Transcript
Mallory Smith (00:00) morning?
Jacob Andreasson (00:03) Like how up everything is?
Mallory Smith (00:06) Oh, thanks. I didn’t wash it.
Jacob Andreasson (00:09) Classic, is it too high? No, no, it looks awesome. Okay. It’s very fun. Very Friday. It’s Friday. It is Friday.
Mallory Smith (00:21) Today’s, going to be a little rough I’m on a weekend.
Jacob Andreasson (00:28) So, I’m thinking sorry, what was that?
Mallory Smith (00:30) Nothing, go ahead. What?
Jacob Andreasson (00:36) I’m going to run through and just confirm volumes. And then we can jump into those questions that Amy had, I figured you could walk through those if that works, and then I want to bring up. I don’t know if you saw that brand new pricing slide that marketing came out with. It doesn’t like it allows us to talk about pricing without like giving them pricing. It’s essentially just kind of like explaining how the pricing works. Have you seen that?
Mallory Smith (01:04) Stop the recording?
Mallory Smith (01:09) Pause it. Do you know how to pause it? Come on, Jake, you can pause.
Jacob Andreasson (01:12) It, oh, this changed zoom updated.
Jacob Andreasson (04:56) Hey, will, Amy, how you doing, will? Good. How are you? Good, happy Friday. Happy?
IPhone (05:03) Friday. No one’s joined yet, no.
Jacob Andreasson (05:06) One has joined. I was about to try to give one of you guys. I think you’re the only person’s number I have, but yeah, do you have a handle on where Amy or Kathy might be? Yep?
IPhone (05:15) I’m texting everyone right now. I don’t know why they’re not on this thing. It’s… funny. I was like, I’m sure they’re on it. I might not even join. Well?
Jacob Andreasson (05:26) I’m glad you did. You probably would have got a call from me anyway. So you’re.
IPhone (05:32) joining.
Jacob Andreasson (05:47) yeah, today should be pretty quick and painless. Anyway. The goal is really just confirm some of, the numbers that you guys sent over. Understand a little bit more about the growth projections from yourself. And then we want to introduce kind of how our pricing works and, the bva that we’ll put together for you guys sounds?
IPhone (06:04) Good Jacob. Yeah, just to give you like, a like a true perspective of our growth. Yeah.
Jacob Andreasson (06:11) It.
IPhone (06:13) it, it’s TBD quite frankly. So, meaning like our New Jersey practice which is about 200 providers and eight surgery centers that’s like the guarantee 100 percent happening like that’s what we’re talking about today. Our, our proof of concept working out with you guys would then allow us to go to our, you know, call it 50 providers in Wisconsin and their six surgery centers, and then our groups in Utah, Georgia, Arizona, and… what’s our other, we have another market that’s in Loi, but those are all like on the idea jersey works well. We would then bring you in as basically our new partner in credentialing. Yeah. And then from there, like obviously, I’m sure offerings and, you know, product introduction would expand beyond that. But so the only thing I can tell you now is what’s on the immediate table is the 200 providers Ish, in New Jersey? Okay?
Jacob Andreasson (07:13) That’s helpful. So, yeah, it sounds like once you have like a credentialing infrastructure set up that it works that scale you can rely on, then that growth will kind of really start to, you know, unfold or you’ll be able to actually see that happen. Perfect. Yep. Sorry. What was that? No?
IPhone (07:32) No, yeah. No, I perfect. I, that’s what I’m thinking as well. Okay?
Jacob Andreasson (07:37) Okay. Gotcha. Awesome. So just to clarify, the numbers that Kathy and Amy had sent over, they wanted to allot for 120 seats in the platform or 120 providers. Are you thinking more? 200? No?
IPhone (07:51) So that 120 might be because those are groups that we know are available to start using the product much sooner than others that may already have an existing credentialing person. Because so we operate a care center model. So they’re everyone’s under 110. We have providers that work directly with like our revenue cycle companies are required service. They have to use our revenue cycle company, but we don’t require them to use a certain technology when it comes to like online scheduling or check in. But this is a service that some groups may need to be sold. It. And that’s why we probably gave you the 120 as a confident number.
Jacob Andreasson (08:29) Okay. Got it. So still we should kind of account for 120. Yeah. Okay. Got it. Yeah, because, I guess I’ll touch on what, the business value assessment is a little bit where there’s really three areas. We’re trying to move the needle. We’re trying to help you accelerate revenue, which is why we can ask for all those questions about timelines, things like that. I think there’s some really significant gains there that we’re going to be able to make. The other pillar is lowering opex, and the third pillar is just a better provider experience which you guys kind of saw through the automation of the platform last Friday. But the lowering opex piece between healthstream and focus one, do you have an idea of kind of where your current costs are at? I do not. Okay. Got it. And.
IPhone (09:13) It’s mainly because I’m just, yeah, I’m not in that I can find out for you, but, I, yeah, yeah.
Jacob Andreasson (09:20) Yeah, that’d be helpful because again, we want to paint this whole picture of, you know, you’re going to be bringing in revenue faster at a lower cost with a better experience for your provider. So that metric, is super helpful as we put together our pricing and things like that. Got.
IPhone (09:34) It. Sorry, I’m just checking out at a wawa?
Jacob Andreasson (09:38) All good.
IPhone (09:41) But, if you don’t mind though, just like I’m curious, what does pricing structure typically look like with you guys?
Jacob Andreasson (09:48) Yeah. So I have a slide here. I can show you might be kind of difficult. Are you able to see your screen?
IPhone (09:55) At all? I am okay.
Jacob Andreasson (09:56) Gotcha. Let me.
Jacob Andreasson (10:02) Cool. Can you see this? Yep? Okay, cool. So essentially, the first thing we do is confirm volumes which is kind of what we just talked about. Essentially how many provider seats you’re going to need in the platform, how many payer enrollments you expect to need new, that includes new payer enrollments and new provider growth, and payer revalidations. So, current providers who are going to need to be re, credentialed. It sounds like right now we don’t really have to worry about the new provider volume. We can really focus more on what are the re, credentialing dates going to look like? Usually that has to happen every three years, and then the kind of discounting mechanisms that we use. So higher volumes are able to essentially offer higher discounts because economies of scale work really well for us as we rely on automation. So, you know, a balance of volumes essentially how much resourcing we’re going to need to do. And then each skew, so core seats, payer enrollment, those all essentially have varying cost tiers based on the volumes that you’re going to be committing to. Got it. And I believe they may have just jumped in here. Hi.
Jacob Andreasson (11:24) Hi, is this Amy? Hi, Kathy. How are you?
19737156649 (11:26) It is. I’m sorry. It took so long. I mean, it just won’t connect the straight way by zoom. So I’m again back in two places, I did a dial in and now getting you back on the computer.
Jacob Andreasson (11:40) Hey, no worries. It sounds like a Friday problem for sure. Hi, Amy. Hi, freaking. Does this? Oh, wait, is this, are Amy and Kathy both in here or just Amy?
IPhone (11:58) I think just, Amy.
19737156649 (12:00) I’m on there twice.
Jacob Andreasson (12:02) Okay. Sorry, I saw the phone number pop up and then I saw it work and pop up. So I thought it might have been both.
19737156649 (12:08) Of you. Yeah. I’m also that phone number?
Jacob Andreasson (12:11) Okay. Got it. Do we want to give twilight zone? Yeah. Do we want to give Kathy another minute here?
19737156649 (12:22) I know we texted her, so hopefully she’ll join. Yeah, but.
IPhone (12:26) We’re Amy, we’re right about to get into just pricing in general. Okay?
Jacob Andreasson (12:33) Yeah. So Amy, as I was kind of explaining to will, essentially what we’ll do is confirm a volume. So, you know, the, I guess a couple of SKUs that we’re kind of talking about right now are the core seats. Essentially every provider is going to need a core seat in the platform and then the payer enrollments, and in this specific case, payer revalidations. So, you know, of these 120 providers, which ones are going to need to be re credentialed because usually we see like on a three year cycle. And then we can, you know, talk about new payer enrollments and things like that down the road. Those are kind of the three SKUs that we’re talking about right now. I can bring this slide back up for you.
Jacob Andreasson (13:22) So, yeah, once we’ve kind of confirmed those volumes, which is Amy Wyatt sent over those scoping questions. Essentially, you know, we’re able to offer discounts based on the higher volumes that you’re able to commit to. So pricing comes to a combination of those volumes and essentially how much medallion would be resourcing and time requirements on our end. And then, you know, various products and SKUs have various prices. We can walk you through what that looks like. But this is kind of the outline of how our pricing works as well. Is there any questions I can answer about this?
19737156649 (14:01) No, it’s pretty straightforward. I’ll be able to fill you in where we are with everything because we’ve been actually gathering together a significant amount of the primary sources rather than just relying on verifications and everything that we’re getting aside from maintaining it ourselves, we’re uploading it to the caqh. So for each provider caqh, that was rather empty before and just had verifications you’re going to find once we transition that the majority of all primary source information should be in there already.
Jacob Andreasson (14:38) Oh, wow. So it sounds like you’ve gone ahead and like done the ceqh.
19737156649 (14:42) I’ve been very busy the last couple of weeks.
Jacob Andreasson (14:46) That’s incredible. And I’m sure the providers are extremely thankful as well, yeah.
19737156649 (14:52) I mean, it cuts down there. One of the things that’s interesting. We do have one group that I just discovered recently said they want to do their own caqh handling, but we’ll handle that internally because I prefer that not to happen because that kind of convolutes things a bit.
Jacob Andreasson (15:08) Yeah. And is that something that you still want medallion to take over on an ongoing quarterly basis?
19737156649 (15:14) Yes. What should happen is anything that is expiring, we don’t want to be the internal, we want that automated. Once we give you everybody’s emails and we would set it up initially, not so much direct to each provider, but we would give you a spreadsheet that breaks down who the manager is, the group divisions manager for each provider. So when something gets to that point, then there should be an auto email that goes to that person saying, hey, you know, this person’s license Da, whatever it is expiring or a little extra notice on their board certification. If it’s one of the ones that’s reaching 10 years or something so that they have sufficient time to scramble. And then they would then of course send that to you. You keep it both on the platform and upload that to the caqh. The goal as I mentioned last week is twofold… one keeps everything cleaner. I truly believe that if the caqh always has primary documents in it, then whenever the payers are pulling from it, all those processings are going to go much quicker. Second is my other goal this year is to start working on gathering the various things that we need for the practice to become accredited. So, 20 26 is learning everything that we need, putting it all together and then making that application because I think it would be very beneficial in many regards for us to be an accredited practice which is not common.
Jacob Andreasson (16:51) Yeah, that sounds like an incredible mandate. Sorry, Mallory. I thought you might have had a question.
Mallory Smith (16:56) Thanks Jake. Quick question on that. You said that you’re going for accreditation to what standards are you looking to get accredited with?
19737156649 (17:05) Haven’t determined that yet it’s still a little bit of a learning experience if you have really great insight on that. I’d love to hear your recommendations.
Mallory Smith (17:13) Oh, gosh I’m flattered. No, I think, you know, I think healthcare is always a business. And the more accreditations you have that stand for that, my starting point would always be like at least CMS or ncqa based on the services that you currently provide, I can always give us more thought and email you afterwards though.
19737156649 (17:34) Right now, does CMS recognize the ncqa? Because I am familiar with the ncqa, I was looking into that one.
Mallory Smith (17:42) Yes. So CMS is technically well, rather ncqa has higher standards in every regard than CMS. So I would say CMS standards, medicare is the baseline for offering services and things in this space. And then one step of several steps above that is ncqa, and then you have joint commission, but joint commission is really for more of that inpatient.
19737156649 (18:04) More hospital. Yeah.
Mallory Smith (18:07) Yeah. So I would recommend.
19737156649 (18:10) Go ahead because I know sometimes when we’re going for our initial accreditations on ascs, one of the things that we’ve done is even if we let’s say, you know, whether we’re going aaahc or quad a, whatever those, that if we go deemed status, it’s so much easier because it’s right off the bat accepted by medicare. Yes, I agree. So, so yeah. So if you said the one that I was already kind of looking into a little bit, that makes me feel better about it already.
Mallory Smith (18:41) Oh, good. Okay. I’m glad I got it, right.
19737156649 (18:44) Thank you. Okay. So that’s one of the things is we want to have it streamlined, we want to try to have somebody in house that is going to be your POC, right? Because we have to make sure, you know, we have our eyes on it all the time. If you need somebody that’s other than a divisions manager who’s going to get a document that needs to be updated, but there’s a higher level stuff that we need to review. We are going to set up. I don’t have that person designated just now, but we’ll have that internal person designed for that purpose. I also like for myself. I could kind of oversee that to a degree. I’m not versed in the actual payer side credentialing. One thing to put everything together. I could probably read through whatever came back. It’s sort of not what I’m busy doing. So that would be what that person would do as well. So if you encounter something on the credentialing that came back from the payer and we say you need direction or what are we going to do? We’ll set up a point person for that.
Mallory Smith (19:49) Okay, perfect. And just to make sure I understand that the, of course, that’s like included in the medallion services. So since it is end to end, we will submit the application. So we’ll follow up on it. If the payer sends back a question, they’re requesting information, we of course can either reach out to this point person that you’ve designated or we can reach out to the provider. So it sounds like you would prefer to the point person. I.
19737156649 (20:12) Think I have to understand, what the more common requests are once an app is submitted, what are usually the kinds of things that come back? So that way it might be a different answer depending on what it is. And we can, you know, have two columns if it’s one of these things that you check with this person. If it’s one of these things, then you go directly to the, you know, the practice manager.
Mallory Smith (20:31) Okay. Yeah, no, absolutely. So what I would say is we have a 96 percent accuracy rate on what we call resubmission errors, which means that any application that gets submitted from medallion to the payer, 96 percent of them go through without needing additional information. So the way we do that, we’re proactive with it. So if we have an application that’s been in process for a, month and a half, and then the payer releases a new updated application, we’ll map it. We’ll send that proactively just to say, hey, you’re currently processing this? But just in case there’s any pushback here’s, the new application version that you’ve done typical pushback. We’ll see would be expiring documents such as the provider’s state license, their Coi, Dea, any of the supporting documents like that. But because we are proactive, we will automatically send that to the payer just so they don’t have to come back to us. So that’s how we maintain that 96 percent from submission to completion without any issues.
19737156649 (21:26) What falls into the other four percent?
Mallory Smith (21:31) It’s a good question… typically just because it’s such a low number. I think maybe taxonomy sometimes it’s erroneous information. We’ve had a few cases where the providers have emailed the payers directly because they’re wanting a status update and they didn’t use the medallion platform for the status update. So then the payers have come back and wanted to clarify that, but I can find out for you, I’m just not entirely sure what the exact four percent would represent. Yep. Okay.
19737156649 (22:05) Just so that if it’s something that we can nip in the bud on that as well, then we’ll do it. And like you said, if it’s something that somebody that’s being newly credentialed is doing on the outside, then we can include that in our instructions to say and make sure you don’t X y Z.
Mallory Smith (22:19) Yes, I like the way you’re thinking, yes, agreed.
19737156649 (22:24) Okay. Awesome. And Kathy.
Jacob Andreasson (22:26) We’re sorry, Amy, did you have another question?
19737156649 (22:32) Nope. No, it’s back to you.
Jacob Andreasson (22:33) Okay, perfect. Kathy, I just want to say Kathy, welcome. Thanks for hopping on here. What I did want to do really fast while we do have a couple of minutes left is just confirm some of these numbers that you guys sent over. So just taking a look here, average turnaround time has been rolling up one to two weeks, average number of payers, each provider is enrolled with 10 to 12. And if we work with workers, comp, 15, we do work with workers comp 15. So we’ll go ahead and note 15 total payers there, average time from submission to par status with payers. So medicare, 30 days commercial plus 45. I’m reading that as commercial at 75 total. Is that accurate?
Ksaunders (23:19) Yeah. I would say that’s probably accurate.
Jacob Andreasson (23:22) Okay. Gotcha. And then blue cross blue shield, New Jersey, 90 to 120 days estimated annual claims, Niles tied to PE, Kathy, I believe you said greater than 100. Can you clarify what you mean by that? Yeah.
Ksaunders (23:38) So, you know, that’s that was a trick question for me. So it varies, right? Because some of these doctors come in so quickly to the practice and they have previous patients from their old legacy practice and they don’t want to stop treatment with them. So they’ll continue to see them even though their credentialing has not come through.
Jacob Andreasson (23:58) Yeah.
Ksaunders (23:59) That’s where we see denials, but, you know, we realize those denials are going to come… you know, due to that. So it does, it varies. It really does. Okay. Got.
Mallory Smith (24:12) It.
Jacob Andreasson (24:12) and then facility enrollment, you guys are enrolling ascs.
Ksaunders (24:19) we are okay.
Jacob Andreasson (24:21) Gotcha. How many?
Ksaunders (24:23) Currently, we have one, two three that are active with another going live, probably Q2.
Mallory Smith (24:32) Okay, perfect. And I’ll jump in there really quick, Jake. So thank you, Kathy. Quick question on that. You’re enrolling them with payers, and just to make sure we’re speaking the same language, facility enrollment, you’re billing at the facility level. Only you’re not including the provider information. You’re getting a per diem per patient. Is that accurate?
Ksaunders (24:50) That’s correct. It’s facility level, okay?
Mallory Smith (24:52) Thank you. And then how many payers per facility do you currently have established? Yeah?
Ksaunders (24:57) So that’s dependent on the asc and dependent on our contracts and who, we, you know, if we have a contract, it’s always medicare for sure. And then Aetna and blue cross blue shield, okay?
Mallory Smith (25:11) Thank you. Are you looking to pursue additional contracts and I can give some additional information there? Yeah, no.
Ksaunders (25:18) So what we do is use an outsource contracting team that is assisting us with our current contracts.
Mallory Smith (25:25) Okay, perfect. So if we, would you want us to submit any facility enrollments on your behalf for these groups or is the other vendor managing that for you?
Ksaunders (25:36) They’re currently managing the three that are active. Okay? It would be the fourth one that’s going live depending on when we would go live with you. So that one would probably be up in the air.
Mallory Smith (25:48) Okay. Thank you. So it sounds like a possibility, but we’ll keep it a very low volume just so you have some threshold if you decide to pursue additional payers, and of course, we have SKU flexibility so you can push and pull from different years.
Mallory Smith (26:01) If you have growth one year, but you don’t experience growth the next. Okay? Thank you back to you, Jay. And.
Jacob Andreasson (26:08) Kathy, is that vendor? Is that like a third vendor? So that’s not focusone or healthstream I take it.
Ksaunders (26:15) No, it is focusone. Oh.
Jacob Andreasson (26:17) It is focusone who’s doing that. Okay. Gotcha. Okay. Cool. And then I think that’s I also forgot to touch on that piece there that Mallory mentioned SKU flexibility when I was going over the pricing. But essentially what that allows you to do is, you know, say you buy a certain amount of core seats and a certain amount of payer enrollments and more providers join.
Jacob Andreasson (26:38) But you don’t end up using as many enrollments. You can actually move that spend around between different skews just based on what the business needs for. So it’s another level of added flexibility. And then you can also push and pull volumes between different years so you can pull in your volumes from year two, if growth in year one is higher than you had projected and vice versa.
19737156649 (27:04) So it’s like we can roll over our unused vacation days, huh? Yes.
Jacob Andreasson (27:11) That’s a good way to think of it.
19737156649 (27:13) From the two.
Mallory Smith (27:14) Thousands, the sprint commercial. Can you hear me now with the rollover minute?
19737156649 (27:18) Yep.
Jacob Andreasson (27:19) That’s exactly what it’s like.
19737156649 (27:23) Is that limited or anything that’s left over can get rolled?
Mallory Smith (27:28) It’s up to 20 percent of the volume, which is why we’re persnickety, sometimes on like quoting the accurate volume per year, so you can roll over at least 20 percent of the annual spend. Great.
Jacob Andreasson (27:41) Awesome. Well, I think that’s yeah. Did you guys have any other questions here? I think Mallory and I have a good heading here. I think as a next step, we’d like to reconnect next week and go through initial pricing. If that works for you guys… yeah.
19737156649 (27:54) I mean, you send it over and, you know, we’ll review it, and I think that that’ll probably generate the additional questions if everything seems in line with what, you know, kind of what we’re used to that won’t create many questions. If it’s you know, the setup or numbers are very different then we’ll probably have more questions.
Jacob Andreasson (28:10) Yeah. No, that totally makes sense. We typically like to walk through it live. Maybe if we could just grab like 15 minutes, would that work for you guys?
19737156649 (28:21) Yeah. Tell me when you think you’d have it ready. Yeah, maybe let’s.
Jacob Andreasson (28:27) see.
19737156649 (28:32) I’m not available next Friday. If it’s next week, we’d have to pick a different day otherwise going the thirtieth, I’m kind of tight. So if I’m looking to book out, I can still do 26 or 31.
Jacob Andreasson (28:46) Okay. Let’s see 26 is.
Mallory Smith (28:50) wide open for me?
Jacob Andreasson (28:51) 26 is not, I mean.
Mallory Smith (28:53) Unless I plan a vacation in the next three days? Yeah, would.
Jacob Andreasson (28:56) 11 a. M on the 20 sixth work?
19737156649 (29:00) That’s okay for me. How about you? Kath?
Ksaunders (29:03) Not good for me.
19737156649 (29:06) Any other time that day Kathy?
Ksaunders (29:08) If it’s pricing, Amy, I don’t know if I need to be on it. Okay? It’s more important that you’re on it, but I do have an 11 o clock on the 20 sixth, which is a,
19737156649 (29:20) can we do it before or after that one?
Jacob Andreasson (29:25) Yeah, it does. Let’s see. We could also do noon. I don’t know. I don’t want to cut your guys lunch break though.
19737156649 (29:33) Noon works for me.
Ksaunders (29:36) We don’t take lunch, right? Amy.
Jacob Andreasson (29:40) We.
Mallory Smith (29:40) don’t eat around here at.
Jacob Andreasson (29:41) Least, no free lunch. Yeah. Does that work for you as well, Amy?
19737156649 (29:47) Yeah, anytime on the 20 sixth, I can do.
Jacob Andreasson (29:49) It. Okay. Perfect. I will send that invite over and then, yeah, we’ll be ready. We’ll be ready to discuss that, but thank you guys so much.
Ksaunders (29:56) Alright. Thank you. I’m sorry, Donna. I have a hard stop.
Mallory Smith (29:59) Thanks. Of course. It was great. Speaking with you.
19737156649 (30:02) Yeah, Amy, Jacob, real quick if you could, though, even if it’s just an hour beforehand, if you could send it over, send over a document before we meet. So, that way, you know, I, you know, we can have a review and digest and make better use of the time with any questions we may have. Yeah, but if we’re first looking at it during the meeting, you know, we’re not going to be able to digest it. Yeah.
Jacob Andreasson (30:27) Completely understand.
19737156649 (30:29) Okay, super. Alright, Amy, thank you so much. Thank you both very much.
Mallory Smith (30:32) Thank you. Have a great weekend. Okay?