Transcript
Jack Schell (00:00) hi Sonia.
Sonia Bajwa (00:00) Hi, I,
Jack Schell (00:02) hope you saw my email. Sorry, I’m already running behind on the week.
Sonia Bajwa (00:07) That’s okay. I totally understand.
Jack Schell (00:10) Yeah. How was your weekend?
Sonia Bajwa (00:13) Oh, it was pretty good. How about you? It?
Jack Schell (00:16) Was good, quite busy, went to an NHL game, went to the sharks versus flyers game with some friends, and then went to a concert. So, pretty full weekend. Did you do anything exciting?
Sonia Bajwa (00:32) No, I was just, you know, ncaa March madness is good to go, yeah.
Jack Schell (00:38) Right, right. Nice. That’s awesome. How’s Monday morning treating you?
Sonia Bajwa (00:45) Really good. Yeah, it’s busy. It’s just busy.
Jack Schell (00:48) Trying to.
Sonia Bajwa (00:48) Catch up. Yeah.
Jack Schell (00:50) Monday being Monday?
Sonia Bajwa (00:52) Yep. It’s Monday. That’s right? That’s for sure.
Jack Schell (00:55) Monday’s Monday.
Jack Schell (00:56) That’s how I feel too well. I appreciate you pivoting and making some time today. I know we had to push and I apologize for that from last week, but hopefully we can be quick and efficient here of course, as always want to make sure that I’m capturing the latest to greatest and sharing some readout on just performance for you all. Also want to just say, I appreciate you helping me to get the appropriate volumes in place for synapticure for the rest of the term. And, you know, we should see that in consumption which I’ll make sure you have most up to date today as well.
Sonia Bajwa (01:34) Okay. That sounds good.
Jack Schell (01:37) You know, I know we had been running with the meeting structure that Molly had kind of had in place when you guys were all partnering, but I do just want to take some time to like level set on agenda moving forward for these calls. Just wanted to just clean some things up and make it really sharp and tight for us to have a most productive conversation. So coming to these calls each month, want to make sure that I’m sharing any medallion updates with you of course, first and foremost, then of course, want to stop and just open up the floor to speak with you about any updates related to synapticure that might be relevant in our partnership or in how we can work better together or even just, you know, if there’s expected growth or what have you that we’re being thoughtful and talking and preparing for those things. Then we’ll do an execution readout to the metrics that you’re used to and a consumption review. So make sure that we’re aware of where you stand with consumption. And then I do carry over an additional project tracker with all my clients. And so I want to add that here for us too. Really that is just to make sure that if there’s anything non standard, you know, anything outside of our normal operating procedures that we might be exploring that we’re keeping meaningful updates on those. What this looks like for some of my clients is like many of them are exploring building out integrations with our open apis to make sure that their systems are talking to each other. So whether they need information from medallion and Salesforce et cetera, that, you know, we’re tracking those updates, you know, this wouldn’t be a meeting for those projects necessarily. But just again, to make sure that we’re each month taking a look at where we’re at on all fronts. So with that in mind in terms of medallion updates, I do not have any significant updates for you today. We are approaching the end of our quarter here at the end of March. And so, I expect the next time we meet in April, I’ll have a nice readout for you in terms of what our product team shipped in Q1 and what went live in Q1 and hopefully have some meaningful updates for you with regard to how we’re progressing and our product investment and product roadmap. So that’s kind of what we would include in this section. But as mentioned, nothing incredibly significant today to share. So, you know, we’ll make sure that we have a Q1 readout for you, in April on, with regard to that. In terms of synapticare, you know, per the agenda, this is where I would like to just, you know, open up the floor and have open conversation with you in terms of how things are going from your business perspective. If there’s anything coming down the line that we should be aware of that we’ll they’ll be looking to medallion to partner on or even if there’s anything specific to the partnership you want to discuss before we get into the execution readout. So.
Sonia Bajwa (04:32) Yeah, absolutely. Yeah. To be honest, there’s a, yeah, there are a couple of things I think on my agenda that I’d love to just work with you on like truly understanding kind of the end to end and how we build confidence when we’re licensing with our provider team as well. You know, one thing that comes up pretty frequently Jack, is our advanced practice providers, right?
Jack Schell (04:57) Okay. When.
Sonia Bajwa (04:58) We are in a telehealth environment and we support different non physician type roles like nurse practitioners, RNS, and physician assistants specifically for nurse practitioners. And for physician assistants, we know that there are some states that require, right, collaborative agreements or some sort of form that the board requires us to complete fill out in order to have that very like legality bucket checked off because that also then supports right? Our liability. It supports protecting our clinicians of all different degree types. Yep, one thing that comes up frequently that I’ve brought up in the past and really want to make sure that we are aligned on kind of expectations legalities. And what boards require for these role types is the collaborative agreement pieces or the notifications to the boards that this individual has this person as their supervisor. There’s typically a two fold that sometimes happens, right? One when we’re requesting a license for an advanced practice provider, the board will say, okay, who is the collaborating physician for this individual? Right? Yep, we provide them the name of that individual. And my assumption is that the medallion is communicating to the board that information, right? Yep two, there then can be a secondary form that needs to be filled out for that state that the board requires that we need to complete, have individuals sign. So that is also on file ready to go for all parties. Yep. What we’re experiencing with that is that we are not getting information for each of those states in order to fill out that form. Okay? And check the boxes, right? To make sure legally we are good to go when an ap license is issued. So that’s one gap that we’re experiencing. Okay, that I really want to make sure that from medallion’s end from our end. And the way that we build confidence with our providers that we’re aligned in the process. And that we are also reassuring them that we do these things because we have noticed that is not being done. And we’ve been in scenarios a couple of times now to be honest where we were given information that everything was set and then the board notification piece was not completed.
Jack Schell (07:54) Specifically, the board notification piece was not completed.
Sonia Bajwa (07:58) So, I think from my end, I really want to understand like what parts of that end to end process? Does medallion own? Okay? Because I think I’m just, I’m now, I’m getting a little confused because I was told that medallion would handle all of that end to end. But I’m now experiencing pretty significant examples of that not being done, end to end. Yeah.
Jack Schell (08:25) And are these previous examples the ones that you’ve provided me or are there new ones that you want to raise to me that I can review with Kyle and like really dig in?
Sonia Bajwa (08:35) I think what I’d love, I think to a provider specifically to use as an example is Jennifer. Yeah, Jennifer green is a physician assistant that we have obtained a pretty healthy amount of licenses for over the past year where we have not been given information for all of those states that the board notification has been completed. We have not been triggered the additional forms that are required for each of the boards in those states to be able to complete. And so that is a great individual and example that can be used for like understanding the end to end requirements for a physician assistant.
Jack Schell (09:17) Okay. And also examples of where there were gaps in the process that we were completing. You’re saying?
Sonia Bajwa (09:24) Yeah, exactly. Okay. Jennifer green, exactly.
Jack Schell (09:28) JENN2 NS, IFER green, exactly how I would expect to spell it. Yep, exactly. Okay. What I will do from here is obviously, I share out an update actually broadly after each of these monthly meetings. Okay? And that gets the visibility of like everybody from my leadership to our engagement management leadership. So what I’ll do when I provide my update is I’ll also set next steps with the engagement management team to look at the Jennifer green example. I want them to take me through it too, to explain to me how, you know, what they’re seeing so that we’re all on the same page, and then also confirm exactly what you’re asking. I’ll even, you know, benefit to like having tools that like record calls such as this too. Is I’m going to clip exactly what you just shared with me and share it out to the team broadly. So that your feedback is given verbatim.
Sonia Bajwa (10:27) Okay. Yeah, because I think what happens is that and just so you know, how we’ve kind of found some of this out or experience is one I go in and obviously, I’d do my own level of research on what type of collab form is required because the names of these forms can be different by state, right? So we have those, our providers then get emails after a license is issued, right in medallion. They then also maybe a week later get notifications from the board that your license is not valid until this step is required or this step is completed. So now we’re in a position Jack, right? Where we did everything that we were. We were told we provided all the information for the license. We get the license number, the issue date, expiration via our medallion notification system. We complete everything internally to get that person up and running for the license. And then a week later we get an email from the board saying we need this item to be completed in order for you to be able and ready to see a patient.
Jack Schell (11:43) Which ideally, that is part of the process when you’re completing everything.
Sonia Bajwa (11:48) It has to be, right? Yeah. I mean, there’s it’s kind of like a non negotiable. Because when we get issued a license, right? Or any, if a provider gets issued a license, every box legality needs to be checked off then, right? In order for us to be able to see a patient. So it’s really the readiness to see a patient then get stalled or it causes a little bit of a hiccup problem internally where we then now have to go back, reschedule patients. There’s a whole back and forth that happens which has now occurred a couple of times, with our provider team after a license has been issued by medallion also, right? Like updates to licensure processes and end to ends. Like the Texas board has a brand new update also that once a Texas license is issued even for a physician, there’s then another step of registering that license in the Texas board, that then takes 15 to 30 business days for them to review and finalize. We have not been given that information until we found out the hard way. Unfortunately. And now are in the process of having to reschedule patients. Now, we’re going back and just making sure that everything was completed and has caused a little bit of a back and forth example being Jessica tate who is a physician that we requested a Texas license for. Yeah, we got the medallion notification that the license was live and ready to go. And then one week later we received an email from the board of Texas stating you need to now register your license. So really when a license is issued, if there’s a dependency, we really shouldn’t then be saying you’re good to go, right? Yeah. And so, I think these are kind of examples that have come up more recently that like cause concern for me about when we’re given information that a license is ready, when it’s not. Yep. I hear you. Yeah.
Jack Schell (13:55) If you’re being told a license is good to go, then scheduling patients, moving them through the process should be without hesitation, correct?
Sonia Bajwa (14:04) We want to be confident, right? That we are relying on you all for the end to end. We’re relying on the support. And of course, we pay for that service, right to be done. And so now we’re having to reschedule patients currently, yes, which is really a revenue hit for us too. Right? Yes, not be able to complete those. And so that has just been a little bit of a tough situation for us to then build confidence with our team about how we approach licensure using, yeah, form right now. Yeah.
Jack Schell (14:39) Of course. And when it comes to having discussed this with our team, obviously these things kind of happen one by one and these scenarios come up and likely we can work through them and resolve them however, you know, sounds like things are building. It sounds like there’s more examples more frequently. I.
Sonia Bajwa (15:03) I.
Jack Schell (15:03) don’t want to assume but have you, as these examples have come up, have you worked with our team on each of the examples already or are these like brand new today and like all happening kind of at once?
Sonia Bajwa (15:15) So I’ve had this conversation kind of earlier on when I first joined, when I, when we started to increase our advanced practitioner role type in our organization to make sure that those board notifications were part of the puzzle. So I had that conversation at that time, yes, I was told absolutely, but our providers who also protect their license then go to the board site to confirm and it’s not there. So I’ve had this conversation earlier on because I wanted to also instill the confidence with my team, and our providers that as we’re licensing them, we’re checking all of the legality boxes, but I’m now also being made aware that it’s still not occurring. So I do want to really like make sure that I understand what the gap is and why there isn’t anything being triggered to us for these board forms and notifications. If it’s required for each, you know, state or a degree type, right? It’s still not happening. So I do want to bring in the overarching topic to you because I think at this stage we’ve talked about this, you know, in our weekly kind of calls, I had brought this up earlier on just to make sure we mitigate stuff like this. And now we’re still.
Jack Schell (16:35) in.
Sonia Bajwa (16:35) a space now that it’s still occurring?
Jack Schell (16:38) Yeah, that’s that was kind of my point, is, yeah… yeah, I want to, I want to make sure that as you are bringing these items to the team that we are working toward a resolution. But yeah, a conversation clearly needs to be had from an overarching perspective of, okay, here are the examples we’ve got Jessica green and Jessica tate, and these are examples where now we know maybe the resolution’s been achieved. However this is impacting revenue delays, scheduling on the synapticure side that’s not… totally acceptable. So that’s where this is. This is definitely what this meeting’s intended for. Let me group with my team, make sure that they understand and then also make sure that I understand and we can communicate and set some specific expectations. Obviously, I’m not in the day to day operations. So I need to confirm with them all, what the expectations should be and are. But that’s my commitment to you is to get with them, to review these examples.
Sonia Bajwa (17:51) Okay. Yeah. I think that’ll be helpful and I think like just really, I know we only have a few minutes but like that’s one overarching topic. I think the second one though is a conversation again that we’ve had in the past on enrollments, payor enrollments and who’s responsible for making the corrections when something comes back as needing like support or additional information. And we were told that if an enrollment was submitted from medallion by medallion, that it’s really medallion’s responsibility to support the end to end. If there’s a correction needed, then of course, if there’s something we need to clarify, we can provide clarity on. But I’m still seeing some of our medicare traditional enrollments come back as needing corrections and the team not replying in a timely fashion to make those. And by team the medallion team. And so that’s another area. We have one particular enrollment that I can give you an example on just Elizabeth rumbaugh. She was an individual can.
Jack Schell (18:57) you spell rumbaugh for me?
Sonia Bajwa (18:58) Yep. It is. R… UM, yep. B a UGH. Okay. We submitted her traditional medicare enrollment in September of 20 25. At that time, we, you know, communicated that traditional medicare is a very high priority for us making sure that any of the traditional medicare line items were really handled and made sure that they were seen end to end during that conversation was around the time I had asked clarity on the corrections whose responsibility it is to follow up if you all needed more information from us that we’re replying in a timely fashion.
Sonia Bajwa (19:43) And we felt really good leaving that alignment, you know, end to end. But her enrollment in particular, we submitted in September 20 25. It seemed as that time that application then needed corrections and there was no follow up at that time. It then ended up being rejected. We now have resubmitted that application for enrollment and it was not submitted until March of this year or I think maybe even the end of February which means from September till now we’ve been in a very tough spot for delaying care and lost revenue.
Sonia Bajwa (20:28) To be very Frank. These are examples that are really rough for me to explain to then my leadership team on why something wasn’t done because we’ve aligned on the process. And now we’re still in a problem situation with that enrollment also not being active.
Jack Schell (20:48) When did you re, request it?
Sonia Bajwa (20:54) In the same ticket item, when we realized that again, that it started to get into that lapse time frame, I re, requested it earlier this year.
Jack Schell (21:05) Okay. And it wasn’t submitted until.
Sonia Bajwa (21:08) March and it wasn’t submitted until maybe March or the end of February. And so there was a very significant delay in between as well on the re, application for this individual, which has again caused us a revenue.
Jack Schell (21:22) Hit, yep. When you say that you went in, you’ve been going in and seeing that there are issues with these applications and our team’s not communicating it. Are you going in yourself to like the application that’s been submitted? And seeing that the response from medicare has been, we need additional information, but medallion hasn’t said anything in platform or via task assignments, correct? Okay. So you’re fully going in and checking what’s been submitted on your own? I.
Sonia Bajwa (21:56) Go in to confirm that an application has been submitted. I look in Pecos as well for anything medicare related to see if there’s anything pending. We get notifications because we’re part of the account holders that a re application is needed if it’s something. Because again, like we’ve paid for the payer enrollment service, we were given information that you all would be following up on the correction. I wait for medallion then to follow up on the correction. But then I get concerned when I do not see any activity on following up on that correction that maybe my team needs to then go back in and do something. But this is a really good example of that where again it’s just significant delays, lack of communication in between. And I feel a little concerned again with our enrollment, you know, requests that are in there especially because we flagged the traditional medicare ones being a very high priority that we’re just not really getting the support in order to make the right business decisions as well for scheduling?
Jack Schell (23:06) Yeah. Okay.
Jack Schell (23:25) I’ve added this to my follow up with the team. I just want to make sure I don’t have any additional questions before we hop here. Okay. Yeah. All right. So I’ll… get with the team on both of these issues. Clearly, it’s impacting operations and revenue on your side which we don’t want. Yeah. And let me just put some pressure on exploring this further thinking about the enrollment piece and how you’re finding required corrections and our team is not communicating them. I want to look at that. Do you know if our team is… leveraging? Are you notifying our team of like high priority specific requests? Like with Elizabeth rumbaugh? And do you know, like had Lee or anybody been marking them as priority for our team? I?
Sonia Bajwa (24:31) Have we had like an entire like medicare enrollment like line item by line item, you know, like document that Lee and I previously in the team were working through? We let, you know, I was very clear. We let them know about our high priority needs. We talked about this. Yeah, you know, very frequently. And so, yeah, the issue is also is that when we do, sometimes I see that they’re marked as a priority in our portal. And sometimes I do not see them marked as a priority even after we’ve discussed it over and over again. So like I don’t know how much then and just to be very truthfully honest, Jack, how much follow… up managing reminders we need to do then I’m just unclear because I think then it turns into us doing much more than what we expect out of a service?
Jack Schell (25:28) Yeah, yeah, yeah, yeah, of course. Yeah, that marked as priority is really what I was getting at. I want to make sure that like we’re leveraging that to mark specific requests as priorities. So… I’ll review that with the team as well. I’ll schedule time with them for this week to go into all of this. And then you likely have an operational meeting tomorrow.
Sonia Bajwa (25:52) Yes, we do that’s. Right? Let me double.
Jack Schell (26:00) Check.
Jack Schell (26:16) All right. I will try to get with the team before… you meet with them tomorrow… if possible. I may have to work via slack with them for today, but I do want to meet with them to talk through these examples and walk through them specifically… and they’ll know before tomorrow’s meeting that I’ve shared, this update.
Jack Schell (26:39) Okay. So, okay, thank you for sharing and for, you know, emphasizing the importance of the experience that you’re having. I will send you the additional items that we typically cover via email… and we’ll set some clear expectations and hopefully move these things forward with Jessica tate, Jessica green and Elizabeth rumbaugh. Sounds like you’re still waiting on items for Elizabeth rumbaugh. Correct? Yes. Okay. I want to immediately make sure that that’s being treated with utmost priority so that we can push that through Jessica tate and Jessica green. Are you still waiting on items for both of those?
Sonia Bajwa (27:28) I need, I just need clarity on the examples that I provided. So one, like with Texas having an updated, you need to register your license in the board even after it’s issued? Like does medallion know that those updates are required when issuing a license? Like, and is that information being communicated to us? Then if there’s an update to a board process that we were not made aware of yet, right? So that’s one thing I just need like clarity on in regards to Texas. But just, any state board change requirement for a license? If that’s something that you all, you know, stay on top of as much as possible. And then for Jennifer green just using her licensure like end to end as an example of what advanced practice providers, whether you’re a physician assistant or whether you are a nurse practitioner, if a board is requiring a form, just making sure that we then are being notified. And if that’s not part of your process, then we just need to know need.
Jack Schell (28:38) To know it.
Sonia Bajwa (28:38) We need to know because we were told previously that it is part of your process and we were reassured. But then we’re still experiencing a gap in some of those forms then being triggered to us to complete.
Jack Schell (28:51) 100 percent. Okay. I’ll get just, I just wanted to confirm with each of the examples that if there’s any outstanding work that I also take this opportunity to highlight that. So Jessica green are great examples for us to like dig into on those specific requirements that you’ve highlighted Elizabeth rumbaugh, great example of where we can improve in terms of like priority treatment. And then also currently has some outstanding work that needs to be done that I’m going to make sure where our team pushes through.
Sonia Bajwa (29:21) Okay. That’s very helpful. Yeah, thank you. Yeah.
Jack Schell (29:26) Okay. I appreciate the time and appreciate you taking the time to take me through all that. Let me get with the team. Again. I’ll try to get with them before you meet with them tomorrow. Okay? I don’t that’d be, it might transparently tight turnaround for that, but I will definitely get with them this week?
Sonia Bajwa (29:44) Yeah, I think even just any information this week, I think because I know some of these things that we discussed are, you know, pretty high level stuff. I’m sure you need a little time to discuss with your team as well. I totally understand. So anything by the end of this week would be fine on that. I think for like high priority items like, you know, like Elizabeth’s traditional medicare that we just, we desperately need that like ASAP. And to be honest, like Jack, like if there’s any kind of like credit or something that we can be provided for some of these like issues and the impacts that we’ve been having. I like, I would love some sort of consideration in regards to that just because again, we’ve now been in positions where we’ve had to reschedule patients and some, you know, like, yeah, it’s just, it’s a little bit hard for us to really kind of to manage that, you know, with these workflows. So I’ll just throw that out there as an opportunity, but just wanted to, yeah, say, I think updates anytime this week is fine. We understand if you can’t bring them with Drema, in our weekly review tomorrow that’s okay. Yeah.
Jack Schell (30:53) Well, I definitely want to. Yeah, most important, sounds like Elizabeth rumbaugh.
Jack Schell (30:58) I want to like draw as much attention to that as possible. Are there any other providers with outstanding that should be being treated as priority that you want me to just highlight again? Yeah.
Sonia Bajwa (31:11) The only other one that we’ve been really working, very, closely on is April stowers which is a new hire that’s going to be on board next week. We’ve been working on obtaining her multi state license in order to get the nurse practitioner licenses that we needed live. We, you know, went through every process and marked that as a high priority and did everything we needed now because she’s starting next week, we haven’t been able to start the nurse practitioner licenses for her in some of those states, which means we’re really coming up on a really tight window of when she’s going to be able to see patients and the readiness. So, I think that’s the only one that I’m just concerned about now that we are, you know, reaching her start date and still don’t have any updates in regards to her multi state license and the nurse practitioner ones that we needed in order to, you know, for her start date of.
Jack Schell (32:11) Course. Okay. I’ll highlight April stowers as well. Okay?
Sonia Bajwa (32:15) And then everything else is just kind of run of the mill traditional… otherwise, those are kind of our highest items right now that we’re trying to track.
Jack Schell (32:25) Okay. All right. I’ll get to work here, okay? And we’ll definitely provide you updates throughout the week.
Sonia Bajwa (32:35) Okay. I appreciate it. Thank you, Jack. Yep.
Jack Schell (32:37) Yeah, no, of course. And I appreciate you sharing. And yeah, this is, again, that’s good that you elevated this to me in this meeting. I’ll share everything else that I have for you, just async for your documentation. Okay?
Sonia Bajwa (32:53) I appreciate it. Thank you. Yeah.
Jack Schell (32:55) Of course, I hope that you have a great day. A great week. We’ll work through this. Okay? I.
Sonia Bajwa (33:02) appreciate it. Thank you. I hope you do too, of course. And yeah, just let me know whenever y’all have any updates, I’ll make sure to communicate with my team as well.
Jack Schell (33:09) Okay. I appreciate you Sonia. Thank you so much.
Sonia Bajwa (33:11) You too. Jack. All right, bye.