Transcript
Philip Stefani (00:00) hey, good afternoon, Lisa.
Lisa Hansmann (00:01) Hey, Philip. How are you?
Philip Stefani (00:03) I’m good. How are you?
Lisa Hansmann (00:05) Yeah, good. Sorry for all the back and forth trying to reschedule this meeting.
Philip Stefani (00:11) Yeah, no problem. I know it’s a super busy time. So, I appreciate you making time right now. It’s great to finally meet you. Sorry, we missed at the onsite but good to connect now.
Lisa Hansmann (00:23) Yes, yeah.
Philip Stefani (00:24) Perfect. And I was looking on LinkedIn. I saw you went to business school in Sweden. I was super curious like how did you end up there?
Lisa Hansmann (00:33) Well, I’m originally from Germany, so I, yeah, it was not as far of a move as it may seem from the U. S.
Philip Stefani (00:43) Yeah, exactly. That’s. Cool. I went to Sweden last year, so I was curious about that very.
Lisa Hansmann (00:49) Nice. Oh, nice. Where in Sweden? Did you go?
Philip Stefani (00:51) I went to, so the trip was to Copenhagen, but we went to malmö and a couple of other places kind of on that western.
Lisa Hansmann (00:58) Side. Okay. Yeah. Malmö was in tupom, maybe an hour and a half or so, two hours from jönköping, which is where I was, yeah.
Philip Stefani (01:05) Perfect. Yeah, it’s beautiful out there. I really enjoyed it.
Lisa Hansmann (01:08) It is it is.
Philip Stefani (01:10) Awesome. Well, super excited to be chatting with you. I know we’ve got 30 minutes on the calendar. Probably won’t take the whole time, but does that still work for you?
Lisa Hansmann (01:17) Yeah, that works.
Philip Stefani (01:18) Awesome. So, yeah, essentially for this call, like connected with Jason and Jeff in Kenya earlier this week and went through a couple of the value pillars and kind of hypothesis that we had about how we think faster credentialing might impact your business. Basically got some really good feedback from Jason on like what was interesting, kind of what was sparking up the wrong tree, but essentially just want to go through those with you and kind of the action item coming out of the conversation with Jason, Jeff and Kenya was to sharpen these numbers.
Philip Stefani (01:48) So just kind of wanted to run them by you and get your point of view on these. So, before we jump in, I just want to make sure like that’s what you understand and anything else you wanted to cover?
Lisa Hansmann (01:59) No, that sounds good. Okay.
Philip Stefani (02:01) Perfect. So real quick, I will just go through at a high level… not too much of the actual operational stuff, but like at a very high level, what our technology is doing is speeding up the credentialing process which today is done by hand as part of Kenya’s function. So there are three specific parts for this collecting provider data, the primary source verification, and the state licensing that we’re going to be speeding up. Specifically, you can see what the timelines are today and what we would be cutting these down to. Any questions on this. I think the bulk of our conversation is really like how this kind of ladders up to the rest of the organization, but I wanted to pause here and see if there’s anything you wanted to dive into.
Lisa Hansmann (02:51) Nope. No, no, looks good.
Philip Stefani (02:53) Okay. So, yeah, the areas of impact we went through this with Jason and Jeff in Kenya. So it sounded like faster hospital program launch, reducing the premium shift spend, and then reduction of total cost of the function were all like, you know, legitimately you know, we can start there for the Roi, the position utilization enhancement might need some work.
Philip Stefani (03:20) But essentially to go through like what these are faster hospital program launch would be eagle signs a contract with the hospital, there is a certain kind of implementation period or the time where you have to do the credentialing for those positions before they can actually launch, start working on that contract. We’d be shortening that timeline. And so the idea is that you’d be able to start that contract sooner and so I can kind of walk you through the math on what we think that might do in terms of accelerating revenue, but really just want to get your feedback on that.
Lisa Hansmann (03:52) Quick question. On this one. Did you say it was Tori involved in those conversations too?
Philip Stefani (03:57) No, we only met with Jason, Jeff and Kenya. Okay? Because.
Lisa Hansmann (04:02) One thing on a specifically on the, you know, being able to implement project programs faster.
Philip Stefani (04:10) I.
Lisa Hansmann (04:10) may have to touch base with Tori and Kenya on that because I don’t know how many programs are delayed due to credentialing not being done versus how many, you know, what is just our normal timeline of the implementation process working, you know, from an it perspective working with the hospital and so on to… you know, in some cases, there may be delay due to credentialing and that’s why we can’t implement faster. In other cases, it may just be the, you know, the normal timeline. So I may just need to get some better understanding from Tori and Kenya to find out how many programs are, you know, waiting on credentialing versus just our normal implementation.
Philip Stefani (04:57) Yeah, that makes a ton of sense. We would, you know, if there are specific figures there that you arrive at, like would love to kind of dial in these calculations that we have specifically to what you’re seeing in the field really just wanted to kind of confirm conceptually like if you can launch these contracts faster that it would be accelerated revenue. We weren’t sure if these are like build up front or build on a per consult basis. We think if they’re built per consult, it might, there might be significant revenue acceleration. If it’s paid up front or paid semi annually or something kind of more distributed like that, then it might not be as much revenue acceleration. So kind of wanted to get your perspective on what it looks like there. Yeah.
Lisa Hansmann (05:38) It is, we do build, our hospitals on a monthly basis. Okay. So definitely sooner implementation would result into revenue acceleration.
Philip Stefani (05:49) Okay. That’s helpful. So yeah, we can come back to the calculation for that. I want to come back to physician utilization in a second before we do that, Jason mentioned, there is recourse to it sounded like premium shift spend where if you’re unable to fill a shift, you essentially offer a higher pay rate for that same shift to another clinician who could take it. We essentially would want to flesh out like the credentialing mechanism could help you avoid that. The idea is essentially if more clinicians are credentialed more widely, you would be able to kind of pick and choose who you wanted to do those shifts rather than having recourse to the premium shift spend. Jason mentioned it’s about 900 K annually. I think, yeah, we would just want to understand to what degree we could actually impact that piece. Not sure if you have a perspective on that currently.
Lisa Hansmann (06:44) Yeah, we are actually working on bringing that number down. We’ve actually had really good numbers, for February, part of that is, and I don’t know if Jason had mentioned that, but we do have kind of a provider compensation model that we’ve implemented for some of our service lines and we’re about to this year, we’re launching it for another service line for hospitalists as well.
Lisa Hansmann (07:13) To kind of get away from these high shift incentives, a portion of it, you know, the majority of the shift incentives are incurred at night, which makes sense, right? Because physicians don’t want to necessarily take a night shift. So a lot of that is incurred at night. We have kind of focused our recruiting on, for the service lines, where we see that being a primary issue. We have kind of focused our recruiting on specifically bringing people on for the night shift, which has helped a ton. And then also the physician compensation models have helped with that. There’s definitely a component to it. If we just have more physicians available, there is less pressure to offer those shift incentives. The challenge is probably going to be, how do we quantify that? And say, you know, this is the portion that we can allocate to specifically to credentialing, but there, there is a component okay that’s helpful.
Philip Stefani (08:19) Excellent. Yeah. So I mean, coming out of this call, like at the very least we can understand, okay, there would be an impact there. We can kind of take as an action item working with Kenya to kind of figure out what, how we might impact that specifically. But I appreciate the perspective on that. The other piece was reduction of the total cost of the function whereas or wherein you have people doing this by hand today, a lot of this is, would be automated with medallion. This one’s pretty straightforward and I can kind of walk through how we think we might, this might play out. But yeah. So then the last piece was physician utilization. The feedback when we walked through this with the group earlier this week was just that it’s kind of the ones on the list here, the one that would need to be fleshed out the most. And the idea here is that for a net new physician that eagle hires before they can be provisioned to any hospital contract, they have to go through eagle internal credentialing. And so, our assumption was while they’re going through eagle internal credentialing, they’re still being paid salary. Maybe there are additional onboarding costs. We would be cutting down that internal credentialing period. So essentially allowing them to be provisioned to a hospital contract sooner. I think the open questions on this would be, you know, a, are you paying their salary while they’re doing those onboarding pieces? If, yes, there’s probably impact here, but if not then maybe less. So.
Lisa Hansmann (09:46) Yeah, they’re only paid once they’re actually working at a hospital, once they’re you know? So, yeah, there is no salary component like base salary component to it.
Philip Stefani (10:00) Okay. No base salary component. What about from like a revenue acceleration standpoint? Would you say if they could go to a hospital contract sooner and work on those shifts that you would be recognizing that revenue sooner or would that more just fold into kind of the hospital program launch?
Lisa Hansmann (10:19) Yeah, it would fold into the hospital program launch because, and same with either that or into, you know, the shift incentive… reduction because if we’re not paying this particular position for an active program, you know, we would be paying a different position. So there’s really? No, yeah, it’s just a wash.
Philip Stefani (10:40) Okay. Yeah, that makes a ton of sense. My sense from that feedback is that probably physician utilization. We remove this from the areas of impact, but we can kind of finalize that as we move through it. So these are broadly speaking the categories that we think we’d be supporting on and then how we think this breaks out in terms of actual numbers. And I can walk through the calculations for each of these. But for we’ll just look at the top here which assumes 50 new providers in a year and 100 premium shifts for faster hospital program launch. It’s essentially the revenue per day of a 350,000 dollar contract, accelerating the launch by 24 and a half days. Assuming you have 20 new contracts in a year, it would be that 469 K number. But what I wanted to confirm with you was like, you know, average contract size as well as how many new contracts you know, on average, you might see just so we can align this, with what your actual numbers are.
Lisa Hansmann (11:43) I’ll have to, I don’t have that number readily available. So I’m gonna need to touch base with my… financial analysis manager to see where we can pull those numbers from. I will say though the other big component is what I had mentioned earlier, like I need to, I really, I need to talk to Tori on our operations team to find out because there’s all kinds of things that can delay a program start, right? Yeah, credentialing can be one of them but I don’t know how often credentialing is actually the issue because if we get that done faster, that’s great. But if we’re still having it issues or whatever we still, you know, can’t actually implement faster? So I’m gonna touch base with her to kind of get a feel for how many programs that is actually an issue for. So we can kind of work that into the numbers.
Philip Stefani (12:41) Okay, perfect. Yeah, that would be really helpful. I think, yeah, that’s a good direction to go in. The only other piece is, yeah, in the conversations with Kenya to go back to this for a sec, like these three categories essentially are obviously what eagle can control. We would be helping optimize those timelines. There is of course, an element that the hospital themselves control when they actually, you know, validate all of these verifications. It sounded like that is maybe a specific pain point and is out of scope here. So yeah, definitely would want to understand if credentialing is a bottleneck for launching those contracts and we can align those numbers… great. So then reduce premium shift spend. I can walk through how this is calculated. I think the premium we were looking at was essentially 2,500 dollars per shift, but it sounds like from the feedback you shared that we would just have to figure out, okay, how much of that would actually be impacted by credentialing specifically?
Lisa Hansmann (13:42) Yeah. And the shift premiums are actually much lower. It could be anywhere from like 250 to every now and then say it’s a holiday and it’s a night shift. It might go up to, you know, a 1,000 or so, but usually there are smaller shift incentives but it’s just more shifts that are impacted.
Philip Stefani (14:02) Okay. Sounds good. So we maybe had the calculation backwards. It’s lower cost per shift, but you’re doing more of, those premium shifts. Okay, that is helpful. And then, yeah, the only other piece is the cost of the credentialing function and I can kind of walk through. So we looked at this with Kenya. Essentially, the ratio today is one fte to, I think it’s 25 providers. We’re projecting conservatively that we could get it to about… one fte to 120 119 providers. I just wanted to see like from your perspective, are there thoughts about like goals around headcount reduction or anything like that? Or is this kind of like, you know, whatever the function decides they need?
Lisa Hansmann (14:58) Yeah, that would be a decision by the function. So I’ll leave those numbers up to Kenya. I can definitely support if there is anything as far as, you know, like average salary for fte or whatever I can provide. I can help refine those numbers if needed. But as far as the ratios and the targets for that, I’ll leave that up to Kenya.
Philip Stefani (15:21) Okay, perfect. So, yeah, in that case, while I have you, we were assuming about 65 K fully loaded. This would be for a specialist and then 90 K for a manager. Do you know if we’d have to adjust these at all?
Lisa Hansmann (15:42) 65 looks and I can look, I may also have to touch base with Kenya just to make sure I’m looking at the correct rules… the this and is this, now, this is just salary, this does not take benefits into consideration, right?
Philip Stefani (16:03) That’s correct. Yeah. So this is just salary.
Lisa Hansmann (16:06) Okay. I think the numbers look reasonable. I can, you know, I can definitely take a look at what we currently have just to see if, you know, if we can fine tune it a little bit more and potentially add, you know, a portion for benefits also. Okay?
Philip Stefani (16:24) Yeah. If there’s that’s actually a good call out. So we definitely would want to capture any of the benefits spend as well. And then there is one software tool that function’s using today. It sounded like from talking to Jeff, this is about 48,000 dollars per year. So that’s what that piece is.
Lisa Hansmann (16:44) The software was, that, is that modio or is that?
Philip Stefani (16:51) It’s credstream or which is the one they’re looking at moving to? Or it sounded like modio and credstream had essentially the same spend. And so there wasn’t going to be change there from year over year?
Lisa Hansmann (17:03) So that would essentially, that would eliminate the need for the software also.
Philip Stefani (17:10) Yeah, or which would medallion would, yes. Yeah, exactly. So that’s taken in as well.
Lisa Hansmann (17:17) Okay. Got it. Okay.
Philip Stefani (17:22) Cool. So, yeah, those are the pieces I wanted to go through again in terms of like hospital contract… acceleration or launch acceleration. Obviously, like if you have feedback on what these numbers for contract value and the per diem revenue should be, we’d love to align on that, but it sounds like the biggest takeaway is like, hey, there are delays. Sometimes we just want to understand how much of that, is from credentialing versus these other things like it. So we can circle back on that piece as well as it relates to credentialing specifically. We’re looking at cutting the timeline down by, you know, about 24 and a half days. So, yeah, just want to understand if that accounts for most of a contract launch or maybe just part of it or not all of it in some instances got.
Lisa Hansmann (18:09) It. Okay. I’ll do some homework on that. I’ll find out.
Philip Stefani (18:14) Cool. I appreciate that. So, yeah, that is pretty much everything I wanted to cover. There’s one more piece. I just wanted to walk through like how we’ll calculate a medallion cost. But before we get to that, any questions or feedback on these pieces? No?
Lisa Hansmann (18:32) Questions at the moment, would you be able to share those numbers with me?
Philip Stefani (18:37) From this slide that we’re looking?
Lisa Hansmann (18:38) At here, the one, the prior ones that we just walked through just so that I can make sure when I, and the ones before the shift premiums, and yeah, those, if you could share those with me so that when I look at my numbers and I can see how close we are or if there’s anything we need to tweak.
Philip Stefani (19:00) Yeah, happy to. I guess the only other thing I wanted to confirm, we assumed… there’s a ratio you’ve got this one to 25 ratio today. I guess wanted to confirm like if the, or, excuse me, if the team would be growing kind of to the tune of two or three ftes per year?
Lisa Hansmann (19:22) Probably, I might have to confirm that with Kenya also… but I, and I can take a look at our productivity metrics as well. I think that’s a reasonable number, but, I will confirm that with her just to make sure.
Philip Stefani (19:41) Okay, perfect. I appreciate that. Yeah, the whole reasoning behind this is essentially we want to be able to map out. Hey, this is what it would look like to kind of grow organically and continue adding to that team versus, you know, if you can keep headcount flat or even reduce here’s what the savings would be by doing that with medallion… which is a good transition to how we would kind of price this out.
Philip Stefani (20:05) So we actually have most of the inputs that we need. The big difference here is that, you know, essentially today, you have ftes who are responsible for various different workflows working with medallion. We would essentially scope out specific volumes of different credentialing actions. So, license applications, hospital applications, and so on and scope out the specific volume that you’re doing year over year and then there are individual line item costs, for each of those actions. So we have most of those volumes from Kenya. What I wanted to ask if you had was, do you have a number of how many providers you’re adding like on average per year? I think that’s the one missing piece that we still need. I.
Lisa Hansmann (20:52) Don’t have that number at hand but I can touch base with our payroll manager. She would be able. I think she should be able to pull what we, who we’ve added to the payroll system last year. So we kind of have an idea based on that. Okay?
Philip Stefani (21:11) Yeah, that would be super helpful because essentially, like we have, you know, all these all the different SKUs kind of mapped out in terms of hospital applications, credentialing license, applications, monitoring, and so on. And we’ll just map those to the provider growth that you’re experiencing or expecting and then that will kind of give us, the total cost for medallion.
Lisa Hansmann (21:35) Okay. Sounds good. When are you looking to get those numbers? I will be out of the office tomorrow, but I will be back Monday.
Philip Stefani (21:46) Okay. Yeah, it’s not. I don’t want to make this a chore for you if like earlier to mid next week. If that works for you, that should be fine. We have some outstanding items that we’re covering with Kenya and Jeff kind of like in parallel. So it’s not like we have a call scheduled to review these updates like for next week or something. So, there’s kind of a time buffer, okay?
Lisa Hansmann (22:11) Okay. Sounds good. Yeah, I should be able to get those to you by, you know, Tuesday, Wednesday at the latest? Okay?
Philip Stefani (22:18) Perfect. And yeah, I will send those salary estimates along to you. I’m trying to think if there’s anything else. Are there any questions that have come up over the course of the discussion?
Lisa Hansmann (22:31) No, I don’t think so.
Philip Stefani (22:32) Okay. Perfect. Well, Lisa, I really appreciate the time. This was super helpful. It sounds like the action items around like refining specifically like hospital program launch. There are some inputs needed from others, at your organization. And then in terms of shift spend and how credentialing might impact that, that’s maybe something I can work on with Kenya and then we have the updates for additional provider numbers as well. But yeah, that’s what I was hoping to cover. So I appreciate all the help on this.
Lisa Hansmann (23:02) Yeah, of course. Thank you so much.
Philip Stefani (23:04) Excellent. Awesome. Thank you. I’ll let you get back to your day, cheers all.
Lisa Hansmann (23:06) Right. Sounds good. Bye, bye bye.