Situation: growing nutritional care model facing scalability challenges in revenue cycle

Changing lives by making it easy to eat well. Nourish is on a mission to make quality nutritional care accessible to millions of Americans through telehealth appointments with registered dietitians, all covered by insurance. Founded by a team of passionate health innovators, Nourish goes beyond telehealth visits, enabling behavioral change through tools like personalized meal planning and delivery of healthy foods, with the goal of covering these services through insurance or supplemental programs.

With a growing customer base and a complex healthcare system to navigate, Nourish faced significant operational challenges in scaling their services efficiently. That’s when they turned to Candid Health for help with automating and streamlining their revenue cycle management (RCM).

As Nourish expanded, they encountered major hurdles in managing their RCM processes. Marina Kemper, Head of Business Operations at Nourish, explains, “Before switching to Candid, we struggled with getting accurate visibility into our data, which made it difficult to make informed decisions.”

Their existing RCM solution lacked sophisticated reporting capabilities, forcing the team to manually process claims and analyze outcomes, resulting in slow growth and decision-making. Adding to the mix, the outsourced billing provider they initially used couldn’t keep up with Nourish’s rapid scaling, leading to backlogs, delayed payments, and a suboptimal patient experience.

“There was a lot of manual work that slowed down our ability to improve the claims journey, and as we grew, these inefficiencies became worse,” Kemper shared. The team knew they needed a more robust, tech-forward solution to not only keep up with their growth but also improve the overall patient experience by ensuring faster and more accurate claims processing.

Solution: a future-proofed revenue cycle built to scale
Enter Candid, an API-forward, tech-driven approach to RCM automation with the ability to grow alongside Nourish's evolving needs in terms of scaling operations and providing insights to optimize RCM processes.

Stephanie Liu, CTO and Co-founder of Nourish, reflected on their decision: "We knew that manual billing wasn't sustainable, and we wanted a partner who could grow with us and help us scale efficiently. Candid stood out for their product orientation and their collaborative approach."

From day one, Candid's platform provided Nourish with visibility into their claims data, allowing the team to pinpoint inefficiencies quickly and make informed decisions. When looking to understand how claims were being adjudicated by payers for areas such as month over month collection rates and the implications on the patient journey, Nourish previously relied on reviewing each claim manually and leveraging a volume of spreadsheets for tracking. The platform's automated reporting and sophisticated rules engine replaced the need for manual claim reviews, streamlining operations and reducing errors.

Benefits included:

• Improved visibility
& reporting: Nourish now has access to detailed reporting on claims data, enabling the team to make quick, data-driven decisions. "We can now see how our claims are performing at a very granular level, which wasn't possible with our previous system," Kemper explains. The visibility also allows Nourish to monitor collection rates in real-time and address any issues immediately, both saving time and cost by eliminating manual processes. This transparency has allowed Nourish to optimize their revenue collections and deliver a better patient experience.
• Scalable automation: Candid's Rules Engine has played a key role in helping Nourish scale efficiently. Previously, much of the claims process was prone to human error, but now, with Candid, there are automated guardrails in place to prevent common mistakes. "The rules engine has saved us so much time and made our work more efficient," says Kemper.
• Customized for growth: As Nourish expands their payer contracts and services, Candid's flexible platform allows them to customize their approach. "Candid's platform is highly customizable, which means we can tweak things as needed for specific payer contracts without disrupting the rest of our processes," Liu notes.
• Streamlined eligibility: One of the biggest time-savers for Nourish has been Candid's automated eligibility checks, which ensure patients' insurance coverage is verified regularly. This prevents issues with claim denials and streamlines the entire care process - a key benefit to ensuring that 94% of Nourish's patients are able to receive care and services and pay $0 out of pocket.

Kemper noted, "With Candid, we can now monitor our collection rates in real time and address any issues immediately. We've saved both time and costs by eliminating a lot of the manual processes we previously relied on."

Results: greater efficiency for scalable growth

Since implementing Candid, Nourish has been able to focus on delivering quality care without being bogged down by RCM inefficiencies.

The collaboration between Nourish and Candid has only strengthened over time, with both teams working together to innovate and refine the RCM processes.

“The Candid team has been a true partner, helping us evolve our RCM operations in a way that scales with our growth,” said Liu. “We know we can count on them to grow with us as we expand our services and reach even more people with affordable nutritional care.”

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