Transcript
Samantha (00:00) hey, mal, you look freshened up?
Fatima Nunes (00:03) Yeah, look at you, sir.
Fatima Nunes (00:44) Alright, I’ll go ahead and let John and Sam in alrighty.
Fatima Nunes (00:53) Good morning, John. Good morning, Sam.
Samantha (00:56) Good morning. How are you?
Fatima Nunes (00:58) I’m doing well. How are you? How’s your week going? Oh, good.
Samantha (01:04) Quickly, it’s Thursday already I.
Fatima Nunes (01:07) Know, thank God… John. I see you’re in the office today?
John Fernandez (01:13) Yes, yeah, I’m usually here Monday through Thursday.
Fatima Nunes (01:17) Okay. Do you enjoy, I guess, do you enjoy being in the office? I know it’s people are just like torn between working from home or the office.
John Fernandez (01:24) I don’t mind it. I mean, compared to the commute that I had where I was previously, it’s much shorter. So I don’t really don’t mind it coming into the office because it’s relatively close… but having a one day home is nice as well. Yeah, yeah.
Fatima Nunes (01:40) Yeah, absolutely. And Sam, are you also in the office or are you working from?
Samantha (01:44) Home? Yeah, I’m in Monday, same as John. Monday through Thursday. I live local to the office. So I don’t mind and I’m up early in the morning anyway. So I actually enjoy coming to the office some days.
Fatima Nunes (01:55) Yeah, absolutely. Okay. Great. Well, appreciate you both joining. And also, thank you for sharing the answers to the scoping document that Mallory and I shared a few weeks ago, super helpful.
Fatima Nunes (02:06) Really. The next 40 minutes or so that we have blocked off is to review everything that Mallory and I have worked on so far for the presentation. So really on the agenda, we’ll start off by aligning on what we heard from the last conversation. We updated some slides based on some new information. And then we’ll walk through the scope and the Roi together to fill in any gaps there. We’re not planning on reviewing any pricing today, but we will walk through how our pricing model works to give you more insight into that. And then we’ll wrap up scheduling the next call which will be a formal pricing review session after today. Does that agenda align with what you were expecting?
John Fernandez (02:47) Yeah. I think it’s sprinkled throughout, you know, I think we’re still at a stage of trying to learn some key elements, right? And we can try to be as specific as we can on at this stage. What we want to learn more about, you know, does… the solution really improve the timing to get far, right? That is a tangible outcome that we would like to see? So like if you bifurcate the whole process, there are solutions that help with the prep which is great. And if that’s involved with it, that’s beneficial. But ultimately improving time to par is a key call it, you know, metric that we’re looking at. The other item that I’d like to get more visibility on is analytics and reporting, the type of reporting management that platform provides. Does it cater to our needs of having for example the very common one doctor, multiple locations, being able to have the visibility to where those things stand for multiple locations. As we have doctors kind of moving all over the map and doctors that are looking to grow their business that might have started in one location, and then looking to wrap up somewhere else. So a good analytics platform that can help support that I… think would be helpful. I think those are the two main areas I think as things progress. And if those items are answered to kind of our satisfaction, it’ll probably open up the door to other questions like what does a, you know, least… disruptive transition look like? Given that we’re already with another vendor, how do we implement that in a way that we don’t skip a beat? Neither myself or Sam could go to the organization to our CMO and say well because we switched vendors, there’s going to be a delay like that. That is not going to be an acceptable answer. So how do we collectively get to a point for planning on that? And that’s… how I see things progressing. So I think we start with maybe those first two right now and it would be helpful, yeah.
Fatima Nunes (05:37) Absolutely. I appreciate you giving us more context there specifically around change management that’s something that we hear often. There’s a lot of organizations they’re working with another vendor that’s very important to them, making sure they don’t miss a beat. And how do you plan for that? To make sure that once, you know, if you were to transition over to medallion, what’s included in that, how do you manage that process, that transition? And so absolutely, yeah, I think that’s I think we could probably couple that in with like implementation if we’ll walk you through what we have today. We’ll get your feedback on this. I know you had asked about pricing the pricing model. We want to make sure we get that in front of you as well to make sure it’s feasible within your budget. And then if everything looks good there, let’s talk more about like implementation change management. That’s an area where myself Mallory, we have an, a large change management team who’d be able to partner with you and Sam and make sure that you have everything ready and that you feel confident in that transition. I know last time we spoke you, I think we’re at starting the second month of that review or that I guess intensive review with the vendor that you’re currently having today. So it sounds like you probably have a week and a half left in that. How are things going there today?
John Fernandez (06:54) Yeah, we just hit the midpoint with them. I think last week, last 10 days, things are progressing. We have seen an improvement. The key is like many vendors, you know, once you call them to the carpet and articulate what an issue is. Most, everyone can circle the wagons immediately to rectify. We are now in the stage of measuring that they can sustain it with consistency. So that’s where I would say we’re at with them right now in that assessment. Okay?
Fatima Nunes (07:33) Okay. That’s fair. That makes sense. So let me go ahead. I’ll share my screen here just to help guide the conversation. Can everybody see my screen? Yes. All right. Great. So, this slide probably looks very familiar. We’ve updated it since our last conversation, and John, based on what you shared last time we spoke, it sounds like success here really comes down to predictability and visibility. I think you just hit the nail on the head earlier, right? With what you were saying, it’s less about transforming the function and more about optimizing what’s already in place. The core challenge today is not being able to consistently answer, hey, when can a provider start seeing a patient and having a data to back that up? So right now, delays can come from multiple places, providers, your credentialing partner payers, but without clear reporting, it’s hard to isolate really where those bottlenecks actually are. And so what you and Sam are looking for is the ability to bring data into the conversation, for example, being able to say, with confidence, you know, these are the pairs that will likely be completed in the next 90 days while others may take closer to 150 days and using that to really set expectations internally with leadership as well as with your providers. And then you also really called out the importance of flexibility especially with providers working across multiple locations. So reporting needs to reflect that level of detail, and not assume parity across sites. Ultimately, if we were to sum it up, the goal is to move from ambiguity to just more clarity where you can confidently communicate timelines, pinpoint where delays are happening in the process and better align onboarding with revenue expectations. And of course, if that’s happening consistently, credentialing becomes something that you don’t have to hear about anymore. So I’ll pause there. It does that align with kind of how you and Sam are thinking about it or did we miss anything?
John Fernandez (09:33) No, I think that covers it. I mean the ideal outcome is to… get to some level of repeatability… in this process that we can kind of count on and see consistently because we know there’s always going to be a section of unknowns and variables that we can’t control. But at a minimum, to provide a good service, I would say there has to be a, good component of it that you can count on as that’s happening over and over again, right? So having a process that supports that, having analytics that could help articulate that to the organization to our providers. I think, that is what we’re ultimately looking for.
Fatima Nunes (10:22) Absolutely. And I think what that brings to mind just around improving predictability, like to your point, right? Every vendor is going to sell you the world. They’re going to sound great at the start. And then it’s only when you start working with them that you’re going to start running into some of the challenges kind of like what you’re saying with today, I think something that separates medallion in the space is our slas, which we talked about how we contractually commit to timelines. And so we’ll dig into more of that. But we do have two slas to improve that predictability on your end on the credentialing front. So the running the primary source verifications, onboarding, those providers. We contractually commit to doing that in three days that’s in writing in our agreements across 400 plus customers that we have today. And if we miss that, there’s financial implications, right? And so, and then the second piece is around once we actually submit that application to a payer, we have 10 days to get that application out the door from the moment that Sam or her team requests that application to be submitted to a payer. So those are really the two slas kind of, to your point improving predictability, where you don’t have to trust what we’re saying. It’s going to be in writing in legal writing and you can review that. Your legal team can review that as well. I’ll move ahead here. You know, as we move forward, we want to make sure that everything we present really reflects both your priorities and what the business cares about. So this holds up at an executive level with leadership as well. Ultimately, I know how these decisions are, they’re group decisions. And so based on everything you shared, this is how we’re thinking about the core goal. It comes down to improving predictability and provider onboarding, so the business can accelerate revenue and better align forecasting and plan for growth. Is that the right way to think about what matters most to the business? Or is there anything you’d tweak or you’d prioritize differently?
John Fernandez (12:13) No, I think that this covers it. I will add that, you know, as we progress and like I mentioned, we see that those two key components there’s executable plans for those. And as we progress, maybe with the conversation, at some point, I would like to bring in probably another stakeholder to meet you guys to ask these questions that’d be dr. Klittman, he’s our chief medical officer. He would be key to part of the decision making of this since as CMO, he’s the one that is fielding the majority of the questions or escalations that are brought up by the physicians that are impacted by any disconnects that are in the process. So he has, he definitely has to get in the game with this. But, you know, doing this before getting the buy in of someone at that level is the right way to do it. It’s the best way to do this if we do have to do a transition and implement. So having them involved early on in the process, I think is key, but I don’t think we’re there yet. I think we’ve still got a couple of boxes to tick but I think at some point just to answer to your point of, you know, there’s other stakeholders in the organization that will be part of the input in the decision making and he would be one of them.
Fatima Nunes (13:53) Okay. Absolutely. And we would, of course, I think ultimately, we want to make sure that you and Sam, since you’re the closest to the process right now that you feel confident in putting us in front of Brad, of your broader team. And then we would work with you all to prepare for those conversations to make sure that they’re tailored to what they care most about. Absolutely. Okay. So I will transition over into the scope of work. This is really based on your answers to our scoping questions last week, Mallory, I’ll let you jump in here. But ultimately, the scope of work is going to drive the cost, right? So better understanding the needs around services volumes annually is going to help us figure out how much this is going to cost annually for your team. And so, mal, I’ll let you jump in here.
Mallory Smith (14:49) Absolutely. Thanks. So based on the response that she gave us, we went through and did our best to kind of get just like a guesstimate if you will on how many applications you’ll need to submit, how many seats you’ll need to have for the providers in the platform. So if we look at provider data management, think of this as just like the core licensing of the product itself. Right now. We have about 152 seats. That is to allow for about 10 percent attrition as well as the new provider growth. You’re seeing about two providers per month. So we’re allotting for about 24 providers. When it comes to attrition. Typically in the industry, we see 10 to 15 percent year over year. Is that pretty average with what you see?
John Fernandez (15:32) I think that sounds right. I mean I’m quoting a different specialty, but I think that’s what I experience in the clinical world around maybe more like six to eight, maybe a little bit less in that space, but I think it’s in the ballpark.
Mallory Smith (15:53) Sure. Okay, Sam, would you agree? Okay, perfect. Okay. Then we can absolutely, we can adjust that number as needed. But ultimately the great news is that it’s not just one seat per provider and then it’s used you’re actually able to reuse that seat. So if you do go through and backfill those positions, then you of course have that seat available for those providers. So that’s where we got the 152 just to give you some growth as well as the ability to backfill. Yeah.
Fatima Nunes (16:20) And I’ll just jump in here. I’m not the best at math. So just to walk you through how we got to the 152 you shared, you have currently 140 providers plus you’re adding 24 annually. So that gave us 164. And then we subtracted 10 percent to factor in the attrition. And that’s how we landed at the 152. So that’s why you see that number several times on the screen. But instead of doing it based off 10 percent, we’ll do it based off six percent attrition and that’ll be more accurate. Sorry, I’ll let you go in.
Mallory Smith (16:50) Yeah, no, thanks. All righty. So then we’ll go ahead and talk about the other 150 twos on the screen while we’re at it. So the other great component because we do have that participating organization status with caqh, we have the bidirectional feed. We are able to import directly from caqh without having the username and password. And then we are able to push it back into caqh as well. So for your team and your vendors currently having to manage the caqh update process, the re, attestation, this is all stuff that happens automatically within the platform. So we have it set up for 152 of your providers. I do want to do a double check because we do have the ability of doing it in totality or by a subset. So if the 152 represents providers that maybe they don’t actually have a caqh, anything of that nature or is it 152 that all the providers do have a caqh? You do have to update them?
Samantha (17:46) Yeah, they all have caqhs. Perfect.
Mallory Smith (17:48) Thanks that’s typically what we see, but sometimes we work with groups that have like RNS, but they want to have a seat in the platform as well. So just always checking that. Thank you. And then at the very bottom, I’ll just kind of wrap up with, the core seats and all those aspects. So monitoring, we know that you’re currently credentialing your providers is about a 45 day turnaround time for that. So we would of course, monitor them to ncqa standards so that’ll be the typical ones that are part of that ncqa, whether it’s Sam, oig, national practitioner data bank, the npdb and I think medicaid exclusions are a part of that. We can absolutely get you some collateral to show you all the different segments there. But is monitoring something you’re currently doing for your providers? Again? This is more of a set it and forget it mentality. Once it’s set up in the platform, you won’t be bothered with it until a sanction or an adverse event comes back and then you’ll be notified immediately.
Samantha (18:45) Yeah, it’s done yearly. They usually.
Mallory Smith (18:46) Do it yearly. Okay. So this one is usually done on a monthly basis except for the npdb that’s continuous. Is that okay?
Samantha (18:55) Yeah, maybe I’ll check it. I thought it was yearly, maybe they are doing it monthly. I’ll have to check within the contract. Oh.
Mallory Smith (19:01) Sure. Yeah. And there’s always there’s certain elements. So maybe foxmo, we can send over a slide over what they check and then Sam that’ll give you something to be able to go back and cross check. Perfect. Okay, perfect. So let’s talk about the services component. The next one’s going to be payer enrollments. So this is just the direct enrollments with the health plans. You’re adding about 24 new providers. So first we’ll always start off with new enrollments, 24 new providers, about 15 health plans based on the responses that you gave us equals about 360 annual applications we would submit on your behalf for new providers. Does that sound accurate with what you’re seeing currently?
Samantha (19:40) I mean some states have more than 15 health plans, give or take, but like Connecticut has probably about 15. New York has more, but sometimes also it’s like for example, blue cross has a bunch of lines of business in our contract. So you just consider that one enrollment, right? Not multiple enrollments.
Mallory Smith (19:56) Yes. Yeah. And that’s a great call out because now there is someone in the industry that actually charges by line of business, which is crazy. But anytime we have to submit blue cross, it will include all the lines of business that are a part of your executed agreement.
Mallory Smith (20:11) Okay. Thank you. And then that payor revalidation. So this one is always fun with the math, but because you onboard certain providers and then you go through the enrollment process. The way that we do this because we have SKU flexibility is you currently have about 126 providers that would need to be revalidated with the payors. We said 126 because you have 140, but that’s to account for the 10 percent attrition. We will go back and adjust this number to just like the six to eight percent for you. And then with those providers, about 12 health plans each for your current providers, based on the responses that you gave. And then we basically took that divided that by three years rolling. So we’ll see an annual revalidation volume of about 504 plans per year. There may be some years where you see 450, there may be some that you see 600 just based on when that recredentialing is due with the payer. But because of SKU flexibility, you do have the ability to push and pull from other years. So that would definitely assist there. Does the 500 number? Does that sound pretty relevant with what you see?
Samantha (21:19) I mean, yeah, I guess so. Yeah, yeah.
Fatima Nunes (21:22) And I think I’ll jump in here, Mallory, Sam, would it be easier if we kind of sent this to you via email? And then you’re able to kind of compare to what you’re seeing with the vendor just because I don’t want to put you on the spot. I know some of these numbers are, you know, might be easier.
Samantha (21:38) Yeah, that’d be great. Yeah, email would be great. Okay.
Fatima Nunes (21:40) Perfect. So let’s go ahead and do that. Mal, and we’ll make sure that we type out the definitions of everything so you can compare, okay, and then let’s skip ahead here then. All right. So what we want to get into is more of how we start to think about a potential Roi with medallion. And so what you’re seeing here is a snapshot from what your current and your future state would look like from a turnaround times perspective. So if we take a look on the left side is site growth partners, current state today. And then on the right is site growth partners, future state. If you were to partner with medallion, so we start top left today. It takes an average of 45 days to complete a credentialing file for a provider and you shared anywhere between 90 to 120 days depending on the payer, of course, for an enrollment application to be approved by a payer. So we took the average between the 98 and 120. And that gave us about 105 days to get an application approved in a provider and network. I’ll pause. Is that accurate so far? Is that data? Do you feel like that resonates with what you’re seeing internally? Yeah.
Samantha (22:47) The current vendor has 30 to 45 days for the psvs, but we asked them to shorten that timeline as well. We can’t have 45 days.
Fatima Nunes (22:55) Okay. So you’ve asked, so historically, it’s been 45 days, but you’ve asked them to shorten it to 30 days?
Samantha (23:02) Yeah. Okay. No, even we told them two weeks for the psvs at most.
Fatima Nunes (23:06) And did they agree to that? How’s that going? We?
Samantha (23:10) Haven’t had any new ones since then. So, you know, the current ones are in there already and completed, so.
Fatima Nunes (23:17) Okay. Good. And then if we move on to the right side, when you partner with medallion, this process will be much more streamlined and efficient and those turnaround times will drop significantly. And again, I know we’ve done several demos but it’s primarily because of the automation that we have set up in the system. It’s a technology more than anything else. And so when we look at the credentialing files, it takes us three days to complete a credentialing file. And John, that was one of the slas that I was mentioning earlier that’s built in, right? We contractually commit to doing that in three days and then an average of 54 days to get an application approved and a provider in network. I think that’s pretty straightforward. Anything I can answer on that. Okay. So if we drop down from a resourcing standpoint, I understand you have a two person team including Sam, you can retain your two person internal team to manage the platform and medallion relationship and eliminate the need for your current outsource partner. So it’d be very similar to the way you’re operating today. Your current in house team will continue to be really the drivers executing, putting the requests, driving the relationship, being the liaison between medallion and sitegrowth partners, making sure that everything is up to your expectations. And then of course, you would eliminate the outsource partner. There’s some other. We’ve talked about some of the other benefits with medallion right around having everything in one platform that’s fully visible where you can report where you’ll have dashboards, analytics, and so on. On the opex front, we don’t have visibility into the current vendor spend today. I know that’s something that while we continue in conversations, we do want to get into and we can also walk through how we think about that as we go on the revenue leakage. We don’t have clear data on that today, but do want to call that out because that is definitely one of the areas for improvement as part of the Roi. But what we can quantify based on the inputs that you shared last week is the revenue impact from accelerating time to revenue. And that’s really what we’re going to be focusing on here. So I do want to sanity check the assumptions behind this slide with you both, make sure we’re in alignment. Really the goal here is to show you based on what we know how much revenue, we would help you accelerate with those new providers that are joining your practice annually. So we split these turnaround times into two separate slides. The first is to show you accelerated revenue based on your credentialing timeline. So those primary source verifications. The second is to show it to you based on your payer enrollment timelines. So this, you know, let’s start here with credentialing first on the provider growth.
Fatima Nunes (26:03) We’re modeling two providers joining per month, which at the end of the year is 24 providers added per year. Based on what we reviewed on the previous slide. It currently takes you about 45 days total to get a provider credentialed with medallion. You’re looking at three days. If we subtract the 45 from medallion’s three day guarantee you’re looking at getting your provider’s credentialed 42 days faster, which means providers can start seeing your patients billing for services 42 days sooner. Based on industry average for similar provider groups. We estimated that each one of your providers generates roughly about 1,500 dollars in revenue per day. This is probably very conservative. We see as high as 5,000. We’ve seen a little bit higher than that, but we wanted this to be intentionally very conservative. So we did hear the math is pretty straightforward. We took those 24 new providers added annually, 42 days that medallion would be doing this sooner. And we multiplied that by 1,500 dollars in revenue generated per provider per day. And that’s where we got that one point 5,000,000 in accelerated revenue. And this is in year one alone. I’ll pause there would love to sanity check these numbers with you. Does this feel directionally correct?
John Fernandez (27:20) I appreciate the framework. I think we can discuss a little bit about some of the guardrails like for example, I’d like to confirm like how many doctors really were added last year. That may be a good basis. The other component is wouldn’t, we apply the same attrition percentage to this population as well. So net, if we’re adding 24 providers, but we’re experiencing a 10 percent attrition, shouldn’t that 24 be doubled down? If the 24 is correct? I think that’s important to kind of call out. And I’m glad that you put that this looks like an acceleration of cash and not incremental cash.
John Fernandez (28:09) Incremental cash is also key here. So, and I know we’re kind of at this line here because of the inputs but identifying… any denials that we receive that we could have prevented that’s an argument for the incremental piece. But I think this is a good starting point for the methodology.
Fatima Nunes (28:32) Good, good. I’m happy that it resonates. So a couple of points here, we would love to partner, right? Work with you around the revenue leakage piece. Some organizations feel very comfortable sharing that we can sign ndas right? Where, hey, this is claim denials we’re seeing annually or you take historical data from the last three years. This is on average how much we’re losing or bleeding in revenue as a result of claims being denied with those payers that don’t retrodate. And so we can absolutely factor that in here. And I think you’ll actually see that on the following slide. I put that as a data gap on the second piece, the 24 providers added per year. So we would only do it based off new providers that are joining because those are the ones that require credentialing to be done. So your existing providers and the ones that leave wouldn’t really be impacting this math. It would just be based off, right? And we can update this to be more realistic of how many providers you actually onboarded last year and the year before, right? And if that number is lower, we can update that. But technically, that’s really what would drive the revenue acceleration. It would be the new providers joining your practices because the ones that your existing providers and those that have left those have already, that process has already started for credentialing. So we wouldn’t really be impacting those. And Mallory, I don’t know if I explained that correctly, but anything you would add there to add more color to that?
Mallory Smith (29:56) Yes, of course. And I think on the next slide, you have it broken down. So this slide, of course, we’re talking about just that initial credentialing, the one where Sam, you had mentioned about 45 days, but they’re shortening that timeline for you. And then the next slide, we’re going to talk about the actual enrollment. So that will actually couple in the existing providers and the attrition and so forth.
Fatima Nunes (30:16) Yeah. So, and we’ll work with you, John. I think that’s a great call out. We want the opportunity to work with you and update this data so that it’s more reflective.
Fatima Nunes (30:26) I know even revenue generated per day. Maybe that’s too low. Maybe it’s too high. What would you say is more in line with what you’re seeing today? I don’t know if you have that data at the top of your mind at the top of your head 50.
John Fernandez (30:38) 100 dollars a day in revenue. It’s a massive amount… but we can validate that to see if that’s quite in the ballpark. But, yeah, like I said, I think the framework is correct. And let’s try to have the right kind of guardrails in the framework because what… tends to happen is as we progress and we get more people involved. Like now, we’re going to move in the direction of partnering with you guys, whatever you guys are putting out there as the Roi, someone’s going to write down in a letter and then they’re going to be like, well, this is what you guys said and they’re going to book it. And then it’s going to come September and they’re going to look to me to be like, okay, we were supposed to increase our revenue by X, by jumping to that, where is it? And then I’m going to look to you guys and I’m going to be like, where is it? So, I think it’s the benefit of all of us at this point to get that number right with realistic guardrails of what’s true here. But this is definitely the right way to go about it. And I think the distinction between acceleration of cash and incremental cash is going to be a big component of this. I’m going through this whole exercise with another one of our vendors that does kind of like pre submission claim work for us, right? And it’s still the same concept. What is the difference between the acceleration and incremental acceleration is valuable? Getting cash quicker helps with cash flow. But the true determining factor is, are we getting more money that we would have lost out of if we aren’t using their service difficulty question, right? So if we can frame it that way, I think it’s a more compelling argument, but I think this is the right track to tackle.
Fatima Nunes (32:55) Absolutely. And we’ll work with you and Sam around this, right? So maybe we can do a follow up session once we refine the scope of work with Sam one off and I’ll share this deck with the both of you. If you want to take a look at it, take a stab at updating some of the data and we can update these slides for our next conversation. I think ultimately, the goal definitely want to be more on the conservative side. We want everybody on your team to look at this and almost feel uncomfortable with how low it is and think. All right, if this is worst case scenario, then kind of we can only go up from here. Yeah. Okay. And then kind of to Mallory’s point here. The previous slide was specifically around generate those credentialing files for your new providers. This slide really shows in terms of impact on the payer enrollment side. So once those providers have been credentialed now, you really want to go ahead and submit those applications to your payers and get them in network. So we modeled very similar based on the 24 providers per year. Today. It takes about 105 days on average for a provider to become in network and billable with medallion. That comes down to about 54 days, which is a 51 day acceleration. So we similar inputs, right? We assumed about 1,500 dollars per day in net revenue per provider. And that results in roughly one point 8,000,000 dollars in accelerated revenue annually. And so to your point, John, right? This is a conservative estimate. We’re not factoring in denial rates or write offs here since we don’t have that data yet. And so that is a gap that we have here. Does that all make sense there? Yeah. And so I think when we add it, right? Ultimately, what we wanted to do, we wanted to break it down because I know that you do credentialing. And then as soon as that 45 days window is up, you have that credentialing file, those providers start seeing your patients. And so that’s where we broke it down. Typically, we would combine both of those so that you see it together what the revenue acceleration would look like, but I did want to break it down to make it easier for you. But if we step back, this is what we’re looking at when we combine both the credentialing side and the direct enrollments, right? So the primary driver here on the overall business value with medallion is the revenue acceleration that’s really all the data that we had. So we’re looking at about three point 3,000,000 dollars annually and that’s based on getting your providers live and billing faster. There’s typically, there’s also an opex component which we haven’t quantified yet that’s tied to your current vendor and operational spend. So what this slide is showing is just the combination of both the revenue acceleration plus potential cost savings. And I think the third bucket that we would include here would be more on like the revenue leakage, you know, how much would we stop or… be able to capture there? And then really the piece that we’d love to drill into, right? Is like the opex, and I think ultimately, we don’t have to do that. Now we’ll give you some time to digest all of this. The reason we really focus on the opex is to help you get a clear view of your all in spend today, so you can make a true apples to apples comparison when the timing is right around medallion your current vendor. I think oftentimes organizations don’t have not saying this is the case with you all. But some organizations we speak with, they think they’re spending a lot less. And then when they start really digging in on the services they’re getting and how much time their current in house team is spending with oversight, reviewing things, they see that number is much higher. And so I think it’s just getting some of the work off of your plate. And we do that work for you by helping you kind of think about it. This way. I’ll pause there. Any thoughts, questions, concerns as you’re looking at these numbers?
Samantha (36:44) Just one thing I know you had emailed yesterday about the hospitals and surgery centers. Is that going to be included also? Is that separate, you know, that’s per application? Because like I said in, I think the last call, we own a few surgery centers, but they also use outside hospitals and surgery centers. There’s roughly around over all states, about 35 altogether different surgery centers, but not every doctor is going to those 35. So some doctors will go to one or two surgery centers. Some will go to four, some will go to none. So it’s kind of, you know, I don’t know if you need that breakdown. I just gave you kind of a rough estimate of how many in total.
Fatima Nunes (37:18) Thank you.
Fatima Nunes (37:19) Yes. I think I skipped over that just for the sake of time, but we do have questions around. So hospital applications licensing just to refine the scope, Sam. So what I’d love to do is get 30 minutes, you me and mal just to review the scope. We’ll send this ahead of time. So you have time to do some digging, perfect. Okay. And then we can refine that. But yes, absolutely to answer your second question, if you have a breakdown of the hospital to providers, that would be extremely helpful. Okay, perfect. John, anything, I guess, how does this number look from like the just as a whole right now and how we’re thinking about a potential business value assessment? I.
John Fernandez (38:01) Think it just has to be valued a little bit further. Like I said, you know, I tend to be more on the conservative side of putting whatever benefit is out there especially, you know, to the finance team, everyone that’s going to potentially bake this number to the budget, but, you know, I’d like to round it to… realistic expectations as much as possible. I’m totally on board with your framework. Your methodology of the approach to kind of get to the Roi. It’s timely. I just went through an exercise identifying the cost of that percentage just in total for both, like for the RCM team in general. So this plays into it nicely. So that’s what I’m used to using in terms of identifying Roi, right? So I think the framework is there. I think we just have to validate a bit on the true numbers of what that anticipated revenue is going to look like. But I think it’s a good starting point, okay?
Fatima Nunes (39:13) Good, good. I’d like to hear that and I think we could work on kind of best case and worst case scenario, right? Be very aggressive, be very conservative. And then you have that data and then you’ve right? You decide ultimately what you want to put forward but you’re doing it based off, right? All the math and the exercises that we’ve done it’s not, you know, you can back up those numbers. Yeah.
John Fernandez (39:35) And I mean, I think from what I’m hearing is that it’s a combination of a lot of things, right? The technology that you use your internal process. But one thing that would be helpful if you guys had to distill down like what is the one differentiating factor that you would say that allows your organization to get to an average part time of? I don’t know if you scale it 51 days, 54 days rather than what other organizations in the industry are experiencing. What would you say is the main driver of that?
Fatima Nunes (40:21) Yeah, absolutely. I see Mallory nodding her head. Do you want to take? And then I can.
Mallory Smith (40:26) I know it’s the buzzword of 20 25 and 20 26, but it is actually the AI and the automation. So that’s what I would say is the unique differentiator just because we’re a proprietary platform built from the ground up. So we’re not having to. For instance, I came from a vendor that had 17 different credentialing softwares all morphed into one. We call it a frankenstein’s monster. So the fact that we’re just starting from the ground up and we had AI in mind when we first became a company, there’s different segments. So I can always go through and we can have a conversation talking about how we employ the AI. But for instance, you take provider onboarding, we have AI agentic, AI to help call the providers, text the providers. There’s AI chatbots within the system. If we look at enrollment, there’s email parsing, there’s, portal scraping that’s happening to check those medicaid portals every single night. There’s so many different layers of AI and automation that are as a part of the entire process that I’m going to say AI is the main differentiator there, but it’s really broken down and we can always provide slides, have additional conversations, just how we use it in every segment.
Fatima Nunes (41:37) And I’ll add to that, I think specifically… around direct payer enrollments, right? We have direct payer relationships and payer process guides. So economies of scale submissions because we’re working with such high volumes and working with these payers, we’ve established those relationships. We’re able to move so much quicker. They’re able to process those applications sooner. And then I think the big thing here and I know, I believe we shared it with Sam on the second demo, John, but it’s just deep understanding of each payer’s follow up guidelines and just escalation paths. This is something that’s built into the system. So once we go through implementation, we would align all the payers that you currently work with and make sure that those are the ones that are aligned in your instance of medallion. And then there’s process guides of how often should you follow up with a payer to make sure you’re not upsetting them, to make sure they’re not ignoring your follow ups. And then just if you have to escalate, what’s the quickest way to escalate, plus all the relationships that we have there. And I think to Mallory’s point, the automation is big, just moving faster, removing those manual errors that sometimes cause those applications to get stalled or to get sent back because there’s something that’s missing data, the wrong number, whatever it may be. And we can, right? I don’t want to get super technical around it but we can absolutely share some more like technical around how that really happens. But ultimately it’s just moving faster removing errors. And then a little bit about what I mentioned with like direct pair relationships and those process guides. Yeah. Did that answer the question? Yeah?
John Fernandez (43:12) Yeah, it definitely did. And to be honest, I’m not surprised. I kind of figured that, you know, either tech stack or, you know, the use of AI would be it out of all the different functions that would be like administrative RCM. Probably the convention process is the best case study to use AI because like there’s actual rules and if you just follow the rules and have a good process to just execute in the deep, then, you know, the way AI is now, it’s probably one of the one functions that AI is probably the most beneficial on. So it totally makes sense that that’s what is being included in that. But it’s also good to know that it sounds like there’s parent relationships too, which is helpful. Things at times do need to be escalated. And just knowing who to call at certain situations to get things kind of expedited is always helpful. No, yeah. It answered my question of like what’s the one key thing that picks you guys apart? I would say, yeah.
Fatima Nunes (44:30) Absolutely. And out of curiosity, I know you mentioned AI automation are those, I know for a lot of the organizations we work with. Those are the top initiatives where the executive team’s pushing. How can we operationally do things faster by leveraging AI automation? Is that what you’re seeing also internally at sitegrowth?
John Fernandez (44:48) Yeah, we do that in other components of the RCM team from kind of like a pre claim submission perspective. We don’t do too much like post submission or on the demand management Ar side. I mean, we do it but I would say it’s not really AI like we do have RPA processes, things like that. We have automation but no real AI yet on the demand management side, but we do have some AI components on the submission side with other partners that help with coding, help with claims probing, things like that. But yeah, I mean it’s everywhere you look in terms of incorporating… it somehow into your RCM functions. There’s benefits to it. But like everything you know, you still need to have the subject matter expert to monitor it to optimize it, you know, but I think that’s also changing too with a lot of the, in terms of AI, it’s learning. So that’s great. It’s also a bit scary but it’s great like it’s kind of, it learns from its mistakes and just improves upon them at a very quick rate. And, you know, dealing with payers that change the rules all the time and quickly that’s a great benefit to have. So, you know, and payers are using AI to deny our claims. Why wouldn’t we be using AI to get our claims paid? So it just makes sense, right? Yeah.
Fatima Nunes (46:34) Absolutely. And I think, you know, the big focus for our CEO or coo is how do we continue leveraging AI and automation to move faster to give a better experience to our customers? And so that’s top of mind that’s the priority as, you know, medallion as a business to do that. And so whenever there’s that opportunity, there’s a lot of things you can’t automate because the nature of the work that we’re doing, but those that we are able to, we’re going to capture as soon as possible.
Fatima Nunes (46:59) And I know we’re at time. I want to be respectful of both of your times. I think as a next step, what I’d like to do is Sam, I’ll reach out so that we can refine the scope of work. I think that’s very important. And then John, I’m going to well to both of you, I’ll share the deck that we reviewed and then just give you an opportunity, just review it, digest the data, update it. And then I’m thinking we can set up some time either end of next week or the following week where we can update that deck so that it’s more reflective of your current state and just be a little bit more conservative. And then I think afterwards, right? We can determine do we want to go present pricing first or do we want to have that change management implementation conversation? We’ll kind of like follow your lead there depending on where you’re at with your current vendor.
John Fernandez (47:42) Yeah, that sounds like a good next step. All right, perfect.
Fatima Nunes (47:45) I appreciate both the times and if you need anything, you know how to contact us. All right. Thank you. Take care bye.