Transcript
Yenny Zhang (00:00) hi, Colette. How are you?
Collette Waddell (00:02) Massive water. I didn’t realize you could see it.
Yenny Zhang (00:08) I like all the plants in your little nook. Thank you. I.
Collette Waddell (00:13) Have managed to keep these alive so far and it’s because I think I sit here right next to them and I’m always like dumping water.
Yenny Zhang (00:20) Oh, that’s nice you.
Collette Waddell (00:22) Know otherwise, if you’re in another place in this house, your odds are not in your favor.
Yenny Zhang (00:29) Yeah, I’m really bad at watering my plants, so.
Collette Waddell (00:33) Yeah, I’m trying to get better. All right. It looks like we’ve got one team member from the spring team on. Are you both okay if I start letting them in or did you want to? Okay? All right?
Collette Waddell (01:00) Hi, Desiree. Hi, Sarah.
Yenny Zhang (01:03) Hello? Hi, again.
Collette Waddell (01:06) Hello… with us. And I’m not sure if you’ve had a chance to meet some of our product team, Yenny and Kelly here joining us and this is just to kind of chat through with you. So I’m going to let them kind of steer the call but thank you. I appreciate the time and getting this started. Hi, Lou. It was just introing Yenny and Kelly to the team here from our product team. So they’ve got lots of questions and just want to chat through this discovery phase of ongoing monitoring and all the things. I’m going to let Yenny drive the conversation. Thanks.
Lubna Kaur (01:49) Nice to meet you, Yenny and Kelly.
Yenny Zhang (01:52) Nice to meet you. Do you mind if we just do intros at the beginning? So I like understand your roles and everything. Awesome. I’ll start off, I’m Yenny. I’m a product manager on the credentialing team, Kelly. Do you want to go? Hi?
Kelly Chang (02:08) I’m Kelly and I’m a product designer on the credentialing team at medallion.
Lubna Kaur (02:14) My name is Lou. I’m the director of credentialing here at spring health. Let me pass it over to Desiree. Oh, you’re muted?
Yenny Zhang (02:24) Sorry, my name is Desiree. I’m the credentialing manager here at spring. Thanks Sarah.
Sarah-Dina Durand (02:32) Hi, everyone. My name is Sarah and I’m a credentialing specialist. So I just handle the sort of day to day credentialing stuff.
Yenny Zhang (02:42) Okay, cool. So we do have like a great variety of folks who work on credentialing at spring. That’s awesome. So I think your feedback will be really helpful for us during this call. So, yeah, thank you again for taking the time today. We want to do some discovery about ongoing monitoring and we want to let you know that we understand that like our ongoing monitoring product right now is missing some core features for you and your team. And in the past couple of weeks, we finalized our QT roadmap. So we have identified this as a primary focus area for the cred team to work on not just for you but like all ongoing monitoring customers at medallion. So we appreciate that feedback. So the purpose of this session today is just for us to understand what your processes are when it comes to ongoing monitoring alert review process, your priorities, your pain points. And so your input is like gonna be really important for us to figure out what direction we go in. So for today, I was thinking we start off with just some like exploratory discovery questions, and then we do have some concepts and visuals to show you just to get your reactions on. And then at the end, we can talk about like next steps if we wanna have any further discovery meetings. Does that sound good to you all?
Lubna Kaur (04:10) That sounds great. And thank you so much by the way. I don’t know if I said this at the beginning of the call, I know that we’ve been trying to kind of flag this for medallion review for a while and, really excited to be able to meet with you and your team and kind of look at what’s on your roadmap and kind of give us give you our feedback of how we interact with the tool. So really excited to share all of that today. Sweet.
Yenny Zhang (04:35) Yay. We are excited too. Also. I see Rohan just joined. Do you want to introduce yourself really quickly?
Rohun Papa (04:42) Yeah. Hey, everyone. My name is Rohan. I’m a product manager on the credentialing team here. Work very closely with Yenny and Kelly. Nice to meet everyone.
Lubna Kaur (04:50) Nice to meet you.
Collette Waddell (04:52) Awesome.
Yenny Zhang (04:54) Okay. Kelly, do you want to go ahead and get started with some of the discovery questions. Yeah.
Kelly Chang (05:01) Okay. So I think I just kind of want to understand ongoing monitoring kind of as like a whole, just like a high level. So I was just curious like for spring, do you guys have like multiple people kind of managing ongoing monitoring for your providers? Or is it just like one role?
Yenny Zhang (05:22) At this time, it’s just Sarah. Okay, cool.
Kelly Chang (05:27) Awesome. And we were curious how often as of right now, how often do you log into medallion for ongoing monitoring? Like is there anything in the product that helps you with your workflow today? And then also what kind of triggers you to log in if you log in at all?
Sarah-Dina Durand (05:49) Yes, I do log in every day and I mostly check ongoing monitoring. If we get like an email or alert stating there’s something new, yeah.
Kelly Chang (06:08) Gotcha. Cool. And when you log in, do you, can you walk me through like what, you are taking a look at within the medallion platform and you’re welcome to share your screen or just, you know, verbally like kind of walk through the process either way works.
Sarah-Dina Durand (06:25) Yeah. So on a daily, I log in and I check the credentialing tab for credential files… and the analytics tab for ongoing monitoring as well as licenses. I also monitor the license expiration dates and kind of take action items if and when a license expires, I kind of outreach our providers and let me think, I think those tabs are like, the ones that I work out of most.
Kelly Chang (07:03) Gotcha. Okay. Cool. When you go to the credentialing tab, and I know you mentioned you were looking for like new kind of ready files, is there anything related to like the, you know, oig, Sam kind of verifications you’re checking out? Or is that more of like you go to the analytics tab to like look at that?
Sarah-Dina Durand (07:26) So, for new files, if something is… marked as needs attention, I’ll take a look at it just so I can add a note to our medical director to then review any like, you know, action or needs attention alert that comes through there?
Kelly Chang (07:48) Gotcha. And when you say take a look, do you mean like kind of hovering over that like icon that says something or do you like go to the analytics tab to look at the provider?
Sarah-Dina Durand (08:00) So, within the credentialing tab for newly credentialed providers, I do it directly within the credentialing tab, I don’t go into the analytics tab to do that because it’s already right there. And then I’ll hover over the PSV report icon and I click into the credential file and make any notes in there. I.
Yenny Zhang (08:32) See. So you’re talking about just like any primary source verification associated with a new credentialing file, then. Is that correct? Not just the Sam, oig, npdb, medicare opt out?
Sarah-Dina Durand (08:46) Yeah, I check all of that.
Kelly Chang (08:49) Gotcha. Okay. Cool. And then when you mentioned going to the analytics tab, what drives you to go there is that the, is that back to kind of the alert emails you’re getting? And if so, what do you take a look at on that dashboard?
Sarah-Dina Durand (09:08) I’ll be honest. I don’t really, it’s kind of overwhelming. I think I’ve mentioned this before because it’s everything is needs attention. It doesn’t it doesn’t really work well for me. I’d like to kind of like have the option of marking. I’ve reviewed it. And then, so then it’s not necessarily disappearing but I know that I’ve reviewed it, but because everything is just needs attention, it seems like an overload of it’s just a big report but the medicare opt out table, I’ll filter it by verified at and just kind of double check within our internal system to make sure that the provider’s profile has the tag. So I work out of there just kind of checking, the new verified at date if that makes sense?
Kelly Chang (10:04) I see. Okay, cool. Awesome. Yeah, we have a few questions around the like review process. So, yeah, very curious to dig into that. I think before we get there, I wanted to kind of understand how like ongoing monitoring fits into the broader like credentialing workflow. So I guess maybe and you can answer this or like correct the question if it doesn’t really make sense. But I was curious like, so if you’re monitoring a provider that has a credentialing event, you know, scheduled in the future, how would this kind of review impact or it doesn’t impact the like future credentialing event and then vice versa if you just received a credentialing file, like you were saying in the ready tab and you see oig or Sam, like kind of has a flag. Does that also impact the future of the monitoring for the provider? That makes sense?
Sarah-Dina Durand (11:02) It could. So if we get an alert from Sam or oig and then that gets reported to npdb later on. Then I’ll check that but it’s not, it’s… kind of like the same issue being alerted in different sources… kind of if that makes sense.
Kelly Chang (11:29) Yeah. So I guess like if you had received a provider with a ready file, like just credentialed and there is something wrong with their oig or Sam, would you want to continue seeing that alert moving forward or would you like want to take an action on that specific provider and like marking it reviewed or something like that?
Sarah-Dina Durand (11:56) Yeah. I’d prefer checking a box or something saying reviewed and adding notes in there. And then it kind of it’s we still have it in the record but it’s not like marked… as needs attention or I don’t like that. It looks like we haven’t reviewed it because it just says needs attention.
Kelly Chang (12:19) Yeah. Okay. So, so I guess there’s kind of two touch points you’re doing this review process. It’s like during reviewing the like cred files. And then, you know, there’s a subset of verifications that go through ongoing monitoring. And then there’s like this separate kind of situation where you’re alerted, you know, about a sanction that’s found. And you’re also reviewing that. Is that correct?
Sarah-Dina Durand (12:44) Yeah. Okay.
Kelly Chang (12:46) I just want to chime.
Lubna Kaur (12:47) In here really quickly just to piggyback off of what Sarah is saying. So, as she was talking about, you know, when there’s new providers that we’re credentialing, we’re monitoring that within the credentialing module. And, you know, looking at if there’s any files that come up as needing attention. And those ones we, you know, direct to the medical director, let them know like what the issue is. The second part of this is the monthly monitoring piece after the initial credentialing is done. And within the module right now, as Sarah was talking about, it’s very overwhelming to view that module the way that it is right now because everything shows as a flag, everything shows as needs attention. And when we have, you know, 11,012 1,000 providers that’s very, that’s a very sticky situation because, you know, per ncqa, we’re supposed to be able to show that, hey, we reviewed this. We took action based on if it’s like an npdb flag or Sam or ig something like that where, you know, we have to take that information back to our medical director, let him know that something popped up. And then if there’s something that we need to do on the provider end of, you know, disabling them or temporarily pausing them from seeing members, we have to take all of those actions outside of the medallion tool.
Sarah-Dina Durand (13:59) So,
Lubna Kaur (14:01) I think what’s a hindrance is there’s no direct way to alert one our medical director that something has come up for his review.
Lubna Kaur (14:08) And then there’s no way for us to mark off that we’ve reviewed it. So, that way when Sarah’s going month over month and is trying to pull all of these queries, you know, it’s really difficult to figure out what was previously reviewed, what was not. Yeah.
Kelly Chang (14:24) Yeah. And I imagine, you know, if we’re running these checks every month, it’s also confusing to understand like, you know, at what point in the, you know, six month look back, you have reviewed and haven’t reviewed, right?
Lubna Kaur (14:35) Yeah. And if we knew like, hey, this came up like six months ago, and this is the action that we took, we don’t have to review it again because we already knew what the issue was. But if it’s a new issue, obviously we would want to know, right? So, like that distinction of, okay, this was reviewed, this is the note for it. This is what the medical director decided, right? But then if there’s something new like this is something that we have to like re, verify or re, kind of like flag to our medical director, if that makes sense.
Kelly Chang (15:00) Gotcha. And when you’re talking about like the kind of ongoing monitoring piece relevant to the credentialing, is it important to understand? Yeah, like the ongoing monitoring analytics, it’s very poorly thrown together. So, yeah, that’s like something we really want to improve. I’m just curious like when looking at this, like let’s say like 10,000 lists of providers? Is it important to understand their, like when they were credentialed at all? Like that kind of relationship, yeah, in the ongoing monitoring process? Yeah.
Lubna Kaur (15:34) I think that would be helpful because again, if there’s like an mpdb alert on their license that was present at the time of their credentialing, and we reviewed it, decided that we were going to continue credentialing and improving that provider, you know, that would be helpful to see in the monitoring module itself.
Kelly Chang (15:50) Yeah. Gotcha. Okay. Cool. Awesome. Yenny. I think maybe I’ll pass it to you to get deeper into like the kind of review process as we’re talking about?
Yenny Zhang (16:01) Yeah, thank you, Kelly. All this information is super helpful. I know you mentioned that the medical director is kind of like the, you know, someone who comes and does a final review. Is that sort of your process for reviewing flagged sanctions? It’s like someone a credentialing specialist, maybe reviews something and then needs to take note of it and then passes it on to the medical director.
Lubna Kaur (16:27) Yeah. Just because he’s the final authority on deciding whether that provider stays with spring and is able to see members or if we need to halt care, got it.
Yenny Zhang (16:37) Whatever.
Lubna Kaur (16:38) Issue has popped up is resolved or if it’s not going to get resolved, then kind of making a decision on whether or not we’re going to continue with that provider.
Yenny Zhang (16:46) I see. And then, do you have a standard process for reviewing flagged sanctions? Does it vary by type of alert like Sam, oig, npdb, medicare opt out, and then, I guess, are there different categories of review outcome that you would apply to a flagged sanction? Can you walk me through that process?
Lubna Kaur (17:12) Sarah does, do you want to chime in on this one?
Sarah-Dina Durand (17:18) So all sanctions and PDB are kind of looked at in the same way because they’re… kind of just like bigger issues versus like just a medicare opt out, which we don’t need to off board or like suspend a provider for that reason. So, and PDB alerts, I, once I receive them, I send them over to our medical director for review. Then outside of medallion, I’ll write down kind of like a summary of their action and the… provider’s status after reviewing that action, and know whether the provider needs to be presented to our full committee and all of this is being done outside of medallion in a Google sheet.
Yenny Zhang (18:22) Ah, I see. And then when you say like if a provider does need to be presented to a committee, is that separate from the credentialing committee process? Is there like another peer review body that reviews that… sanctions? So.
Lubna Kaur (18:39) Generally, they’re presented to the committee, but we also have a quality of care team that kind of reviews, you know, things that happen that are more so like member complaints. So there’s two kind of variations of that committee. But most of these issues that are, you know, sanction based or had ptb alerts or things like that would go to the medical director, he would make that decision. And then if, you know, if it’s a more, if it’s like a reason that requires a little bit more debate, then it would go to the committee where the voting members would kind of vote on what they want to do.
Yenny Zhang (19:12) Ah, and you, when you say committee, you mean like.
Lubna Kaur (19:15) Credentialing committee? I thought, yeah.
Collette Waddell (19:17) I was gonna just chime in just to ask a clarifying question. Lou, it sounds like if the provider has, is going through credentialing that’s when it would then land on like a committee agenda for review versus, and I don’t know, Yenny, if you were asking like if it’s like a, there’s no open credentialing application in process for that provider, but it’s like a flag that comes up in between like their credentialing cycles. Is that then also presented to your committee in that same fashion or is that managed it?
Lubna Kaur (19:53) Goes to the medical director first and then he’ll do his review. He’ll reach out to the provider to figure out, you know, what their side of the story is. And if it’s like a smaller level complaint, like it’s a DUI or something like he might make that kind of decision on his own. But if it’s something that is either confusing or requires a little bit more decision making or just debate, then that would go to the committee. And then he would present that information to the committee. And then they would vote.
Yenny Zhang (20:21) I see, I guess to Healthstream Colette’s question. So, like if the provider’s like in between recred cycles and they’re not due for recred in like two years. Would that process still happen where it goes to your cred committee or is there another separate?
Lubna Kaur (20:41) We’re trying to make it happen because it’s a part of our ncqa requirement. So, when it comes to like complaints or adverse events or things like that, they do need to go to committee. So, it just depends on the flag. Really, if it’s like medicare opt out, is it going to go to committee? No, but if it’s like, you know, some sort of legal case or something like, that would go to committee.
Yenny Zhang (21:04) Yeah, that makes sense. Sarah, I know you mentioned you have a Google sheet that you work out of to do all of this op platform work. Is it possible for us to take a look at that or for you to share a version of that with us after the call?
Sarah-Dina Durand (21:24) Yeah. I don’t know if we’re like allowed or able to show data so I can take the data out. Yeah, yeah.
Yenny Zhang (21:34) Yeah.
Lubna Kaur (21:36) Or something?
Collette Waddell (21:37) Yeah, like an example, like a fake, you know?
Sarah-Dina Durand (21:41) Doctor, of course. Yeah.
Lubna Kaur (21:42) Yeah.
Yenny Zhang (21:46) Nice. Yay. Is, so, I know there’s like a flood of alerts not just in the dashboard but in emails too. Sarah, are you sifting through every single email that comes in? I know they’re really duplicative because we’re monitoring every month, like we’ll send the same email every month. Yeah, I guess what’s your workflow right now for sifting through all of those alerts?
Sarah-Dina Durand (22:14) Yeah, I just look through them as they come like kind of individually. And again, it’s just, it’s kind of unclear to note what was already reviewed versus like something that is entirely new.
Yenny Zhang (22:30) Yeah. Understood. It’s really difficult. Is there a timeframe in which you need to review flag sanction alerts by? Is there like an SLA that you need to apply to internally?
Sarah-Dina Durand (22:45) Yes, I don’t have the dates off the top of my head, but… I know once we receive a review, we kind of have to take action on it within the like day or so. And then once like the medical director reviews it, we kind of have to… alert or communicate with the provider within a week, I believe, but I don’t quote me on those dates, I can give you the actual dates in my follow up email, okay? But it’s kind of quick like turnaround for sure.
Yenny Zhang (23:25) Yeah, yeah. I understand these things are important to action on quickly. And then what does done look like for reviewing of flag sanction? Is it, I know, I understand like there’s you’ll review something, send it to the medical director, the medical director will do something, is some, is like this whole process considered done after the medical director has taken whatever step, like medical director does their sign off. And then, yeah, yeah.
Lubna Kaur (23:54) Because he’s the final decision maker. So once he’s decided on something or the committee votes on something, then that would be considered done.
Yenny Zhang (24:02) Got it. Cool. So just to repeat back, you do the sanction alert process. Someone, a specialist has to review all the alerts that come in. Those get sent to the medical director, the medical actually, sorry, where is the committee process in between? Like the specialist and the medical director? Is it after the?
Lubna Kaur (24:26) Medical, the medical director is the chair of the committee. So, oh, okay. Yeah. The same thing. Yeah, I see during initial credentialing during re, credentialing or whenever there’s an alert that, you know, requires a decision on his end?
Yenny Zhang (24:43) Got it. And so I guess with your current committee process, are you sort of like bringing in that off platform information as an addendum to like the credentialing file that we produced today? So you’re like looking at the cred file whilst also looking at the off platform information of your review in order to make a decision on, you know, what to do with the provider? Yes. Yeah.
Desiree Maravilla (25:11) The provider, will, the medical director will sometimes outreach to the provider and they’ll get more information from there. So outside of medallion, okay?
Yenny Zhang (25:19) So, it’s like the cred file and then like the review data and then any like provider correspondence that happens.
Yenny Zhang (25:27) Awesome. Okay. That was all really helpful information. Now, I’d like to shift gears just to understand like the compliance requirements and audit readiness that is important for this flow. So, I understand there’s an ncqa policy there’s like a whole section on ongoing monitoring. When you get audited or if there’s like a payer audit or an ncqa audit, what are you showing them today to like prove compliance according to that? The ongoing monitoring part of ncqa? We.
Lubna Kaur (26:09) Show them our monitoring logs that are pulled directly from medallion, but they too ask the same question of how can we tell who reviewed it? And when?
Yenny Zhang (26:19) I see. And then I guess for the like, who reviewed it and when are they just asking for like we want to see the special that the specialist reviewed it or are they looking to see like I want to see specialist and medical director and the action taken? So.
Lubna Kaur (26:35) They generally want to see a specialist review it and then whatever the decision is that would be presented if they’re asking for like evidence of complaints and adverse events. So it really depends on again the complaint type or the flag type. But, yeah, I.
Yenny Zhang (26:55) see. So it sounds like you’ve had like audits like this in the past and yeah, this has just like come up, got.
Lubna Kaur (27:02) It, we try to like finagle our way out of it and just say like, hey, we have like a separate, you know, quality of care protocol and, you know, this happens outside of platform. But yeah, like majority of our auditors ask where they can see where someone has reviewed that particular complaint type.
Yenny Zhang (27:21) Right, right. Do you have any payor contracts or anything outside of like an ncqa specific audit where this comes up?
Lubna Kaur (27:33) So, ncqa governs, like all credentialing contracts, right? So any payor contract that we have for delegated credentialing will have the same language that ncqa has about ongoing monitoring and the needs for that and how often it should be reviewed and what should be reviewed kind of thing. Got.
Yenny Zhang (27:52) It, yeah, that makes sense. So, okay, it sounds like the, like, I understand there’s a part of that ongoing monitoring policy that talks about needing to like bring findings of a flag to some peer review body. So just to reiterate that’s like the credit committee for your team. Okay. And then how often do you get audited and need to like produce these reports?
Lubna Kaur (28:23) Once a year with each payer, and it depends on when the contract was signed. So that’s when the timeline kind of begins.
Yenny Zhang (28:32) Super helpful to take a step back to the beginning of the conversation. So, I know we have our ongoing monitoring dashboard that houses our oig, Sam, medicare opt out and PDB, your team also mentioned license expiration monitoring. So, how… are let’s see what is the type of review or action you take for license expiration monitoring versus like Sam oig, those are more serious sanctions. Yeah, just curious to hear about that process.
Lubna Kaur (29:13) So, we have some comms set up internally on the medallion end where providers are outreached, you know, X number of times to let them know that their license is expiring and they need to review it so that’s kind of like a separate automated workflow. And then once the license has either, you know, lapsed or, you know, they still have not responded at that point, we would review that and block them from seeing members until the license has been renewed.
Yenny Zhang (29:42) I see. So you already have like a pretty clear workflow like action that needs to be taken. It’s just.
Lubna Kaur (29:48) like, yeah, but I think like in the ongoing monitoring dashboard, there’s no information for the licenses. I think Sarah looks at the licensing part of the analytics dashboard. Yeah, yes.
Sarah-Dina Durand (30:03) Yes. And I think I had, I think it would be beneficial to have some sort of like right now. I’m just kind of like writing in the notes section saying I have outreach for renewal once the license shows expired, but that’s not being done within the monitoring dashboard that’s being done in the licenses tab. And.
Lubna Kaur (30:35) the license usually does have to be a part of monthly monitoring. But I think what medallion does is goes by the nptp, but correct me if I’m wrong.
Yenny Zhang (30:47) Yeah. We do. Yeah. So npdb reports on a lot of different things that’s why, like you said, Sarah, like information about Sam oig, will sometimes be in the npdb report. We do use npdb for our license sanction monitoring. And then we have separately like license expiration monitoring which is in that separate dashboard. So I understand there’s a lot of like information that’s in different places and.
Lubna Kaur (31:09) Then one thing to note, this might be a slight deviation from our current conversation, but it was discovered recently actually that medallion doesn’t report if there’s anything outside of just active or what was it? Des? Was it active inactive? And then pending, I think pending. Yeah. So there was there’s instances sometimes when licenses are actually shown like active, but they’re actually not. And this came up because there was a provider in Florida who was approved with a expired license, but they were showing it’s active on the platform end. So that’s one other thing that’s kind of a big area of concern for us because, you know, with license monitoring, we do have to report if there’s any issues with that. But currently within the medallion system, there’s only those three options.
Desiree Maravilla (32:02) It’s only like the, it’s a really big problem. And I am very concerned of how many providers might be showing as active in our member facing system due to this system you guys have going on where it’s only monitoring the expiration date. So, if a provider’s license is suspended, but the expiration date was in the future, it’s going to show as active. And.
Yenny Zhang (32:26) that’s incorrect.
Desiree Maravilla (32:28) Yeah. And so this instance is we only knew about this was because a provider themselves brought it up to us and said, why is this showing as active when my license isn’t active? So that’s a, really big problem. Yeah.
Lubna Kaur (32:44) Yeah. The monitoring module, if that also can be kind of looked at to determine if there’s ways for us to see if there’s licenses that are either suspended or I don’t know on hold or, you know, not just those three categories of active and pending.
Yenny Zhang (33:03) Yeah, I understand. That’s a big issue, right? If we’re saying something that’s like valid and it’s actually not. Yeah. Well, I, yeah, I think our active and active, yeah, is just based off of like expiration date, which isn’t you know, a true reflection of the provider’s ability to practice. So.
Desiree Maravilla (33:21) A legal concern at this point, right? Like having a provider show as active and if they’re technically not active, if there’s a.
Lubna Kaur (33:31) Because what was it on the, on that particular provider license active? Slash?
Sarah-Dina Durand (33:35) Clear. Yeah, yeah, it.
Desiree Maravilla (33:37) Was inactive. So the provider’s license on the state board is showing as inactive slash clear. But the expiration date is for the future. And so medallion’s verification came up as active. Yeah.
Lubna Kaur (33:55) So that’s like a, you know, a care delivery quality of care concern.
Desiree Maravilla (34:00) Yeah.
Yenny Zhang (34:01) I understand there’s a lot of downstream implications to that. If you’re not, you know, I’m.
Collette Waddell (34:07) not sure if you saw right after our call, I flagged this to the team again. And then I, ironically enough, the head of our licensing team had just submitted internal product feedback and using that Florida one as an example. It was like she was reading our mind or like it was almost like she was listening to our conversation before I even got off. It was already submitted. So, so, yeah, we just flagged that internally.
Lubna Kaur (34:40) Yeah, we just, we only bring it up because it’s part of the whole monitoring, you know, workflow.
Yenny Zhang (34:45) Yeah, yeah. And thank you for raising that. Okay. One other question I had before we move on. It sounds like you’re using notes a lot to document some things. Where, I guess where, which notes are you using in the medallion platform? Notes can be left on in a lot of different places. So, yeah, just curious where you’re storing information right now in the platform?
Sarah-Dina Durand (35:16) So I’m only doing that per licenses. So within the licenses tab… if I go into existing licenses and I’m reviewing expiration dates within a time frame. So like for the end of the month, for example, I’ll add notes within the notes section on that page saying I’ve outreached a provider for renewal and, or license expired. I’ve removed it from our internal system, things like that, but I’m also doing like keeping track of my actions on a separate Google sheet again because it’s not really a way to like show what actions I’ve taken outside of just writing the note. Yeah… yeah.
Lubna Kaur (36:10) So, I think from a product perspective, it would be helpful to see the note tied to the provider’s like license or the provider’s profile. And it would be even more helpful if we can like tag our medical director and he can address that note or add his own. That way the information stays within the platform and it’s you know, reportable and we can pull information based on like, you know, whenever audits show up that we’ve reviewed these things.
Yenny Zhang (36:38) Yeah. And to.
Sarah-Dina Durand (36:39) add to that, I think it would be better from a user experience standpoint to have like a totally separate report for expired licenses versus like that one big report that I just then I have to kind of filter out by dates. So like, if we had a report, I think we do under the monitoring for like expiring and then, but there’s not one for expired. So I think it would be beneficial to kind of have like a completely like separate reporting for that for just expired licenses versus like having to filter out of the big.
Lubna Kaur (37:29) Yeah… yeah. Because right now, in the licensing analytics tab, it just showed, you know, upcoming expirations, but there’s nowhere that we can find some, you know, stuff that’s already expired.
Yenny Zhang (37:47) Okay. This is hopefully information. Yeah. I, so… with monitoring general it’s like licenses and the Sam, oig, et cetera. It’d be nice if that were all like together for all of your review processes. Okay. I would like to move on to the visual that we’ve come up with just to do some, get your reactions… Kelly, do you mind if I hand off to you now?
Kelly Chang (38:19) Yeah. I think before we show that, I kind of wanted to just understand like the broad mental model of how we’re thinking about like ongoing monitoring and how it relates to the provider. So I guess just to summarize like would it makes sense to kind of because I know you guys had mentioned like the ongoing monitoring tab is very overwhelming because everything is like kind of needs attention. I wanted to just like dig a little bit there and understanding like, so would it make sense to kind of show all of the verifications like tied at the provider level, just like, would that make sense first question? Are you?
Lubna Kaur (39:01) Saying instead of it being separated out into the different tables that it is right now? Yeah?
Kelly Chang (39:07) Like, kind of just like high level. Like all of this is like makes most sense to group at like the provider level. Is that correct? Yeah. Okay. Cool. And then when we talk about like kind of having something reviewed like because I know you guys are managing, you know, a lot of volume of providers. So just kind of want to understand like, would it make sense to kind of have like a separate bucket of like providers that have been like reviewed and curious also how the review fits into like the medical director review because there’s like your guys’ review. And then there’s the medical director review, right? So, like, how would that also be split? Yeah. So.
Lubna Kaur (39:50) Our review then goes to the medical director. If there’s something for us to flag to him. So like if it’s a medicare opt out where like we have a separate workflow for that, but that’s not necessarily something the medical director has to make a decision on. But if it’s like an npdb flag or Sam or ag that, you know, once we review it, then we would flag it to the medical director. So if that’s what I was saying is like if there’s a notes section where we can either like tag him or assign something to him, assignments would be helpful too to just, you know, in case there’s someone that’s outside of Sara who’s going to be monitoring or something like that. Yeah. But yeah, seeing it per provider with all of the sanctions or sorry, all of the monitoring that’s available for that provider in one place would be a good place to start with. And then having an area where it shows what’s previously been reviewed and things that are new that have not been reviewed. And when we say previously reviewed like some sort of functionality where either we can like bulk update what we’ve reviewed or add notes or some sort of like checkbox, something like that.
Kelly Chang (41:00) Yeah. And when we say reviewed it’s like because we run these checks, you know, monthly it’s just like, you know, maybe a like sanction comes up, right? And you’ve reviewed it. But I mean we’re still going to run that check. Yeah. And so it’s just a matter of like flagging that you’ve like done an action to it, right? Correct? And then would it be helpful to also show like a group of providers that’s been sent to like the medical director somehow or like just to kind of track?
Lubna Kaur (41:31) Yeah, that would be super helpful because we can just pull that directly and then share it for audits. Then instead of having to create our own, you know, separate kind of spreadsheet that we’re managing in Google sheets right now, cool.
Kelly Chang (41:44) Awesome. Okay. Yeah, I just kind of wanted to like understand the general like higher level, but, yeah, kind of speaking to let me share my screen. Yeah. Can you guys see this? Yep? Yeah. So our team just like I mean, obviously, we wanted to focus this call just around like your pain points and we will edit, you know, and kind of build product around that. But this was just like a preliminary idea that we had. So obviously, this dashboard only shows like, you know, five providers. So we understand the volume would be much higher but kind of just to like confirm. It sounds like it makes sense to kind of group, you know, the provider and then have the specific like verifications that we’re showing tied to the provider. So that’s kind of just like this concept. And up here, we just like we’re exploring some different ways to show like because we’re managing, you know, multiple like thousands of providers. Yeah. Is there any sort of like,
Lubna Kaur (42:54) data?
Kelly Chang (42:55) That, that would be helpful to kind of show a top level kind of what we have here. Like it says alerts this month or, you know, review, not review just like any ideas on what would be helpful? Yeah.
Lubna Kaur (43:05) I think that would be super helpful to show like total alerts for the month, what’s been reviewed, what still needs a review?
Kelly Chang (43:11) Okay. Cool. Yeah. So this is, it’s just like a prototype that we had put together. And so the kind of concept here is when you click into this, you know, you kind of get to dig into like the specific like verifications. So this shows like, you know, oigc and medicareopt, mpdb and these like show the like specific verifications checks that we’ve done. Do you think it would be helpful to show like in detail? Like if you just look at this chart here, you can ignore the top section, like checks that we have ran to, you know, like five months. Yeah.
Lubna Kaur (43:49) Totally. That’s great. Actually. Okay.
Kelly Chang (43:52) Awesome. And then here is just this concept of showing like for oig, we found a new flag. So, yeah, I think the like kind of pain point we’ve talked about is like being able to distinguish between like a non reviewed flag, right? And a reviewed flag. Yeah. So, yeah, I think we need to build, you know, the system in a way that, that’s like obvious. And so, yeah, I’m not sure this is the best solution here, but the idea is like you could see there’s like a new flag. And then we were just playing around with like a reviews flow. So here, you know, maybe you click into the mark review flow and then you select like a decision… here. Remember if we already asked this, but when we’re reviewing, is there like a specific or like, are there like categories of things that we would want to mark this review process as, or just like a top level, like review is kind of good to go. Because here, we just have like, you know, escalate to committee, but maybe that’s like medical director. I don’t know if there’s like corrective action that, you know, specific things I think.
Lubna Kaur (45:04) That makes sense. Sarah, des, do you have?
Sarah-Dina Durand (45:07) Yeah. I think we would want to show the end result. So like reviewed approved to stay on something like that or reviewed provider, suspended or off boarded something like that. So we know action was taken. We reviewed it. This was the end result.
Yenny Zhang (45:27) How is, so, I just want to clarify like this, is this reviewed, obviously, this is like a mock that we came up with really quickly. Yeah… from how you all were describing your process, it sounds like there is like a two step kind of like decision tree. So it’s like someone a specialist comes and reviews something. And then like the medical director makes that final action… for the intermediary step where a specialist is reviewing something. Yeah. Do you like you, Sarah, would you need to categorize your review here?
Sarah-Dina Durand (46:03) Yeah. So to have like reviewed pending committee decision and something like that would be helpful? Yeah.
Yenny Zhang (46:12) Okay. And.
Kelly Chang (46:13) then like the committee people or the medical director would then like change it to the final. Would that workflow make sense? I.
Lubna Kaur (46:24) Think so or like if Sarah has the authority to come back and change it based on what the medical director?
Kelly Chang (46:29) Yeah, that’s right? Okay. Yeah. Okay. Makes sense. We.
Sarah-Dina Durand (46:32) also.
Kelly Chang (46:34) Where.
Desiree Maravilla (46:34) it kind of keeps timestamps of the status changes. So like when it was changed to like in review or something, we have the timestamp of when that was selected. And then I don’t know committee approved. You know what I mean? Like, can we, is there a way to have that included where the timestamps are?
Kelly Chang (46:57) Yeah. I kind of see like a history of the like statuses. Yeah. Is there a case where you’ve gone through a review of a provider? And then you would need to like unreview it basically or like be?
Sarah-Dina Durand (47:09) Oh, yes. Oh yeah. Sometimes we do have like an appeal process. So, if like a committee decided on something but the provider has the rights to appeal that decision, which we have to get done. I think within 30 days, they have 30 days from the date we decided on their file to kind of appeal that decision. Does that make sense? Yeah.
Kelly Chang (47:36) And if, in that case, what, how would that, because like I know we’re talking about like, you know, grouping these providers into this like reviewed kind of bucket.
Collette Waddell (47:47) Would you want.
Kelly Chang (47:48) them to be moved out of the review bucket or it’s more of just like changing the status of like their outcome essentially?
Desiree Maravilla (47:56) Changing the status, I would say, okay.
Yenny Zhang (47:58) So, yeah, I guess to that appeal process, for instance, like would that come up in the medical director part of the review? Like the medical director, like emails a provider and the provider like appeals. And then maybe the final outcome like the resolution is that like there was an appeal and then we display their understanding correctly? I.
Collette Waddell (48:21) Think.
Kelly Chang (48:23) Let me.
Collette Waddell (48:24) Just jump in. I mean, it sounds like really if they could kind of move through, the workflow, right? And then mark it resolved because they think it’s resolved, right? And then, but then the provider has, you know, maybe there’s still that window where the provider then decides to appeal. So, I mean, and the, to the spring health team, please correct me if I’m kind of off track here, but I’m thinking you really just need a way to go in and edit like a formally resolved one to maybe update that, it was like to change the final outcome. Yeah.
Lubna Kaur (49:01) I think that would make sense. Yeah, because if a provider appeals and then we reverse the decision based on the appeal, the ability to go back and change the status while still having that like audit history of the user, you know, the user history with the timestamps that des was alluding to. I think that would be helpful.
Kelly Chang (49:23) So,
Collette Waddell (49:23) essentially not make it to where once you like have resolved an item, a review that you think is resolved but not lock you like prevent you from making a future edit to that decision. If something else came to light, right? That was really good too. Yeah.
Kelly Chang (49:41) That’s what.
Collette Waddell (49:43) I was thinking when you guys were talking about that. Yeah.
Kelly Chang (49:45) I think that makes sense. I think maybe like the other kind of piece I’m trying to understand better is like the difference between having a provider been reviewed and how we then kind of display the like sanction found past that review point. So obviously, like we’ll you know, we’ll continue running these checks for these providers, but there’s this concept of like when do we alert you of the sanction found? So right here, there’s this kind of like suppress email notification concept. So I’m curious like when you’re going this review point, how does that process? How does that play into like wanting to be alerted about that sanction being found?
Desiree Maravilla (50:31) Well, if it’s something that’s popped up and it was reviewed, it shouldn’t pop up again, right? If there’s no change to it, if there’s a change to the sanction or if there’s additional information like say npdb… if there’s a way that there’s any type of change to anything that’s you know, in the sanction or npdb or anything, then can we get flagged again? But if there’s absolutely no change, then we would like for it to just stay as reviewed from the last time that we reviewed.
Kelly Chang (51:02) It, and you wouldn’t yeah. And I would assume you don’t want like email notifications as well on it?
Lubna Kaur (51:10) Yeah. Once it’s been reviewed, right? Yeah.
Kelly Chang (51:13) Yeah. Okay. Makes sense. Yeah, I think then it makes sense to kind of like bucket that into like one workflow. So that’s really helpful. Cool. Yeah, I think this has answered a lot of the questions that we’ve been looking for at least with this prototype, Yenny, do you have anything else?
Yenny Zhang (51:34) Yeah. I just wanted to make a distinction in this prototype between like the reviewed and resolved here. I think the reviewed and resolved is kind of similar speaking directly to your workflow of like having a medical director come in and make the like final mark the final outcome.
Lubna Kaur (51:52) So.
Yenny Zhang (51:52) Yeah, I just wanted to call out that in this prototype. But yeah, I think what’s missing from here that we talked about was license monitoring specifically and license expiration monitoring. So, yeah, yeah. Sorry for not including it.
Kelly Chang (52:12) I.
Yenny Zhang (52:12) know.
Kelly Chang (52:13) The prototype looks.
Lubna Kaur (52:14) Promising, I will say that. So, thank you so much for showing that to us. Excited to see how this plays out and looks once it’s complete.
Yenny Zhang (52:23) Yeah, me too. I.
Kelly Chang (52:24) Think once we start like, you know, we’ll take back all of the feedback and probably put together a more like directed prototype and like would love to walk you through that with like actual, yeah, like direction of like what we’ll plan to build. So, yeah.
Lubna Kaur (52:43) And if you need any like piloting help, we’re more than happy to volunteer.
Sarah-Dina Durand (52:48) Wait.
Yenny Zhang (52:49) There’s one. Sorry, I was gonna.
Sarah-Dina Durand (52:53) Say, I have just one question between, I understand this prototype or dashboard is like ongoing monitoring, but what about when a flag comes on during initial credentialing? Would this be handled in this same page or would that be handled elsewhere? Like under the tab? It’s a.
Kelly Chang (53:17) Great question. I actually, I’m curious what you, how you would want that to be handled? Like, does it make sense to have the, this kind of review workflow live in the kind of credentialing like cred file like in your ideal world? Like in that kind of credentialing space or do you think it kind of makes more sense to show the credentialing date here? Like flag gets a new credential or whatever, and have it like a separate kind of dashboard to work out of?
Sarah-Dina Durand (53:54) I’m thinking, sorry, no.
Kelly Chang (53:56) No, no, you’re good.
Collette Waddell (53:59) And I’m speaking for spring only just as if I were sitting in your shoes. So I would imagine Sarah, it would be helpful because as you’re going in, looking at those credentialing files that our team has just processed and handed to you all in that ready queue, some way to log this review workflow simultaneously, right? Like, yeah, like not having to like toggle in multiple places to.
Sarah-Dina Durand (54:32) I guess maybe just having that.
Lubna Kaur (54:36) Option within the credentialing module to mark it as reviewed. And then it shows up in this ongoing monitoring log.
Kelly Chang (54:45) Yeah.
Sarah-Dina Durand (54:46) Yeah, I think what?
Lubna Kaur (54:48) Makes most sense. That way, it stays in the monitoring log, but we don’t have to like, you know, do double work by doing it in credentialing module and monitoring module. Yeah.
Sarah-Dina Durand (54:59) Yeah.
Lubna Kaur (55:00) Gotcha. Makes.
Kelly Chang (55:01) Sense. Yeah, because it’s all kind of like connected. So kind of what I was maybe asking early on, there’s like two touch points, right? Of when this review would happen. It’s like the receiving the cred files, reviewing those sanctions and then past the credentialing event where we’re just like ongoing monitoring these providers. It’s like the other kind of instance, when, okay.
Lubna Kaur (55:24) And then re cred would be the third one. Whenever that comes up in the three years past the cred date.
Kelly Chang (55:31) Gotcha. Okay. Yeah. What’s interesting is also like because we, in the current medallion dashboard, we have like the committee tab and then the closed tab. So, I mean, in the closed tab, there’s also the approval like outcome tab. So when we talk about the outcome of this, like, you know, the medical director reviewing that, are those the same outcomes ultimately? Or it would be like different?
Sarah-Dina Durand (56:02) Yes, I think what is not captured currently in the credentialing tab is when I send a class two file as needs review. Because so then that tells us it’s not a clean file. There’s an action there’s. Something, right? Yeah, I send it to committee, but then it just kind of sits there if the provider that needs to go see the full committee and they have to vote on the file. Does that make sense? And that only happens like we have the like larger meeting on a monthly basis. So like let’s say the provider would need to go to the full committee to be voted on to.
Yenny Zhang (56:47) Be discussed?
Sarah-Dina Durand (56:47) And voted on and that, you know, we credentialed at the beginning of the month, but the meeting isn’t until the end of the month, that would just kind of sit there under the committee tab, but,
Yenny Zhang (57:00) like, so.
Sarah-Dina Durand (57:06) I forgot what your question was? No, yeah.
Kelly Chang (57:09) Yeah. So in the case where you’re saying it’s sitting there like what, sorry, what was the kind of pain point there of like how would you resolve that?
Sarah-Dina Durand (57:17) So, when we’re when we send it over to our committee or medical director for review and it’s saying class two file, which?
Yenny Zhang (57:29) You know.
Sarah-Dina Durand (57:30) Tells us there’s an action if it can then be shown… here. Like kind of what is happening, you know, how we said, like reviewed or pending committee decisions, something like that?
Yenny Zhang (57:43) I see. Okay.
Kelly Chang (57:45) Yeah. So the, yeah, because my original question was understanding how the outcomes of this ongoing monitoring review is connected to the credentialing review and like approval process. And so, yeah, I guess what we’re you know, summarizing is like we want to better connect like all of these workflows and kind of tie maybe the outcomes better.
Sarah-Dina Durand (58:12) Yeah, got it.
Yenny Zhang (58:14) I have a question about that. So, like in the committee process, a cred file has already been generated. So you could imagine that maybe we like a provider has flagged, oig, someone reviewed it before.
Kelly Chang (58:32) The cred?
Yenny Zhang (58:33) File was generated, but the final resolution from the medical director obviously hasn’t happened until committee. Is it just important to show that like maybe in the cred file, someone reviewed it, and then the resolution itself doesn’t need to be in the cred file because it’s happening during the committee process… or I guess what? Yeah, I guess what would be important to show in the credentialing file itself?
Sarah-Dina Durand (59:04) I think it would be beneficial to show that like why, the file is just sitting there and within the credentialing tab… because right now, it’s just like, you know, if another team’s kind of looking at, to see if, you know, where the provider is… in the process of getting credentialed. There’s no clear it’s just kind of like sitting there so they can assume they’re probably waiting for xyz, but there’s no clear weight of kind of showing that right now. So just say, you know, it’s pending within the cred tab. Got it. Okay.
Yenny Zhang (59:54) So, I know we’re at time. I want to thank you all so much for providing all this really valuable feedback and information to our team. It sounds like you’d be open to future sessions while we continue development on this. Is that correct? Yeah.
Lubna Kaur (60:12) Absolutely.
Yenny Zhang (60:14) Amazing. Okay. We’ll take all this information back and, you know, start working on this and, yeah, I think we’ll just work with Colette to schedule any future meetings. So we can iterate on this. Yeah.
Lubna Kaur (60:28) And then whenever you guys do plan to release, just like some sort of timeline or product roadmap would be helpful to see.
Yenny Zhang (60:36) Definitely. And.
Collette Waddell (60:38) I know, you know, we asked an hour of your time. Thank you for the hour of your time today, because I know that this was a lot, but I think it was really interesting. So, appreciate it. And Yenny and Kelly, I mean, that mock up was actually really cool. So.
Lubna Kaur (60:50) Yeah.
Collette Waddell (60:51) Excited to see where this goes.
Sarah-Dina Durand (60:54) Thank.
Yenny Zhang (60:54) you guys so much. Yeah.
Kelly Chang (60:56) Thank you so much have.
Yenny Zhang (60:58) A good afternoon. Bye bye.