Episode 20: Streamlining Provider and Payer Data Exchange

Jim Dougherty, co-founder and executive chairman of Madaket Health, explains how his company is simplifying the administrative process for providers to collaboarate and share data with health plans so they can focus on their patients.

When Jim Dougherty realized that healthcare was facing the same problems he’d tackled in financial services almost 15 years before, he decided to create a solution.

As co-founder and executive chairman of Madaket Health, Dougherty is helping to decrease the time spent on administrative data exchanges between payers and providers. What used to take four months now takes only four minutes.

In part one of this two-part episode of How I Transformed This, Virsys12 founder and CEO Tammy Hawes and her co-host Clark Buckner talk with Dougherty about the story of how Madaket came to be, and Dougherty also shares his vision for the company’s future.

Bringing Fin-Tech Technology Power to Healthcare

As serial tech entrepreneurs who had helped build the leading fin-tech platform for document sharing, Dougherty and his co-founders decided the healthcare industry was “ripe for disruption”.

“Just like the financial services sector twenty years ago, healthcare was dealing with new regulations, deregulation and the introduction of new technology, all while lacking innovative software that could make things simpler for providers.

“We knew we were world-class enterprise software creators, and we knew that, generally speaking, people would agree that healthcare software is 15 to 20 years behind leading edge, but the deficit we faced was that we had never done healthcare before,” Dougherty shared. “We knew that there must be a place in healthcare where we could apply our software skills.”

Through extensive market research, Dougherty and his team learned that between $23-24 billion was being spent on communication between providers and insurance companies. They also identified five key types of information exchanges that were overly complicated for healthcare systems due to a lack of software. 

“There was no organizing principle whatsoever, it was the same things over and over again,” Dougherty explained. “We decided to try to replicate our success at Intralinks and become that platform that sits in the center.”

Freeing Up Providers to Focus on Patients

On average, a doctor works with 25 different insurance companies, and before Madaket, they would have to communicate with each of those companies individually.

With Madaket, a doctor can send updated information to all of their insurance companies in one simple step, reducing the average communication time from four months to just four minutes.

“That benefits everybody. The payers get a more consolidated delivery of data, providers get paid faster, the intermediaries get paid faster. So everybody wins when we do this successfully,” Dougherty explained.

Just as importantly, this allows doctors to spend less time on administrative tasks, freeing them up to focus on improving the quality of care for patients. “Taking away this wasted motion — that used to take four months and now it takes four minutes — and giving it back to the doctors, we think is a huge contribution on our part,” he said.

Partnering with Salesforce to Expand Madaket’s Reach

To date, Madaket has tackled two of the five key areas of information exchange — EDI enrollment and payer enrollment. The company is currently in the middle of Series B fundraising, which will help them to build solutions for the other three areas and continue to expand their reach.

Through the fundraising process, Madaket has built a partnership with Salesforce — first as an investor and now as an ISB Partner. With this mutually beneficial relationship, Madaket is able to gain more clients and prospects while Salesforce can deliver new, innovative solutions to their healthcare clients.

As they build out this relationship, Dougherty also hopes to monetize the data Madaket has collected to help provide insight into the marketplace. “The future goal is to do what we did at Intralinks, which is to become the de facto standard in this exchange of data.” 

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