Transcript
Kevin Murphy (00:00) hey, Kevin… hey, fletcher, hey, garrison, how’s it going gentlemen?
Garrison Goodman (00:06) Hey, Erica, Claire.
Fletcher Hall (00:19) This is everybody for today.
Fletcher Hall (00:24) Just to recalibrate on, I guess the purpose of this meeting, I think what we wanted to do is spend some time walking through that Roi analysis and just kind of Erica align with you on thoughts and considerations… for what leadership is looking for there to help move this forward… what we need to maybe consider as far as not only volumes but kind of how you’re looking to deploy with a new partner here. So, I thought maybe we could just spend some time in that excel sheet and then we can just ask you some questions and maybe get aligned on that point. And then if there’s questions around kind of how we got to the model or… scenarios that we could work through, we can just kind of keep that in open dialogue. Does that make sense? Is there anything else we wanted to cover?
Kevin Murphy (01:28) I think probably term like length of term out years. Erica, what else… from a terms and contract perspective? I.
Erika Detert (01:43) Thought we had like a, I don’t recall that we were going to talk through the Roi. I’m fine to do that, but we needed to understand what the go forward plan was, why, what the benefit to us would be to lock in for three years versus understanding like what built in incentive there would be for us to sign a longer term agreement. I don’t know Garrett. Yeah, Garrett, I felt like you had like three action items. I’m not recalling… all three of.
Garrison Goodman (02:19) them. Yeah, no, sorry. No, we wanted to one first, hey, we agree on the value and the outcomes that we’re delivering it’s like, hey, why we’re doing this and what the, what we can bank on in regards to, you know, the Roi achieved from healthpro. From there, if we’re good on that, then I think absolutely align on a contract that makes the most sense for you all. I think I wasn’t aware like, hey, there was, you know, wanting to understand the difference between a year and a three year. I think our goal was and we can obviously run you through the contract that we put together.
Garrison Goodman (02:54) And I think Erica, our goal was to get feedback from that contract. It sounds like you’re saying is like, hey, what is the difference between a one and a three year term or a five year term?
Erika Detert (03:03) No, I’m saying, if you want us to sign up for a three year term, like why would we want to do that, right? Like with all of the change that exists in the market, what are the incentives for us in a multi year agreement?
Garrison Goodman (03:17) Yeah.
Erika Detert (03:20) Specifically as it relates to, I don’t know why I have a mental block on this but doing… enrollments as a group Kevin.
Garrison Goodman (03:28) The delegated.
Erika Detert (03:29) Delegated thank you plans for delegated commitments for delegated like what this looks like over time just knowing there are so many entrants in such a like steep technology curve around this.
Garrison Goodman (03:46) Yeah, I think it, and there’s two other pieces. One is like, hey, we wanted to also set up just like a product roadmap session for you so you could get our thoughts of like, hey, how are we staying ahead of things? What’s our vision on the landscape so that you have confidence that yes, not only would be a good vendor of choice now, but in the future, so you could see like, hey, we have good directionality on and a good, you know, thought leadership in the space. And the third piece was also, Kevin was going to work with the operations team to understand from their perspective, how they think about a few of the things that we talked about before. So there’s a couple of different tracks. This one was primarily just on the value and the contract piece.
Garrison Goodman (04:30) So, I think best if we kind of walk through this Erica, have you seen this before?
Erika Detert (04:35) Yeah. I think Kevin may have, we may have, is this the same one we walked through?
Kevin Murphy (04:40) Yeah, this is, yeah, yeah, this is the, it’s the same one. I think it might’ve been. I think fletcher’s updated some of their pricing on it. So it might be a little different. Yeah.
Garrison Goodman (04:52) Just to summarize like the options you’ll see here are based upon the volumes that you all need. And we’ll get into the, you know, how we got to those volumes. In short, I don’t know if we have it in front of us, but the advantage for going with multi year and a larger upfront amount is obviously unit cost changing. So we’ll happily detail out to you so you can compare options, but I think like let’s first and foremost, make sure that we a align on a comfortable number of enrollments. And then what the impact of this overall objective will be both conservatively and on the high end, but probably end up somewhere in the middle. And then hopefully we can walk away with like, hey, where do we want to start from an enrollment perspective?
Fletcher Hall (05:38) Yeah. Just… to orient on that. So, I think like these three scenarios obviously were built with from… healthpro’s… perspective, like number of new hires study state et cetera. With a low medium and high range. So, we built our models around these kind of three scenarios for medallion. It doesn’t we’re happy to contract to the lowest volume if that is like is a more comfortable de, risked commercial arrangement for you? All the difference is you’re going to get different unit pricing, right? The two things that inform unit pricing are volumes and then as well as term length. So these price models were built off of a three year, our standard three year term agreement and reflect… different volume pricing mainly on the enrollments. Because the other numbers aren’t drastically changing as much as the enrollments.
Erika Detert (06:44) How does your cost? So, how does the, why… is volume more price… advantageous for you? Like how can you offer lower pricing and higher volume? How does that work economically for you? It’s better?
Fletcher Hall (07:01) Predictability and resource allocation, right? So not everything is completely automated. We have folks both from a technical and operational level that we need to deploy for, you know, strategic relationships and for volumes, right? So the smaller set of volumes come at a higher cost because we have kind of less predictability in that model that we’re you know, forecasting to a certain volume.
Erika Detert (07:33) So talk to me a little bit about that mix of technology and people, right? That’s sort of the first I’m hearing that they’re I… mean, like that it’s people heavy because that’s sort of what it, how much.
Erika Detert (07:48) And if we’ve already talked about this, forgive me, but how do we think about the amount that is technology versus the lift? That is people?
Fletcher Hall (07:57) It’s a good question. So garrison, I’ll take a swing at this and feel free to chime in… fundamentally the automations that we built into the platform are built around sources that are automation automatable, right? So we can build PSV automation, we can build automation around acquiring data from caqh, we can build automation around compiling that data and putting it into a structured submission for enrollment. We can automate you.
Kevin Murphy (08:36) Know, structuring,
Fletcher Hall (08:37) enrollments to medicare and medicaid, you know, there’s a lot of things that we can automate the interaction between that counterparty and medallion as your delegate with that counterparty whether it’s a payer or a federal or state entity requires some level of operational oversight, right?
Erika Detert (08:58) We.
Fletcher Hall (08:59) need to have people in the loop here to help manage either one offs or kind of bespoke requests from… those entities that are not just, you know, data automation equations. So operationally, we staff a team according to the volumes and the mix of payers that we are going to be supporting for you all… also think about things like delegation and delegation audits, right? Like that’s, not a process that you can just do with technology, right? You need to have a person that’s responding to an auditor and pulling the necessary data and is prepared to speak to that data on whatever, you know, on whatever cycle that audit happens right every year. So that’s the blend of kind of the operational mix also within ncqa credentialing, everything needs to be verified with… a human in that workflow, right? So we can compile a PSV and we can reconcile a PSV. But ncqa guidelines dictate that it needs to be verified and checked by a human in that process. So it’s you know, there’s probably 20 more of those types of scenarios, but that’s based on kind of an askew level credentialing… and enrollment and delegation.
Fletcher Hall (10:46) Okay.
Erika Detert (10:48) I think one of our major concerns was around enrollment and the proliferation of enrollment that we have today. I think we’ve talked about that a couple of times. I.
Kevin Murphy (11:00) Don’t I think one.
Erika Detert (11:00) of the things we asked for is like what could you do either in terms of like flags or workflow or to help us manage some of that? So like I think one of the things that’s sort of being lost here is like that, this is just a very different way than our current process operates. And so that’s gets into the conversation that Kevin mentioned where we have to talk to our operators. Obviously like we’re not, we don’t want to interrupt like introduce disruption. And we also don’t I think the continued conversation about the pricing is this unit concept is that we’re paying upfront not based off consumption and that we don’t have a great handle on what our enrollment consumption is today to be able to predict that. So like those three items still, I think exist, Kevin, keep me honest.
Kevin Murphy (11:56) No, I mean, I think… to me the, like… what gives us concern, right? Or we’ve talked about this and I want to rehash the volumes, right? Like we just don’t know what they’re going to be, right? So I think we probably need to price somewhere in the middle part of this or the lower side and bake in some like we might go over and that’s what we’re going to end up paying. But we aren’t like locking ourselves into a, you know, exceedingly high number on an annual basis. And then the other piece is like, how can you all help us keep our enrollments down and keep the units down? Like that is the I’d rather tack towards let’s go low and try to not go above it as much as we think, right? And so like, what are the, like, you know, the tools? And I feel like that’s probably the integration conversation like how do you help us keep those enrollments lower? But I also think, you know, we’ve talked about delegated roster management, you know, and I know that takes time which is like does that play into year two, year three? The kind of pseudo delegated stuff that you’ve talked about fletcher where you’re able to submit like roster type stuff to payers but like they’re not technically counted as a delegated roster in here. So like we might see a time benefit from that, but we don’t really get a pricing benefit on that. So like those are the types of things that like how.
Fletcher Hall (13:36) do we, how do we?
Kevin Murphy (13:37) Incorporate that piece, you know, into this where, we can sign up for lower consumption with the expectation that we’ll probably exceed it. But there are tools that we’re using to manage that. Cause I mean, then it is more of a I… don’t know. We are like, I think in general like we are paying a consumption rate, whether we’re paying per head for advantum, whether we’re paying per unit here. It’s just like purchasing a subscription. It’s just really hard to find that fine line. And I think that’s where we, you know, obviously we’ve gone back and forth on should it be high? Should it be low? Should it be somewhere in the middle? Like I’m kind of geared towards let’s go lower and try to limit the enrollments as much as possible.
Erika Detert (14:26) But I think what you’re hearing is like that, this pricing is like not in alignment with our business, right? So, like if we’re having a business downturn and we’re not able to hire people or we don’t need people, but we continue to have to pay a set fee like that’s, not a great model for us to be in, right? Like you’re compounding to our, to a slowdown or to a financial stressor that we have versus mitigating it. And I think the enrollment piece just feels like that… could… be an absolute wild card that makes this entire proposition… unattractive… for us, right? Because we are not used to managing enrollment today and metering enrollment and managing that unless there’s some sort of solution that you can think of to help us manage with that, like we can’t throw additional people at this problem to start trying to bottleneck or white knuckle enrollment, right? Because in any intended benefit of speed, you’re going to lose because we’re not going, you know, like we’re… not going to either not have people enrolled to do the right care or have some additional administrative costs of trying to make sure that people aren’t over enrolled. So, I think what we’re continuing to express is like this model of pricing does not align with our business. And so we’re saying, from an enrollment standpoint, is there anything you can think of to help us manage that? Is there any sort of per person cap flag, anything that you can think of to help us manage that? And then the other one is like this constant set payment regardless of whether we have usage or not is difficult for our business. So, yeah.
Garrison Goodman (16:31) I hear a couple of things. One, we know that there’s some uncertainty around the number of enrollments that we need two. How does that change if we move to delegated? And then three, you?
Kevin Murphy (16:42) Know in.
Garrison Goodman (16:44) Regards to the level of predictability that we feel confident over the next two and three years, how do we have, I guess some flux around that capacity if I’m understanding those three things, right?
Erika Detert (16:59) Or change the contract to be a consumption basis. Yeah.
Garrison Goodman (17:04) So, my question is like, so one, if moving to medallion, correct me if I’m wrong, we will be able to have the data actually in a place where we’ll know how many enrollments?
Erika Detert (17:15) That we need correct like that would be a no because we don’t know how many enrollments that we need today. We have people say, if you hire them to the state of Illinois, enroll them in everypayer in Illinois. We don’t have like our current approach is when in doubt enroll like broadly enroll folks. That is a culture shift. Yeah.
Fletcher Hall (17:47) I think that the short answer is we can limit and we can align with you all, to cap locally enrollments. We, you know, we went through some of these in the last call, right? Like there are things that we can put in place to structure the consumption of enrollments that they’re more aligned with what will provide the best outcome and impact to your business, right? So, like decommissioning payers where there is no claims process, decommissioning, enrollments, where, you know, there’s.
Erika Detert (18:25) there aren’t.
Fletcher Hall (18:25) active claims in the last, you know, 90 days or whatever, right? Like or maybe it’s a, you know, there’s 15 payers for a new group or a new facility, and it’s you know, you’ve seen that they’re in that market. Only really four of them are active channels for you, right? Like we can put those types of mechanisms in place. I think the big question is… can we put that all in place within the first year? Understanding how many providers you want to bring on board and the kind of hiring aspirations, right?
Erika Detert (19:02) So,
Fletcher Hall (19:03) balancing across what might be a higher volume of enrollments because of new hires versus higher number of enrollments based on, you know, just kind of status quo enrollment activity, right? Those are two different volume scenarios. Yeah… I’m less.
Erika Detert (19:26) Worried about the second. Because if someone says like, oh, we need this enrollment, they probably need the enrollment. Like if they, after someone’s working there, it’s more on a new hire front end where they say enroll me in every plan in the state of Illinois when they live in Chicago, right? Like they’re it’s probably, they’re not going to make it to peoria, so, any local plan there, but it’s bigger than that too, right? So, I know that you sort of threw out this idea at a high level. But like, what does that look like? Who works that? How does it get managed? You see what I’m saying about their, this like turns into an administrative thing… item for us. So just.
Garrison Goodman (20:11) so, I’m on the same page, it’s a bit unique. Why is it a challenge for you to understand what payers to enroll a new provider with?
Kevin Murphy (20:22) Because our business?
Erika Detert (20:24) Is.
Kevin Murphy (20:25) it’s unlike any. It’s not like a standard brick and mortar. We have an outpatient practice. We are in like to take Chicago. We’re in 50.
Erika Detert (20:34) Long.
Kevin Murphy (20:35) Term care, independent living, assisted living facilities in that area, we are providing our operations team. They want the ability to move people around to cover as needed. And in each of those facilities, there could be any number of different payer mixes. So, in some of them, you’re going to have, you know, a lot of medicare, a lot of uhc, a lot of humana, but in another one, you’re going to have blue cross and you’re going to have Aetna and you’re going to have cigna, but they want the ability to be able to move that person, that therapist to whatever site, they need to cover that week. And this is part of the very.
Erika Detert (21:20) Simply said, like at a higher level, Kevin, because like we are running an inpatient practice. So whoever lives in that facility, whatever insurance they have, we have to provide care. We are not running an outpatient facility where we say these are the insurances we take. And if you don’t like that, you can go somewhere else. Like we have to give care to whatever insurance the residents of that facility have. So we, it’s not like your dentist where they’re like, oh, we don’t take delta dental anymore. Like doesn’t matter whatever’s in the facility we have to take. And then to Kevin’s point on top of that, where you’re in these dense populations where there’s different mix. It’s not like we can’t just credential for the top three insurances at this site. There’s like this neighboring site. So now it starts to get this multiplier effect of, yeah, that’s helpful usability of our folks. So that’s so thank.
Garrison Goodman (22:16) you for that and for your suggestions earlier too on ways that we could structure it? Fletcher and I would have to go obviously go talk to our executives and figure out something that works. You gave us some good examples of things that could be done. How do you have it with your current vendor today? This is an example like how do you, we pay a?
Kevin Murphy (22:39) Per month fee per head and they cover everything from credentialing to enrollment. Doesn’t matter if we enroll them with one payer or five or 10. Yep. Okay. It’s one fee.
Erika Detert (22:52) And then, and there is like some stair stepping based off the length of time that person has been an employee of ours. Yeah, yeah.
Kevin Murphy (22:59) It’s not material, but, yeah.
Garrison Goodman (23:02) So, those two points hey, your business and like how you have it today are helpful for me as I’m communicating internally. And then I think, is there like an enrollment volume where you’re like, hey, we’re going to hit this? We know it.
Kevin Murphy (23:16) And that way,
Garrison Goodman (23:18) we could have like some basis of like certainty around where we’re going to be, and then a percentage of potential flex that you guys would also be comfortable with. Again, this is us just, I think getting creative here, trying to figure out what could potentially work based upon the flexing that you all would need.
Garrison Goodman (23:42) Where you’re saying like, look, we think we’re going to hire but like things can change in 12 months or less or however long, but like maybe we could model it to like a conservative growth that we think is, you know, I don’t want to say like if the wheels fall off, but to the sense, we’re like, hey, we’re fairly confident that we’re going to get this. And then I think what, you know, fletcher’s showing there is like, hey, we are going to be getting some additional revenue from this too. So we should be able to cover ourselves in that regard, if there is an economic downturn, but how can we model this in a conservative way of like a level of enrollments that we’re fairly certain of?
Erika Detert (24:29) Well, we could start at a lower. You could do it as a minimum, right? So that we have a minimum. And if we go above that, once we hit that higher tier, you could retro us back and credit us for the higher tier, right?
Kevin Murphy (24:44) Like if it seems like.
Erika Detert (24:46) What, and maybe I’m wrong, but it seems like what you’re trying to plan for here is some sort of revenue predictability for?
Garrison Goodman (24:54) Sure. Yeah. So as.
Erika Detert (24:56) Opposed to us taking 100 percent of the risk, we could meet somewhere closer to the middle, where instead of saying like, oh, if you have this low end of the, if… you sign up for a low tier, all the price is going to be higher and like maybe in the short term, we pay a higher price until we got to the higher tier. And then you could retro credit us like for the length of that. Assuming it’s a year going back to the beginning of the year when we’ve triggered the next tier. So then that way we sort of meet in the middle on it, you’ve got some amount of set revenue, but we’re not paying some rate that we may or may not hit. And then if we do hit it, then we get the benefit, of that tier. So we’re not locked into a potential downside.
Kevin Murphy (25:45) Yeah… yeah, I.
Garrison Goodman (25:49) Understand. And you’d say like, hey, if we, you know, gain confidence in our growth plan, then we would just obviously grow and then we would unlock those next tiers… where it’s like, you know, you.
Kevin Murphy (26:03) Asked about, you asked about enrollments, right? So we did about 7,000 last year that’s coming from data from our… from our current vendor. So give or take, I don’t know if that’s 100 percent accurate. That’s all new providers too. So that doesn’t include anybody that may have been like in, you know, on our roles already and we then needed to put them on to new plans. But I think that that’s, the big, the majority, is that right? But I think that’s to Erica’s point like we, that is a, as soon as anybody comes on, we just get them, you know, we make sure that they can see everybody, you know. So like we just need ways to manage that because I think if we went back and looked at all of this, we would say, you know, especially for some of the states like Illinois is the big one, you know, a lot of these folks probably only see like, you know, I would say 90 percent of the business probably comes from three payers in every site. So it’s but if we only.
Erika Detert (27:04) enroll them with those three payers. And for some reason, they need to see some other patient. And it’s an issue like that’s. Going to be a massive dissatisfier for our operations team. And then they’re going to be saying like as opposed to getting us a revenue benefit of being able to treat sooner like you’re preventing us or putting our business at risk because we can’t treat this resident that just moved in.
Garrison Goodman (27:29) Do you have any data around like… number, like the percentage of billing towards each pair that you enroll with?
Kevin Murphy (27:43) No, we don’t okay. And we don’t have like, what? Like what we have for our enrollment mapping? Like our enrollment pay like that’s not mapped to our billing system.
Kevin Murphy (27:56) Like we’re actually doing some of that with our athellas project and it’s like a huge nightmare. And that’s just for two states. We say, you know, just a very high level example. We say like, you know, we credential somebody with optum that equates to like 17 different uhc plans in one state. So, it’s just very difficult to like map all of those and say, you know, hey.
Erika Detert (28:22) You know, these.
Kevin Murphy (28:24) Three plans we don’t actually need to be enrolled.
Erika Detert (28:27) With this is part.
Kevin Murphy (28:29) of the thing, it’s like it’s an administrative nightmare to stay on top all this stuff. Yeah.
Garrison Goodman (28:33) So, I mean, on the one hand, it’s a data challenge. On the other hand, it’s like an operational perspective challenge as well where you don’t want to be bottlenecked based upon the enrollments that you have allotted for by a specific payer.
Erika Detert (28:47) And you want to be?
Garrison Goodman (28:48) Able to treat somebody when they come in. So I get that we’ll take some of that back and totally understand where you guys are coming from. So, with that, assuming we can work something out, I think the other thing we want to just agree to and align on as well, is that, hey, if we get a contract structure that makes sense that allows for some of that flexibility and uncertainty.
Erika Detert (29:14) Do we?
Garrison Goodman (29:16) Agree on the outcomes that we are going to be solving for? And I think a lot of this is going to be driven by new revenue that you’re able to gain by decreasing the time it takes to start treating. So, so.
Erika Detert (29:31) Fletcher can.
Garrison Goodman (29:32) You run through some of that. And as you, as you’ve seen it and just make sure that we’ve got alignment, from Erica?
Fletcher Hall (29:38) Yeah. And just before we jump into that, I’ll get to that in a second. So you said last year you onboarded 950 providers, would it be, would a safe model assuming?
Erika Detert (29:50) Your.
Fletcher Hall (29:50) steady state provider? Plus, let’s say 788 or do you want to shoot for the 950 as total number of providers that we would carry on the platform for the first year?
Erika Detert (30:02) I do not want to be locked into anything like I don’t I want, I do not feel comfortable being locked into any based off last year. This is what we’re going to do, okay? Next year. And I, it’s going to be a hard sell for our PE sponsor too. They’re like where we’re at right now, it’s very much about flexibility, right? So, like if they made the decision that they wanted to strategically exit some region or sell some portion of it like that, this would be a risk to us, right? Like we would have stranded cost because we would have some amount of this, right? Like the… planning for the base case or some upside or is not going to be… a model that we can move to in the short term is?
Garrison Goodman (30:55) Is there a minimum that you could commit to? I?
Erika Detert (31:00) Think we’d have to think about that, right? Like Kevin, we’d have to go back and figure out like what? Yeah… I mean contract minimums are, I’d… say Kevin, like rather common. So we can figure that out. I think what we need, what we need to understand is again, like the… mutual incentive time, like if we do hit that medium case, I don’t want to be paying rates on the low end, that doesn’t work well, either, okay? And also like, and then that continues into like year two and year three, right? As we talk about… different ways to do enrollments as, you know, you all have whatever technology roadmap us knowing that the speed of change in this landscape like we need to be tied in to what are mutually beneficial meaning from a financial standpoint for us or from a benefits outcome, what… do years two and three look like? Like how does it improve?
Fletcher Hall (32:20) So, I mean, just for, because we have to, we have to back into a model on our side. So I’ll just use the I’ll use, this low volume as kind of a mint. We’ll talk about a minimum, right? Like just so we can structure something and have somewhere to work from. We’ll.
Erika Detert (32:34) use that as.
Fletcher Hall (32:35) Maybe the minimum, the.
Erika Detert (32:36) steady state.
Fletcher Hall (32:37) Providers, at least in the first year you.
Erika Detert (32:41) Know you’re.
Fletcher Hall (32:41) going to have to re, credential, you know, a third of that network you’re.
Erika Detert (32:46) going to likely move.
Fletcher Hall (32:47) Beyond 350 new providers.
Erika Detert (32:51) Right. We.
Fletcher Hall (32:54) just need somewhere we.
Erika Detert (32:55) need to.
Fletcher Hall (32:56) Peg to some.
Erika Detert (32:57) Volume, I think.
Kevin Murphy (33:02) Doing we’re continuously doing roster cleanup?
Kevin Murphy (33:11) You go even lower than I would go to 2000?
Erika Detert (33:14) You know?
Erika Detert (33:20) Feeling a little frustrated because I feel like we’ve continued to communicate across these calls the same challenges that we have. And like, I feel like the refrain is like, if this is, if this is the model then like I, we need to know that this is, it like this is the only financial model. It’s not going to change. There’s no flexibility. And then Kevin and I need to make a decision based off of that. But I… feel like we keep expressing the challenges and then like the answer that I’m hearing back is like, okay, then pick a tier you want like pick a minimum, pick a number you want to be at, yeah.
Garrison Goodman (33:56) No, Eric, I think we heard what?
Erika Detert (33:57) I’m communicating is that doesn’t work?
Garrison Goodman (33:59) For us? No, no, I understand. I think in terms of expressing to you the Roi we’re going to base that off of like what we have modeled here, I think is where fletcher was going. Not necessarily saying, hey, pick a pick.
Erika Detert (34:13) A number for?
Garrison Goodman (34:13) For pricing, I think we’re kind of we’re hoping to move, hey, we’ve understood you, we heard you, we need to go back internally and understand what’s possible. But we wanted to also align with you on like, hey, based upon these numbers here here’s, what the value could be to you? So, sorry, if we didn’t make that clear, we were kind of a moving topics. Does.
Erika Detert (34:35) that make sense?
Erika Detert (34:44) Okay.
Fletcher Hall (34:47) On the Roi side, and I think it’s like they’re all kind of moving scales here, right? Just note that the way our contracts are structured with our slas are targeting closer.
Erika Detert (35:08) To.
Fletcher Hall (35:08) the higher range of this days.
Erika Detert (35:12) Saved based on.
Fletcher Hall (35:14) The SLA that we structured. So wherever the volumes land in number of providers or whatever it is. I think.
Erika Detert (35:23) As long as we’re.
Fletcher Hall (35:25) orienting towards what our SLA and our contract is.
Erika Detert (35:28) Written towards.
Fletcher Hall (35:31) That’s I.
Erika Detert (35:32) guess what I’m trying to relay?
Fletcher Hall (35:34) Is like kind of what your guaranteed as guaranteed Roi is based?
Erika Detert (35:40) On.
Fletcher Hall (35:40) medallion’s commitment back to hph. So, like where it says?
Erika Detert (35:47) If you don’t hit your SLA, you’ll pay us to make sure that we hit these Roi… numbers. That’s what I heard just heard you say you have contractual.
Fletcher Hall (35:56) Recourse.
Erika Detert (35:57) What that we can just exit so that’s not really recourse. Is it well?
Fletcher Hall (36:01) You have exit?
Erika Detert (36:02) If that’s what the positioning, is that the SLA guarantees us the Roi that’s awesome. Put that in writing, and that would protect us from a downside, but exiting the contract for non performance is not the same thing as that… you’re going to credit us back. Like if you don’t hit your slas, and so we don’t hit our Roi, you’ll credit us the difference that’s.
Fletcher Hall (36:23) what that’s what the SLA right is written to?
Kevin Murphy (36:26) So, you’re credit?
Erika Detert (36:27) Us dollar for dollar?
Fletcher Hall (36:28) It’s both.
Erika Detert (36:30) It’s.
Fletcher Hall (36:30) both a, it’s both consumption credit. So, if you, if.
Erika Detert (36:35) we didn’t hit.
Fletcher Hall (36:35) our SLA across 10 percent of our enrollments,
Erika Detert (36:42) there’s a.
Fletcher Hall (36:43) Structured credit. And then you also, if we don’t hit that over three periods, you also have an exit clause.
Erika Detert (36:49) So, if you don’t hit the 10 percent, you’ll pay the value of our revenue that we didn’t generate for those missed… SLA individuals?
Fletcher Hall (36:59) Not the revenue, no, okay.
Erika Detert (37:02) So, but the Roi is based off us bringing in revenue, right? But.
Fletcher Hall (37:08) You wouldn’t pay us for that for?
Erika Detert (37:10) That.
Garrison Goodman (37:10) Service miss.
Erika Detert (37:14) But that’s a fraction of… guaranteeing the Roi, it’s guaranteeing your, that we won’t pay for missed slas, but if you think about your Roi is based off of the fact that speed to enrollment is going to allow us to generate incremental… revenue or revenue faster than we could under a different model, right? The cost of… credit to do that credential or that enrollment is just a small fraction of the overall.
Garrison Goodman (37:49) Do you?
Fletcher Hall (37:49) Have, do you have any recourse with, your current vendor at all?
Erika Detert (37:56) Our pricing is a lot lower. I think that’s the difference, right? Like our exposure risk and we don’t have any, we owe this amount of money every single month regardless.
Garrison Goodman (38:10) So based, yeah, I think like based upon the, you know, 2000 or so enrollments or so and based upon the provider growth around the, I think it was like the 350 mark or so or what it was. If we can get to conservatively 35 days faster, then we should achieve, you know, a 1,000,000 dollars or more that would be if the wheels fall off from us.
Erika Detert (38:33) We see.
Garrison Goodman (38:34) 50 days on average. And so we think realistically, it could be somewhere on, the 100 percent side. But even if we’re conservative right there in the middle, just based upon that, you should see an additional one point 3,000,000 in revenue and our slas are tied to what you pay for us.
Erika Detert (38:50) So, it,
Garrison Goodman (38:50) it’s actually net new that you would gain than you currently have today and you, what you pay for, that is what you pay for us. And we would credit that, if we missed that, but I mean, we don’t really have that happen, which is why we.
Kevin Murphy (39:03) contractually commit.
Garrison Goodman (39:04) To it and we even, you, know, that we can do.
Erika Detert (39:09) This.
Garrison Goodman (39:09) That’s why that’s why we do it. So, I think like what we just want to get to an alignment that is, hey, if we can drive conservatively which is below what we’ll contract to that, this speed gain will net new revenue for you.
Erika Detert (39:32) I’m gonna also read the language around the SLA in detail, absolutely.
Garrison Goodman (39:39) But I think we were just asking like, hey, do you agree that if we can speed this up, this will deliver revenue to your business?
Erika Detert (39:48) Like it’s back to like the, at what cost, right? So, your… what, how many enrollments are you assuming that we do per provider in… this Roi cup?
Fletcher Hall (40:04) Off of this model here. So in the adult, it was two thirds of your providers. So seven to 11 enrollments per provider. I don’t.
Kevin Murphy (40:14) know if this is the Roi is reading, it might not be reading from that tab. So it’s like if you’re trying to figure out.
Erika Detert (40:21) If you scroll back down, I.
Kevin Murphy (40:22) Can tell you exactly what it’s pulling from… basically, you know, each column is a percentage, of the new higher target based?
Erika Detert (40:34) On.
Kevin Murphy (40:34) the number of days that medallion is saving us on the left and then at a 50 dollar of revenue per.
Erika Detert (40:41) Day collection.
Kevin Murphy (40:44) Essentially or 50 dollar revenue generation per additional day?
Erika Detert (40:52) At an assumption of how many enrollments? Sorry… the, it’s what is the Roi when you need the cost of what I’m trying? Like what’s the total cost of like enrolling a person that we’re assuming, so… that’s this?
Kevin Murphy (41:07) Is the, that’s just the revenue? If you scroll down?
Erika Detert (41:11) I… think I projected.
Kevin Murphy (41:14) Out like the net Roi is based on 50 7,500. So you can see there… those tie back to if.
Erika Detert (41:26) you scroll up down… a little bit, the.
Kevin Murphy (41:29) Roi summary, right? It’s basically like those are the buckets there the.
Erika Detert (41:35) Advantum.
Kevin Murphy (41:35) Cost the medallion cost… the tiers and the enrollments aligned?
Erika Detert (41:42) Within, yeah. So that’s what I’m pressure, testing the medallion cost.
Kevin Murphy (41:49) Takes into account the higher medallion cost for.
Erika Detert (41:53) Enrollments. How are we, right? But how many enrollments?
Kevin Murphy (42:02) Can you click on that one? What is that cell referencing? Okay?
Garrison Goodman (42:07) So that there?
Kevin Murphy (42:09) So, if you scroll up, you can see, you know, it’s.
Erika Detert (42:12) that… one is 20.
Kevin Murphy (42:18) 600 enrollments, but.
Erika Detert (42:20) The middle.
Kevin Murphy (42:21) Case is 5,200 enrollments, and that, the highest case is 8,700 enrollments. Okay?
Erika Detert (42:26) But that’s okay. So, how about out of how many people were on boarding? What is, what is like the line like line 20?
Garrison Goodman (42:33) Three line, 23 is the new hires, right?
Erika Detert (42:45) And dividing it by five, 25?
Erika Detert (42:52) Enrollments per individual is what you’re assuming?
Kevin Murphy (42:58) I mean, we have it broken up by payer, by adult and peds. So, yeah.
Garrison Goodman (43:03) I mean,
Fletcher Hall (43:04) roughly, it’s seven.
Erika Detert (43:06) Per,
Fletcher Hall (43:07) adult provider and seven. Yeah.
Kevin Murphy (43:10) I think Eric is just taking and dividing it by 23.
Erika Detert (43:13) Yeah. Why did the assumptions change by tier? It’s probably more conservative since they go up. But… yeah.
Kevin Murphy (43:23) I think that like we… credentialed between one and three payers per peds provider, we credentialed between seven and like you could model this out 700 different ways. Right? So, I was trying to keep certain things like.
Erika Detert (43:39) They’re just.
Kevin Murphy (43:39) All scaling up?
Erika Detert (43:50) I think, I don’t know what information additional information you need from us. I think the solves are, how do we reduce… our downside as it relates to like being locked in to a fixed amount monthly or the volume of the fixed amount. And then, yep.
Garrison Goodman (44:09) Yep. I hear you there. But as long as we’re looking.
Erika Detert (44:14) at it.
Garrison Goodman (44:14) As like, hey, obviously concerns on the number of providers, seems like, you know, we’re actually aligned on like potentially the number of enrollments per payer, excuse me per provider, but I think we’re like, hey, if we, the whole point.
Erika Detert (44:29) Of this is like, hey, we.
Garrison Goodman (44:30) Can get somewhere close to like what you’re currently paying, but we’re going to deliver on significantly amount of speed and volume, which will net new revenue for you. And if we’re.
Erika Detert (44:39) doing.
Garrison Goodman (44:41) that, Erica, we just want your alignment that, hey, this is meaningful, for the business we can do that, you know, 50 30 day change per.
Erika Detert (44:50) Provider?
Erika Detert (44:56) I mean, theoretically… right? But we,
Erika Detert (45:07) so, is… there value to credentialing people faster? Yes, and like worth?
Garrison Goodman (45:14) Making this big change, right? Well.
Erika Detert (45:16) That’s a different question because what is it going to cost me for every day of speed? Because there’s a point where that may not make sense… right? Like if I had to pay being… hyperbolic, intentionally, right? Like… some people for a 1,000,000 dollars a person, they start the next day, it’s probably not worth it, right? So there’s a meat point where the cost to, right? Like it’s a cost benefit analysis of the cost it’s going. And the piece that I can’t lock in on is like, what is the cost? Because the enrollment piece is a wild card… and your pricing model assumes I get the revenue. That may not be the case either because of hires or because of whatever… right? Like there’s some assumption that these people just like continue to flow through the pipeline which might happen and which might not happen. But the RI, assumes that the revenue shows up regardless. So, those are my two challenges. So, I’m theoretically in agreement with you that, yes, credentialing people faster does have a value associated with it, but it’s not in a vacuum, right? Like we can’t just say like that thing is good. And so all the other variables are it has to be in balance, like it’s a cost benefit. I need to know what is it going to cost? And what is my exposure of like the high end of what it could cost? And if I don’t have the people flow through, then the revenue obviously doesn’t happen. But I’m still paying for the service that I’m not utilizing. So like those are the downside risks that… I’m.
Erika Detert (47:06) the overall like this isn’t this is a nice Roi story if it works, perfectly, right? But there’s like upside and downside too. And it doesn’t just mean that we like binarily move from like medium to low, right? Like it could be a mix of variables where we could end up upside down.
Garrison Goodman (47:22) Yep. Okay. The, the good news is like, as you grow like if you were to have significantly higher provider growth, each provider you hire, you make more money on by significantly reducing the time, to work or so or to bill, yeah.
Fletcher Hall (47:39) But not processing 30 enrollments for every provider, right? Like, I hear where, I understand, the dynamic of the, that cost benefit, right? Like the unknown is the number of enrollments?
Erika Detert (47:53) Can I just ask maybe?
Fletcher Hall (47:54) Just a Symplr question. Like, so as you take, I,
Erika Detert (47:56) would say two things, the unknown is, the number of enrollments and the number of people that we will successfully be able to hire.
Fletcher Hall (48:02) Yeah. Sorry. Yeah, that piece, too, right? Two things, that’s a variable that’s on your side, that, yeah, that is more dynamic.
Erika Detert (48:13) As you,
Fletcher Hall (48:14) as you’re building the case with?
Erika Detert (48:17) Your.
Fletcher Hall (48:17) leadership and your PE partners.
Erika Detert (48:21) Like what, what’s the?
Fletcher Hall (48:23) Optically, if you said medallion and advantum are the same cost, but here’s all the potential upside for medallion. Does that, does that?
Erika Detert (48:35) Get… a project?
Fletcher Hall (48:37) A project stamp of approval or is it still we’re seeking cost relief?
Erika Detert (48:47) So, if medallion and,
Fletcher Hall (48:48) advantum were the same price, but, you know, we’ve got a SLA, we’re more integrated as a platform. You’re going to have better insight into your enrollments. Is that enough to make the change? Or is there going to be continued another layer… of, well, no, we are also seeking to reduce our costs from advantum, irrespective of all the potential upside?
Erika Detert (49:18) So, I think like I’ll defer to Kevin and Christine on the value of the platform. And I think the… they like… medallion offering more… right? And they’re the ones who would make the call on that. I think if the pricing were the same… but the pricing has to end up being the same, not the potential of the pricing being the same. If you want to see what I’m saying, right? Like, I know exactly what I pay advantum today and all of these wildcard things that I’m mentioning if they happen, I don’t have downside risk, right? So like, theoretically… yes, but here, I… have a lot of downside risk. The downside risk at advantum is like, you… know, maybe this doesn’t work slightly as efficiently.
Kevin Murphy (50:24) I would say, I would agree with Erica. I would say like if price at the end of the year, if we knew the price was going to be exactly the same as what we pay advantum. Well, 100 percent. I think we would go with medallion, right? It’s worth the it’s to me. It’s worth the switching cost. And I think you’re I think we’re going to get a much better benefit out of it.
Erika Detert (50:43) So, yeah. But to Erica’s.
Kevin Murphy (50:45) point like it’s difficult.
Erika Detert (50:48) To know how those things are going to?
Kevin Murphy (50:50) Align when it comes to the final pricing.
Erika Detert (50:54) And just,
Garrison Goodman (50:55) for our conversation today, what is possible on the high end in terms of your hiring plan?
Erika Detert (51:08) A 1,050?
Fletcher Hall (51:09) In new hires?
Erika Detert (51:11) I’m sure Kevin used some logical math.
Fletcher Hall (51:14) Yeah, I mean, we have a, we have.
Kevin Murphy (51:17) A target of 350 new hires a month. But, those are across all of our business. So that’s not including or that includes, the full service long term care business which we don’t credential for because we don’t like it’s it, it’s a different book of business. So, what… percentage of that is new hires that’s row eight? I just put in 25 percent like that could be a little bit higher could be a little bit lower. I think a 1,000 is probably, I mean, we, I don’t know we did 950 last year. So, you know… I think 100 more than that like it’s in the ballpark and.
Erika Detert (52:03) Yeah, the 950, Kevin included turnover. No, that’s we have an undercurrent of turnover as well. So.
Erika Detert (52:20) Ultimately, there’s additional… upside there because we turn over, call it 30 percent of our staff.
Garrison Goodman (52:30) Annually. Okay. All right. For the time helping us understand your business, your concerns, you, and for your patience and helping us understand that and ask some of the questions. Again, I think we understand what we need to go. Do we’re going to go speak internally and communicate and advocate? Hey, these are the challenges. What are, what is our?
Erika Detert (52:54) What?
Garrison Goodman (52:55) Are our options basically? And when we get that solidified, we will come back to you and run through that. And by no means do we think it’s going to be, a final conversation by any means. So, thank you for the partnership here. And it feels like, hey, we’re directionally aligned. If we get cost, we’re actually aligned on the value that you get from speed and that this is worth making the change. If we can make the contract structure make sense and limit some of the upside or, excuse me, the downside risk for you all. And of course, there’s many more things, to, you know, refine and review in the contract and such. But I think we have a good basis, to go from here. So give us a few days and we’ll reach out, to schedule another session with you all.
Erika Detert (53:40) Yeah. And just again, to be clear, like we,
Garrison Goodman (53:44) are.
Erika Detert (53:45) are interested in the we,
Garrison Goodman (53:47) are interested in looking at?
Erika Detert (53:49) Making the switch, right? Like it’s why we continue to invest time to have the conversations and to work through it. So, if that was like the crux of that question, like is this a real opportunity and are we really considering it 100 percent? We are, this isn’t like I.
Garrison Goodman (54:07) wouldn’t say we’re gonna be in.
Erika Detert (54:08) An exploratory phase, like I think Kevin and Christine have said, like this is going to be advantageous for us in multiple ways we need to.
Garrison Goodman (54:14) Work through how it would work.
Erika Detert (54:17) So, just to be clear, like from our standpoint, like there is genuine interest, it is a serious proposal, like we have discussed it outside of just us, right? So if that helps with like if there’s absolutely, and.
Garrison Goodman (54:31) And we appreciate, the coaching on what you all need, right? You’re gonna have to stand on two feet to this and present it internally as well. And so, thanks for putting your fingerprints on it. And like I said, we’ll come back with something, but thank you for the time and the partnership. Thank.
Erika Detert (54:46) You. Thank you all.
Garrison Goodman (54:47) Right. Bye.