attractadditional patients and serve
their patients better andbetter.

Jonathan (33:59):
Right on.
Well, Rafiq, where can peopleFind you online.

Rafiq Ahmed (34:02):
Yeah, so online, I'm mostly a lurker slash
consumer of information on mostonline 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 wherewe post a lot of our analysis

(34:22):
and findings from using theprice transparency data.
A lot of that is related tobehavioral health and ABA
therapy.
I'm also much more active onLinkedIn, than any of my other,
kind of social media presences.
And so, post a lot about kind ofthe latest updates.
or comment on the latest updateswith Serif Health and sort of
price transparency, at large, onLinkedIn as

Jonathan (34:44):
Rock on.
Well, go follow Rafiq and histeam because I think this is
profoundly important work that'shappening in our field and
across all of healthcare.
so Rafiq, are you ready for thehot 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 tobe remembered for?

Rafiq Ahmed (35:03):
So, I think on, yeah, on my deathbed, I think
it's definitely about personalinteractions and being able for
people to remember me as a kindperson, someone with a sense of
humor, someone who, you know,made people's day better by,
hopefully, our interactions.
So, I think those positiveinteractions is what I'd hope to
be remembered by.
But then I'll also take if, uh,if Serif Health can make a

(35:26):
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 importantself care practice?

Rafiq Ahmed (35:33):
So self care practice, um, I would like to
say it would be, uh, trying toexercise daily.
I try to get in something afterthe workday, but if I can't do
that, I'm a big fan of getting amorning walk in early morning,
like as early as possible.
getting to sort of breathe inthe sunlight.
I think LA, we're blessed, uh,with pretty good weather here.

(35:54):
So getting some of that earlymorning sunlight and sort of
that peace and calm, at thebeginning of the day is always,
uh, something that I try tostart 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 itback 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 mostgenres into one song.
Out of almost anything I know.
So it's hip hop, but it's alittle bit gospel.
It's a little bit pop, a littlebit R and B.

(36:26):
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 18year old self, it would be, I
think I followed this advice alittle bit, but maybe even take
it more, but don't be afraid totake risks, rejection is not
that bad.
I think after going through thefundraising process for Serif
Health and getting.
You know, 90 rejections to,every, acceptance from, a firm

(36:58):
on fundraising and believing inthe idea, you know, I can handle
rejection much, much better.
So I think don't be afraid oftaking risks, take the leap,
and, have fun while, while doingit.

Jonathan (37:08):
That's the definition of resilience, right?
And you know, I, what's the TedLasso?
My family and I just watched allthree seasons of Ted Lasso
together.
It's so good.
But what, like the happiestanimal in the world is a
goldfish.
Because their memory is like 24hours.
So you just go on to the nextopportunity.

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 aninteresting one.
I, I am a fan of style, so Ithink 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 ameeting, if it needs to be
casual, it's good.
And it's still prettycomfortable, maybe not as good

(37:49):
as house slippers, which wouldbe my number two.
But, uh, I would say the loaferwould be my versatile form of
footwear.

Jonathan (37:56):
That is perfect.
Well, Rafiq, thank you so muchfor coming on the pod and taking
time to share your wisdom, dude.
Keep kicking butt for ourhealthcare field.

Rafiq Ahmed (38:02):
Well, thank you, Jonathan.
I really appreciate theopportunity and excited.
This was my first podcast.
So hopefully one of one of manymore to

Jonathan (38:10):
You kicked it in the butt.

Rafiq Ahmed (38:12):
Thank you.

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