Transcript
Nic Schisler (00:00) hey, Diego… hey, Nick. How was spring break last week? Good, good.
Diego Basagoitia (00:11) I just need a break. Didn’t really get a chance to rest at all.
Nic Schisler (00:17) No, not with young ones and obviously trying to entertain them all week. Our oldest goes to a program as well a little school, but it’s not all day, you know, it’s only till like one o’clock and then we have a nanny who picks her up and takes care of the other one the whole day.
Nic Schisler (00:37) And we’ll be in your scenario in a couple weeks from now where it’s spring break is a little bit later here. Obviously just because of how the school year runs here. It’s a little bit different, but, we’ll be right there with you in about two weeks. We know what that’s like. Yeah.
Diego Basagoitia (00:53) It’s it’s a… so I did look, at the yes.
Nic Schisler (01:01) At.
Diego Basagoitia (01:01) the, what was it proposal? Yes.
Nic Schisler (01:04) So,
Diego Basagoitia (01:05) I did, and I went over with Randy one of the, one of the items. We had a few questions more than anything else and.
Nic Schisler (01:16) I.
Diego Basagoitia (01:17) know part of this was trying to project out the future in essence, but we did look at our budgets and we’re just trying to figure all this out as best as possible. But right now, we’re at, you know, we’re pretty much done with March. We’re entering April, right? And… we’re anticipating along, give me a second. I just had the meeting this morning too. So give me, let me pull up that file.
Diego Basagoitia (02:22) Okay. So we’re pretty much at the end of the month in terms of for us when it comes to hiring… our future count for the end of the month is 158. And that’s including up until.
Diego Basagoitia (02:44) Up until the first week of April. So, with that being said, I’m going back and forth on to whether or not this 180 for year one is going to be correct. And the main reason is provider turnover. We’re having we had a higher than expected turnover month, which is kind of what we see sometimes around this time Ish.
Diego Basagoitia (03:17) with that being said, I don’t I no longer feel we’re going to get to 180 by a, by what is this supposed to be by may thirtieth end of may? Because by may fifteenth or really by the, yeah, my may fifteenth that’s it, right? That’s really our cutoff. Anything that gets added on there is moving forward. So, I know our year two number ends up becoming like 170. I think it, was that,
Nic Schisler (03:45) getting back in it right now, sorry.
Diego Basagoitia (03:56) And again, I don’t know if this is going to change if we have like some one hell of a miracle end of April, beginning of may month. But right now, I don’t see, I got a, I got a class of 10 people starting next week and that’s already included in my total future count after I have the turnover.
Nic Schisler (04:17) So year one, you had 150, year two is 170 and year three is at 195.
Diego Basagoitia (04:28) And I’m seeing.
Nic Schisler (04:31) 160 in the platform now?
Diego Basagoitia (04:36) Yeah, that 160, we probably got to term people that’s what that’s telling me because my, I go by our HR file, not the medallion file. And our current future count is 158 providers. So if you’re at 160 there, there’s probably at least a minimum of two that need to be removed. That would be my guess and I’d have to talk to Gina and Kristen to see how long it’s taking them, to fill out the paylocity information and then terminate in medallion. I’m not entirely sure how long that’s taking because we, I don’t think we found a way to link that just yet. Okay? So.
Nic Schisler (05:24) I think the numbers we forecasted originally, you were like, hey, maybe an additional 30 but it could be 20. So we started with 30, but it sounds like you’re not going to get to that potential 180 number by the end of may. I think it’s, the term date goes till may thirtieth totally understand. We’re like at the end of March now, as we’ve been having this conversation. So, would you say that medallion court like these numbers need to be cut in half, like down to 15 or less or I’m.
Diego Basagoitia (05:59) thinking probably more like 20. So instead of 30 moving it to 20. But then this is where the second part or the second question Randy and I have, which is we’re trying to understand how this would affect year two now, right? If year two number is 170. And I’m expecting 170 at the start. Pretty much. That means that I’m already going to be over the expected annual year two amount, right?
Nic Schisler (06:31) Yes, or right on the cusp essentially depending on if you actually bring on the full 20 or not.
Diego Basagoitia (06:37) Right. So then for me to pay for the potential full 20 now, for the two more months that doesn’t help me at all in year two, correct? That’s not going to be an added 20 on the 170 that’s just going to move one.
Nic Schisler (06:53) 70, just year one, that’s right? Because we’re not looking at year two. That’s correct? I think that’s why I originally talked a couple of weeks ago was, do we need to talk about year two and three? Like from a long term perspective? And I think I remember you just being like, hey listen like let’s not worry about that right now. But I ultimately like that’s kind of where I was going just by doing the math. I was like, well, if you do this, you’re going to already be at that number. I think the good thing, is that from… a pricing standpoint, like when you all originally did the deal with us, like you have some very preferred discounted pricing off the bat. So I don’t think, you know, while I know like every dollar counts, I think even if you say, hey, like let’s just tack on another 20 for year two and year three, we can always, keep an eye on it, right? But I don’t think it’s gonna be that huge of an incremental lift, in spend, but that’s easier for me to say, right? Like I understand it’s your company there’s PL people turn etc, so totally sympathetic to that. But I also want to go about this in the right way where it’s like if you’re expecting some growth, like I would rather you say I can’t be exact, which I understand you can’t be exact. But I would rather you be on maybe the lower side of projections. And have I’d rather us be in the position where, okay, you’ve used it. Maybe we have to might do this exercise again. But I’d rather us do the exercise again than having a lot looming out there that’s just going unspent essentially if that makes sense. Well?
Diego Basagoitia (08:32) That’s that’s kind of where this is because what ended we ran into a situation where we in essence had I’m going to call it too much inventory licensing and this was with our ehr system. So we were paying for a lot of licenses that never went used for too long of a period. And instances could turn into that if we overestimate and then don’t get to the usage of it.
Nic Schisler (08:57) Exactly, which is why I want to try and be a good partner with you. I don’t want to have that same thing happen with you.
Diego Basagoitia (09:04) You know, and that’s what I want to avoid because that was a six seven month battle, yeah of kind of going back and forth and trying to find a happy medium. So.
Nic Schisler (09:14) If you’re at, if this year, you were supposed to be at 158, and let’s just say you’re gonna really be at like one.
Nic Schisler (09:29) Let’s just say we do the 20, right? Sorry, there’s a bug flying around here that’s 178. You’re supposed to be at you’re, supposed to be at 170 just to start year two. Obviously, there could maybe be a little bit of churn. I mean, like what if you just put an additional 15 seats on years two? And in year three, that way, it gives you a tiny bit of wiggle room. It’s not a ton of growth, but it gives you a little happy medium or go.
Diego Basagoitia (10:01) Ahead. No. I was gonna say that because of how, so, like I said, I anticipated 150 by the end of this year, right? Sure. It let’s just say right now that just by the end of this year, it’s going to be the 170, which is what I expected by the year end of year two, right?
Nic Schisler (10:22) I.
Diego Basagoitia (10:22) think we’re moving. We’re we’re ahead by a year, give or take Ish, on the growth. Meaning… what I’m trying to get at is moving… the 170 to 195 for year two. And then I’m gonna have to look at year three as.
Nic Schisler (10:42) as.
Diego Basagoitia (10:43) probably, what is that 25 probably in 30 on top of that. So that would be at 225… but we don’t need to cross year three right now, right? Year two is the one that’s around the corner. Yeah, we don’t I.
Nic Schisler (10:58) wouldn’t focus about year three, but the.
Diego Basagoitia (11:01) licensing for year two, if we don’t if I don’t have enough licenses, I can’t add the, whatever it is. What is the caqh delegations and medallion core stuff?
Nic Schisler (11:15) Well, I mean, technically you can there’ll just be a point in time where is, if you hit 120 percent of consumption, there would be a trip invoice that we send you would, but I would rather be in the position where we’re doing the exercise we’re doing now where it’s let’s get something in place. So you don’t even have to worry about that. And then we can just continue to track consumption closely. That way if we’re getting back to the point of where you are. Again now, it’s again, another proactive conversation and not a reactive one. Gotcha. And as.
Diego Basagoitia (11:49) far as right now going back to year one, the like… I said right now, it looks like we’re going to probably be at that 170 because like I said, future count and that future count currently goes until… honestly the start of the second week of April, right?
Diego Basagoitia (12:07) End of the first week, start of the second. That’s what puts me at 158. I know I’m going to still have further turnover and I’ll probably have some more hires. Now, my… I don’t believe I’m going to have a huge amount. And the main reason I’m saying that is that I went from 154 to 158 providers over the course of 30 days that’s.
Nic Schisler (12:37) the, you know.
Diego Basagoitia (12:37) Just to kind of give you an idea what the turnover looked like assuming… let’s say the next 30 days after that, is another I’m going to say five people on top of, that puts me at about 163. So I think the 170 is probably the most that I think year one will provide. If.
Nic Schisler (13:00) we bump everything down from 30 to 20 seats. Like if I, for the original proposal that I sent you, if I take all those numbers from a quantity standpoint, and I bump it from 30 to 20. The new, the new total just for, the next couple months is 34 31. So it’s 30.
Diego Basagoitia (13:21) Four 31 that’s.
Nic Schisler (13:22) correct in 61 cents to be exact. And.
Diego Basagoitia (13:26) That’s for 20 feet. That’s.
Nic Schisler (13:28) correct. Okay. And so then I think from there, it’s a matter of do you want to do something ahead of time now for year two? So you have it. And then, you know, if you do like another 20 or whatever it… it’s probably going to be a similar number to the number I just told you. So I think all in, I think we would still probably keep everything under 8,000 if I’m doing rough math in my head right now.
Diego Basagoitia (13:55) When you say all in, are you talking about moving that’s.
Nic Schisler (13:59) if you decided that’s if you, I’m sorry, that’s if I think you’re saying, hey for year two, I’m gonna need to add seats, but I think sounds to me like you’re trying to decipher how many, I think if you said, hey, I’m gonna be at 170, but I was supposed to be at 170 at the end of year two. If I need more seats, I need them. So if I’m gonna do another 15 just doing that rough math, I’m trying to just kind of give you an idea of where we’re gonna land from like the pricing standpoint essentially. So, so.
Diego Basagoitia (14:28) Then in essence, it would be if this was, if 51 47 is for 30 seats. Let’s just say let’s just say for all intents and purposes, I’m gonna hit that 170 if I’m increasing roughly five a month where originally I thought it was gonna be 10 a month. I’m half of that right now. But again, that changes so drastically it’s tough for me to really we were at a rate of 10. Now we’re at a rate of five due to turner, sure. So that tells me I’ll be at 170 come June, July, probably end of July, beginning of August. That, that’s probably where I’m sitting at 170 if I assume a putting the 30 more, right? I would have to, we would read we would reconcile in July August for those additional 30 seats to move that 170 to 200, if that’s.
Nic Schisler (15:27) if that’s what you wish. If you want to wait and do it, then you certainly can to see where you land between now and then that’s totally fine. And if you want to get this in place so you at least have this for the incremental… growth, you might have that’s fine. If you, and then you want to do year two, and we can plan for that. When you have a better idea of where you might be in like mid July. We can, we can have that conversation then we can have it in June. However, whatever is best for you, okay?
Diego Basagoitia (15:53) And I have one last question on all of this and I don’t know, I, you, you’ve heard a lot about from Randy and I on how we felt about the onboarding and of course, and all the issues that, yeah.
Nic Schisler (16:08) You know?
Diego Basagoitia (16:08) I still feel like we haven’t even fully. I know we’re on boarded, but I still feel like the growing pains have not gone away, right? I know we’re doing a lot on both ends trying to get that smoothed out. There’s. Still issues here. And there, I mean today, I have a, I have a 30 minute time slot carved out with Gina because again, there was something medallion was unable to do. So we’re just gonna do it because it’s affecting, my half my Louisiana business and I can’t wait anymore. But my comment here is we are looking at acquiring business, another business in another.
Nic Schisler (16:42) I’ve told.
Diego Basagoitia (16:44) you guys that we were part of why we brought medallion on board was to help us with other states, right? To get credential. Make, you know, you all being the expert in credentialing. My comment is as we acquire a business, these numbers kind of go out the window real quick because I have, of course, I have no idea if I’m going to have 20 providers or 100 providers, right off the.
Nic Schisler (17:11) Bat. Yeah. You know, when that’s when that might happen, we’re.
Diego Basagoitia (17:16) hoping that this gets done in the next 12 months. Okay? So that’s why it’s gonna affect more year two and year three pretty heavily. That’s why I’m trying to get my head wrapped around all of this. Sure, my concern right now overall is I don’t want another rough onboarding, of course, you know, when.
Nic Schisler (17:36) You, when we.
Diego Basagoitia (17:37) acquire this business. We’re gonna already be in debt from day one. I don’t need taking heavy losses because we can’t get them yeah credentialed with the right business lines and having all the chaos. So, of course.
Nic Schisler (17:51) I don’t.
Diego Basagoitia (17:52) know what we’ll have to do. I mean, we’ll cross the bridge as we get closer, but I don’t.
Nic Schisler (17:56) I think we need to do a reset from a PE standpoint when we get to that point. And what I have seen be very successful for other customers. And I have worked one of which right now that we were in a very similar position with and we are in a much different situation now is that the teams just work much more closely together in the way that enrollments are submitted. How they’re being submitted? The documentation that we have in place today compared to when we were going through implementation is like night and day essentially.
Diego Basagoitia (18:35) And so.
Nic Schisler (18:36) I think we probably need to just do a big reset there because I think that’s there’s other pieces of the puzzle that I think come into play from… how we were handling things and internally, but I think that in essence, like sure, we have a payer directory and all the things. But at times like the payer directory goes out the window if you have a certain way that something needs to be processed, and if there’s a certain, you know, check that needs to be done to the application. But we’re going off the payer directory, we’re going to constantly have the same issue, right? And so, I think big picture, like we need to revisit some of the way the apps are being handled and that’s where we need to bring Jason in and probably get some more documentation like if it’s screenshots, whatever it is. So we can document that internally. And from what I’ve seen when we do that with the other customers, I have within my book of business that is a game changer now, obviously too, I think as I mentioned last week, new coo is coming on board, right? He’s bringing in a lot of change, really quick hitting the ground running. I also think there’s going to be a lot of upside there too as well. So I think it’s going to be a really good combination of things that we see what happens here in the next three to six months essentially. But like in the short term, I think we need to kind of maybe revisit the way some of the apps are being handled, just ensuring like the way we’re submitting them are the correct way essentially that’s the crux to the issue. And we have specialists, you know, making errors on applications where errors really in my opinion should not be happening, right? And that’s I think the frustrating part for you. The frustrating part for me, the frustrating part for Jason is that he and I aren’t the ones submitting the applications, but we’re sharing the feedback and the sentiment. But yet the mistakes continue to happen. It’s just like listen if we have this documented like just follow the instructions and we won’t be in this situation, you know, right? And, and I know you didn’t get a chance to join the last advisory council, but that was feedback that was shared by multiple customers on the call.
Nic Schisler (20:44) And so it’s not just you, it’s happened to the customers and that feedback’s going all the way up to Derek our CEO that’s why PE is such a big focal point this. Year coming out of kickoff. So I do think that I’m very confident where we will be between now and end of year with payr enrollment, very confident. Yeah, that’s definitely. So the year two stuff, go ahead. Sorry, I was going to say.
Diego Basagoitia (21:10) That’s going to definitely be an area of high focus because.
Nic Schisler (21:12) Of course, not just for you for a lot of customers. Yeah, I mean, it makes, trust me it’s a bullseye. So… it makes sense like where you are now and especially if you’re going through some type of M a, right now, I mean, I would agree. I don’t think it makes sense for you to try and forecast, for year two. I would say let’s focus on this. Let’s just continue to meet monthly as we have been when we get into June, keep me posted about what the M a looks like. How that might… you know, really have an influx of things. And then, we can revisit things. We can revisit pricing. We can look at things if we can try and help you there. If that’s a big factor. So we will try and be the best partners that we can throughout this, yeah.
Diego Basagoitia (21:57) And that’s going to be something whenever again, depending on the size of whatever we purchase there, will I’m gonna have to reach out to all my partners and we’re gonna need some kind of volume pricing because I really do not know… again, we’re looking at practices as small as 20, but as large as 150?
Nic Schisler (22:18) So, that.
Diego Basagoitia (22:20) You know, in essence could easily double us overnight. I’m trying to make sure that, yeah, I don’t.
Nic Schisler (22:27) want to get in the position where like now we’re forecasting for year two, this goes through and you’re like whoa, like these numbers, are we’re going to need way more? You know what I mean? So like it doesn’t make sense barring what’s happening to even talk about year two right now?
Diego Basagoitia (22:41) Okay. Last question I do have on all of this and it’s more of me trying to understand a little bit and knowing what Kristen, Gina crystal are working on?
Nic Schisler (22:52) Since I.
Diego Basagoitia (22:52) still anticipate to be under or at being best of 170 by June first is.
Nic Schisler (23:03) There a.
Diego Basagoitia (23:03) Value, is there what’s the value right now for me paying the additional 15 to 20 for the next 60 days versus just holding.
Nic Schisler (23:15) off.
Diego Basagoitia (23:15) And not dealing with paying that, that’s my only last question on it because right now, those licenses are just not getting the.
Nic Schisler (23:24) access.
Diego Basagoitia (23:25) Correct. Yeah, that’s.
Nic Schisler (23:28) correct. I mean, essentially, if, even though you might have a little bit of turn, I mean, essentially right now, even if you have two more come on, you’re still going to be exactly at what you were contracted for. So you’re you kind of like have to do it otherwise, it’s just going to be an invoice that we’re going to bill you for that and any other additional incremental growth that you have. At least this way it’s just already accounted for up front. Essentially. Okay. And then, so year one, this is what you have, we move into year two. We stay close on year two. You keep me updated with an M, a work that you have going on and we move forward from there essentially because that’s what I’m.
Diego Basagoitia (24:05) trying to see. Is it worth just moving this or waiting again… two more months? That’s really all we’re talking about. Yeah, and whether or not that’s affecting, I don’t think it’s affecting, our teams in any way right now, but I don’t know if that’s because I’m short sighted or we’re not really at a position where it’s hurting us currently because it’s not because of the timelines.
Nic Schisler (24:33) Yeah. I mean, I just, from what you’re telling me from this like little wave of growth that you have, I mean, I, I’m never going to sit here and tell you force you to do something obviously or what to do, but it would make more sense just based off of the little growth that you have to put the 20 in place. That way you have it and you don’t have to worry about it and it’s done. And we revisit year two and 90 days from now essentially, but that’s the decision that you and Randy have to make at the end of the day and what’s best for you all. But essentially, most of the customers that are generally in your position like this is what they do essentially. And I think that’s the reason why I think gabby and I have just been trying to proactively have that conversation with you. So what I can do is let me resubmit the 20 seats to gabby so she can approve it. And then I’ll resend you the proposal. And then that way you just have the updated number and then you guys can just let me know how you want to move forward essentially.
Diego Basagoitia (25:28) Right? Because I mean at the end of the day, even if we moved it to 80 because that’s above the 170 in year two, I would still have to pay an additional in year two already off the bat, right? Correct?
Nic Schisler (25:40) Yeah. So that’s what I’m saying. It’s best to just do this. Have your seats, let’s revisit year two early on and just keep me updated about the M, a conversation like even if we get into late April and you’re like, hey, I’m having a better sense of this. Now, this is where we could be at then I can take those numbers back to gabby and I at that point might just, we might just need to revisit year two and year three and just say, can we give you a little bit of better pricing to help you out moving forward, right?
Diego Basagoitia (26:07) And that way once we know who our targets are in essence, and what, like I said, I don’t know if we’re going to be acquiring multiple 20 group, 20 clinical clinician practices or if I’m going to hire one or acquire one large clinical group. I, we’re still working on, we have a list of about 30 candidates, but it’s not like we’re we don’t have options. Sure. The question, is who’s going to be the option, right? Of course, so.
Nic Schisler (26:37) Okay.
Diego Basagoitia (26:40) Then let’s do that. Let’s currently, I think 170 is probably going to be the right number, okay?
Nic Schisler (26:47) Unless, somehow?
Diego Basagoitia (26:48) Out of left field, we find some kind of weird gold mine of people, but, you know, we got.
Nic Schisler (26:56) Anything can happen in today’s? World as you probably know, yeah.
Diego Basagoitia (27:00) Really cool. You.
Nic Schisler (27:01) Know, one day gas prices, you’re not complaining about it the next day? You’re like what are we doing? So I just submitted that to gabby. She should approve it here this afternoon. I should have it back over to you by late this afternoon, and then just let me know if you all have any more questions and we can discuss if needed. All right. And I.
Diego Basagoitia (27:19) got, I’ll, let Randy know. And the number you told me was 34 31, right?
Nic Schisler (27:23) That is correct. 34 31. She just approved it as well as I’m doing this right now. So I’ll have this over to you at. I have a meeting right after this, but I’ll get it over to you while I’m on that call. Essentially. Okay. All right. Not.
Diego Basagoitia (27:39) A problem. I got a meeting on right after this.
Nic Schisler (27:41) Call too. Okay. Let me know if you need anything else. I don’t know if I’ll be on the call.
Diego Basagoitia (27:48) Oh, there’s one question duke, yes, I know the last thing we brought up was going to be the cost of payer enrollments for all the tricare issue?
Nic Schisler (27:57) Any.
Diego Basagoitia (27:57) movement on that? I mean, ideally, I thought I was going to be doing it through the delegation, but because the delegation failed with tricare now?
Nic Schisler (28:08) I have to.
Diego Basagoitia (28:08) Do 150 people and that’s going to cost me 150 times. What is it? 141 50? I don’t even remember right now. Okay? Let me.
Nic Schisler (28:19) Circle up with Justin and see if he’s having internal conversations and just see if he can’t prep him on some of that to maybe be prepared to have some of that conversation tomorrow, okay?
Diego Basagoitia (28:30) Because that one really frustrated me as you can imagine.
Nic Schisler (28:33) Yeah, of course. I mean, we did.
Diego Basagoitia (28:35) We passed the Kirana one, but, yes.
Nic Schisler (28:38) I heard that. The,
Diego Basagoitia (28:40) tricare one is they won’t, they’re not accepting what that last thing that Janine sent, they’re not accepting that as acceptable. So I, we’re stuck for a year, Okay. Let.
Nic Schisler (28:58) Me, let me drop that in our internal channel we have regarding you all. And then see if we can’t get an update there for you if not by the call tomorrow, just before we go into the weekend. Okay. All right. Thank you for the time this afternoon. I’ll be in touch shortly since gabby just approved it. Let us know if you have any other questions, obviously, we can talk more about year two when timing makes sense. And she’s aware of that. I told her about September. We talked about some of this the other week, when we chatted, so happy to revisit that conversation when the timing is right based on what’s going on for the org for you all. Okay?
Diego Basagoitia (29:31) Sounds good. All.
Nic Schisler (29:32) Right. Thanks Diego. Talk to you soon. All right. Bye bye.