Transcript
Josh Brunell (01:40) thank you. I’ve been looking forward to talking with you soon. Please let me know if you have any issues.
Josh Brunell (09:44) Hi, Michael. Can you hear me? I think you are muted.
Michael Santos (09:58) Good to see you. Hey, josh. Sorry about that.
Josh Brunell (10:01) No worries. How’s your week going coming back from himss? Playing catch up, I assume.
Michael Santos (10:07) It’s good. All of our cfos are at like an internal CFO conference. So, it’s a lot quieter this week, which is nice that’s good. Yeah, nice. Nice.
Josh Brunell (10:19) And you’re in Florida? You said, yep.
Michael Santos (10:21) We’re just maybe 10 minutes north of Orlando. Cool.
Josh Brunell (10:25) Cool. Awesome. I’m in, I’m on the opposite coast. I’m in orange county, in a town called mission viejo which is just south of Irvine, but,
Michael Santos (10:36) right smack.
Josh Brunell (10:37) Dab in the middle between la and San Diego. So, yeah.
Michael Santos (10:40) I.
Josh Brunell (10:42) do have some customers out in the Florida area though. We’re pretty… we’re not really located like we don’t support our customers, our clients by Geo. We just have like, I really have customers across every state. So, yeah.
Michael Santos (10:58) It.
Josh Brunell (10:59) was good. It was good. Meeting you at himss. What’d you think of the conference? A lot of walking?
Michael Santos (11:05) It was good. Yeah, a lot of walking a lot of good information. So I enjoyed it. This was my first himss conference, but actually, like I don’t know 10, 15 years ago, my mom actually used to work for himss, she doesn’t anymore, but so she had a connection. She used to go to the conference every year. I remember. Yeah, 15 years ago when I was much younger, I think we tagged along. So I didn’t we lived in Tennessee at the time, but we came down to Orlando for the himss conference when she was working for it. So, but my first time going to himss. So it was a good one.
Josh Brunell (11:38) Me too. It was my first time as well. Yeah, I mean, I talked to a lot of people, so forgive me, but I did take some mental notes and so as far as like the time today wanted to just dive into more about our discussion around adventhealth primary care network, specifically, some of the challenges and bottlenecks that you had mentioned around credentialing process and payer enrollment, and all that good stuff. I know you have hundreds of clinics in Florida that, and you mentioned, I think there are about 500 providers looking to grow to a 1,000 plus in the next couple of years. And so often with that scale, yeah, there’s a lot of complexity and challenges from an operational standpoint. So we’d love to dive in before we do. I know we only have 15 minutes. I don’t have a hard stop at the top of the hour, but wanted to see, do you by chance?
Michael Santos (12:34) I think I might, but I think what I,
Josh Brunell (12:37) yeah, we could be brief. We could get a lot done. I think in 15 minutes, I just wanted to see, yeah.
Michael Santos (12:44) Because I’ll give you a kind of a more of an intro but then I do want you to meet my provider onboarding manager. He’s out today and tomorrow, I talked to him yesterday, but probably we’ll be able to connect you guys. So, yeah. So provider confidentiality… we’ve got 52 hospitals plus a different medical group. So I’m considered a medical group and.
Josh Brunell (13:11) It is kind of run.
Michael Santos (13:12) through our corporate office. So I’m being dicey entertaining vendors. But ultimately, what I have to prioritize is even though we’ve got this whole corporate structure and we have this internal team. We’ve existed as our own tax study for more than coming up on two and a half years and we’re still having credentialing delays, issues, panco’s, not updated timely, and.
Josh Brunell (13:35) Now my,
Michael Santos (13:36) primary medical group is in mssp. And so I’ve got providers that have left 18 months ago, and why am I still have these patients or these providers in my attribution? So I’ve got lots of issues and so I’ve got to be careful what I ask and who I involve in the conversation and not step on people’s toes internally. But I need to know what’s out there and can it be that much better? And if we can’t do it ourselves and our own corporate team, then I need to be the one to then ask the questions and then layer in the correct executives to say, all right, you could say, no, you could say, yes, you could say let’s think about it more. But that’s where I’m coming from because ultimately, this does affect my business and it affects when we can see new patients and our actual downstream revenue. So we do have skin in the game, but I’ve got to tread carefully and bring in the right team members and executives at the right time.
Josh Brunell (14:25) I hear you and, yeah, you’re not unique to that case. I mean, I don’t think I’ve ever partnered with an organization where we haven’t needed to have alignment across both the provider onboarding group and their leadership team, and finance, and the executive team and corporate, you know, when large health systems, you know, corporate gets involved, maybe a corporate procurement team. So like I get it. So I mean my job here really is to like obviously help you map out where the fit is and where the value is that’s going to be gained from an rri standpoint and put together a business case on your behalf in partnership with you for you to then take back to the leadership and confidently say, hey, this is how much this process is costing us today and what the impact is to the business. And these are the contractual outcomes that medallion can help drive. And here’s why this might be worth looking into versus you just, you know, sending them an email and saying, like, hey, I have this vendor I talked to at himss, you want to chat, so I can help that, put that together fairly easily. And yeah, I mean, obviously, we talked at a very high level but like have you looked at our website or talked to? I guess anyone at medallion in the past? Like I guess what’s your kind of exposure to our, what we do?
Michael Santos (15:46) Really just our conversation back and I haven’t been able to research the site or anything but.
Josh Brunell (15:51) All good. Yeah, I think.
Michael Santos (15:53) A high level talk through, yeah, a lot of the, a lot of the mechanics and how you guys are able to kind of make that a lot faster and automate some of that and also make it easier for like, your onboarding providers as far as all the documentation they need, et cetera.
Josh Brunell (16:09) Yeah, exactly. And I’ll just, I’ll share like a couple quick slides, but like this will be a conversation. I just want, can… you see my screen? Yep… we could jump ahead of the agenda. So, like, just like high level talk about who we are as a company problems we solve and then talk about your specific problems you’re looking to solve and then how, our platform can help, right? And so, at like, the highest level, we’re looking to use AI and automation to reduce the amount of administrative burden across the provider onboarding process. All processes from, collecting provider data upfront to managing things like caqh, to, submitting, payer, enrollment applications to the health plans that you work with, to securing state licenses, handling renewals, doing actual like primary source verification, credentialing, hospital privileging, if they’re getting, you know, your providers are getting placed at care sites. And so we’ve built, a platform and a tech driven approach to solving these problems to help organizations like yours that are scaling their provider networks very quickly to get through that process with faster turnaround times, better accuracy from a reporting standpoint, and an audit trail standpoint. And, to help, I think from a finance standpoint, the one thing that you probably care about is like getting them through the process of the, obviously, our providers are billable quickly. They have a great experience. But also like our, that helps accelerate revenue for the organization, helps you grow. And the big thing is that our mission is to enable just one operator on your organization to handle unlimited scale with automation, opposed to having a team of 12 people that you’re having to add another fte to every you.
Michael Santos (18:05) Know, couple months.
Josh Brunell (18:06) Because provider growth is at a point to where they just are over capacity. So, we work with large health systems, provider groups, digital health companies who are like facing those scale issues. And these are like the core areas of our platform which I talked about you have.
Michael Santos (18:23) A question so really quick, is your perception? Like most prospective clients like me that come from like a larger system? Like I actually don’t know like are they using some older software and it’s helping them or do I think it’s just an army of people doing a ton of manual forms to each platform and payr, all of that, because it tends to kind of be, it’s either people driven or they’re just on a software solution already.
Josh Brunell (18:46) Yeah, I guarantee you it’s both. Okay. And here I’ll just skip forward here. This is like the status quo like we typically see as far as like metrics and the kind of current state, like we often see anywhere from two to three software tools used in this process. They may an organization of your size, probably has a dedicated med staff services team that might be, or a provider onboarding group that may own a piece of that process. They may, you may have a group that sends like the welcome packet to the provider saying, hey, we need these documents from you. We collect those documents. They may take those and then run primary source verification or may take those and submit pay enrollment applications. There may be a dedicated team that you work with that does like hospital privileging, like we see it as like a lot of different siloed responsibilities shared across the organization. And sometimes there’s a single tool that doesn’t sometimes there’s multiple, but.
Michael Santos (19:41) the.
Josh Brunell (19:43) ultimate outcome is typically the same. It’s like not a lot of vendors in this space have built out automation to streamline the process. It’s mostly like a giant glorified spreadsheet that they’re just used to track the information and collect documents, but not necessarily automate the process. So like what, yeah, what medallion does is, yeah, we are a cloud based platform that you would have access to and our team would have access to. Yeah, but we’re fundamentally different in that, yes, we have a platform but we don’t just give you the software implement, it train your team and kind of walk away. We actually are contracted to outcomes. So we have an operations team that will step in as well to help drive these outcomes around faster turnaround times, accuracy. We’re accountable for the cred files that get completed and ready for a committee. We’re accountable for the enrollments being submitted and progresses with payers. We’re accountable for turnaround times, accuracy. We put those in our slas. And so if we don’t get it done in a certain timeframe, we’re on the hook and that creates just like a very different model for organizations like yours because you’re not relying on manual processes, manual teams. It’s automation that your team is leveraging, you own the strategy. We own the execution both with our platform. And then we do have humans in the loop because for compliance standpoints, you gotta have people that look at a ncqa cred file before submitting, or same with medicaid and medicare in some states as well. So, but it’s not like.
Michael Santos (21:25) We’re replacing a team of 10 and we’re just basically, you’re gonna leverage 10 people in your side where we’re just outsourcing.
Josh Brunell (21:31) No, not at all.
Michael Santos (21:32) Software solution, but you’ve got to like you said, QA troubleshooting, escalation, stuff like that, right? 100?
Josh Brunell (21:39) Percent… we can’t operate without at least an administrator or two on your team. Typically, we see one or two is probably like all we need. And once again, based on the strategy and the process, all your team would do in the future is like essentially, hey, create a profile for a provider, invite that provider into medallion, link their caqh profile, all that data comes into medallion, and then they’d request, hey, we need them enrolled with these 10 payers in Florida that we work with. Makes the request. We’ve built automation off of all of the unique requirements across 900 plus payers. So all they have to do is hit request. Our platform then goes to payr portal, submits the data from medallion into that portal, and then handles follow up via AI and email. Your team has a full paper trail of all that activity, step in at any point at time if you need to escalate. But yeah, it is very much so automated and you’ll see it in the platform. But, yeah, just at the highest level, we’re not just like a standard kind of like bpo or an offshore team that’s just handling this with brute force. It’s automation first.
Michael Santos (22:57) You know what’s funny is like those Amazon grocery stores, they have a bunch of cameras and they’re like, oh, it’s AI tracking what you spend. And then they found out that it was like, oh, it’s actually just a bunch of people overseas like tracking what you did in the numbers. Yeah, that’s wild. Yeah. So.
Josh Brunell (23:16) I mean, it sounds like you don’t have like probably huge insight on like the team makeup or the software they’re using, but I imagine director of finance like you’re very much so privy to what the outcome is of some of the bottlenecks that you’re experiencing on the revenue side, on the cost side, I assume, correct?
Michael Santos (23:37) And my provider onboarding manager, I’ll hear the complaints that the corporate team is not moving fast enough and it’s delaying our provider starts and, you know, they have added people, but the company is just so big. I’m like, all right. Well, do we, can we ask for our own solution? Demonstrate that there is a tangible Roi that’s significant? There’s a lot of politics involved. But I do want to, I’m, looking at his name is William, his calendar and I’m looking to maybe schedule something for us next week. He’s the one that will have a lot of the brains. He’s also not the decision maker, but he’s going to be the one that’s going to have all the technical knowledge that will make like this makes, you know, 40 percent sense to me but I’ll listen and breathe to this question.
Josh Brunell (24:23) Yeah. Is, is, does he, is he part of, or does he lead the team or is he just part of it? He does lead? Okay. Yeah. And yeah, I would love to have a conversation with him, walk him through the demo along with yourself. I think, the areas that would be helpful for us to understand going into it are like at a high level, like where is the most time spent? Or I would say where’s the team tending to get stuck in that process or providers tending to get stuck in that process? Is it collecting their information upfront that’s delaying the process? Is it dealing with annoying payers that aren’t responsive? Like, where can we step in, and maybe add the most value? If, if we could get that from him ahead of time, unless, you know those things, but, if you have like a general sense of like where the biggest time suck is for his team. I think that would be helpful going into the demo. I think what he.
Michael Santos (25:21) will say because I think his team will start some of that stuff on, right? He’ll ask the providers for all your own documentation. And that’s part of like once you sign your offer and the legal team executes the document, there’s a list of stuff. So his team does that. And his team is not the bottleneck, it’s the actual credentialing team. And the bandwidth of the credentialing team is too small and we’re growing so fast.
Michael Santos (25:42) Like what is it March? I’ve opened up… four locations this quarter and I probably have four to six opening in the next quarter. Like, and so the recruitment is fast. How.
Josh Brunell (25:56) many providers would you say in like a given? Like some of?
Michael Santos (26:01) Them are consolidations. We’re closing the small clinics, building these larger ones, but on average, a new master space is about 10 providers or so… got it. So.
Josh Brunell (26:11) You’re doing like 50 a month, yeah. Or?
Michael Santos (26:16) Maybe it depends on like the timing of the construction of the space, but that’s how we’re going to get from like 375 providers to 608 providers, and that’s going to go, yeah, upwards over a 1,000 after that. So, there’s that complexity and we’re going to start having new tax ids in new states that they exist today as clinics, but they’re going to come under our legal entity from a different adventhealth group. We’re all going to need credentialing. And then you’re not only will we just take them over. We’re going to master plan, we’re going to grow in those other states besides just taking over them from the other adventhealth group. So, there’s a lot of stuff in the pipeline. I’m like, I don’t know if we’re comfortable being able to handle that work quickly enough. Yeah. And.
Josh Brunell (27:02) And, what starts to pile up too? How long have you all been operating? Like, I guess, at this scale at our?
Michael Santos (27:09) Legal entity at this size about it was January one, 20 24. Like the clinics aren’t two years old. Some of them are 20 years old, but under our, it’s going to be two years. Okay? So now,
Josh Brunell (27:20) you’re going to start running into the, re, credentialing and re, validation burden as well because every two to three years is when typically payers will request that, provider is re, enrolled essentially, so up for renewal. And so, yeah, you have to deal with that. And then, that adds on to the burden of the team as well as like as you’re just growing as well.
Josh Brunell (27:43) There’s other things that are like annoying to keep up with like caqh attestations have to happen quarterly for your providers, and that’s a typical requirement for a lot of payers. So, like the amount of admin burden just grows. I hear you. Cool. I mean, happy to schedule the time I’ll stop sharing now,
Michael Santos (28:02) Are you Pacific Time? I am?
Josh Brunell (28:04) But yeah, I could be, I’m.
Michael Santos (28:07) looking at 12 eastern Monday, the 20 third. So nine pacific. That works for me. All right. Let me book it now. Let’s make sure I have your info.
Josh Brunell (28:33) I’ll send this invite to you and then, if, can you, do you want to drop his email in the chat or if not, I can, just send it to, you add him?
Michael Santos (28:41) I’ll add him. Okay, I’ll.
Josh Brunell (28:43) do that, cool. Sending it now. So, 12 PM on Monday, the 20 third?
Josh Brunell (28:50) Yep. And yeah, this was helpful. Last thing is like, make sure that like bringing this business case to those team members, we can talk about this, on the next call. But like pretty simple calculus to say, hey, how fast is your payr enrollment or the end to end process today? And then we’ll contractually commit to what our turnaround times are, and we’ll compare those two, yep, easy calculus to understand like, hey, how much are we potentially accelerating time to bill time to revenue? And then on the operations side?
Michael Santos (29:26) We can talk about.
Josh Brunell (29:27) Some of, the ways that we help reduce costs as well, on the meeting, but, yeah, excited for the demo. I know you have a hard stop. I’ll send this over. Any other questions Michael?
Michael Santos (29:36) I think we’re good. We’ll talk to you in a couple days awesome.
Josh Brunell (29:39) Thank you. Sorry if I was talking fast at 15 minutes, I had to.
Michael Santos (29:43) No, you’re good. Sorry, I missed the notification. So I was sitting here doing other work and I’m like, oh, I got a voicemail. All good.
Josh Brunell (29:50) All good. Thanks for jumping on. And thanks for the introduction here next week. Excited. Yep. All right. See you soon. Bye.