Transcript
Antoinette Flores (00:00) hello? Hey, good afternoon.
Cliff Marg (00:02) Good afternoon. How’s your day going so far?
Antoinette Flores (00:04) Good. How about yours?
Cliff Marg (00:06) Yeah, not too bad. I’m actually, I’m in Phoenix, Arizona, visiting my parents. Oh, nice. This is normally the nice time of year and it was like 103 yesterday.
Antoinette Flores (00:18) Oh, wow. Humid.
Cliff Marg (00:21) It’s definitely like a very dry heat in the desert, but 103 is like not, it’s certainly not pleasant when it’s humid. It’s still not pleasant when it’s dry.
JAHI006 (00:32) It’s certainly not in what the middle of March.
Cliff Marg (00:36) Yeah, that’s exactly. Yeah, this is usually like prime like golf season and I don’t think there’s too many golfers out in 103 degrees.
JAHI006 (00:46) So, where is home for you? Ordinarily?
Cliff Marg (00:49) I’m usually in southern California.
JAHI006 (00:51) Oh, okay.
Cliff Marg (00:52) Very nice. So not too far, not too far. That’s great. Yeah, nice to meet you both looking forward to kind of chatting a little bit more. I know you spoke with Alex. I believe it was last week.
Cliff Marg (01:03) I have, I listened to that conversation. I’ve got, you know, some good content for today. Yeah, my goal really is, I’ve got a few follow up questions, just trying to understand kind of current state and then really what you guys are trying to solve for can share a little bit more about that. And then, you know, I’d obviously love to share a little bit more about medallion, explain how we’re working with some similar fqhcs. We also work with, some primary care associations that support, you know, statewide fqhcs. So very familiar and ultimately just trying to get to a, an understanding of, you know, if there’s something we can help with or not. So that’s kind of the goal is just aligning, on mutual fit. Does that sound all right? I guess I’ll put it to both of you in terms of anything that you’re hoping to cover today specifically? Well?
Antoinette Flores (01:51) I’m just really looking to hear about, what kind of features you guys have to help streamline our processes with credentialing and payer enrollment. Right now we are, can you hear me? Okay? Yep. Okay. Yeah. So right now, we’re really pretty much using spreadsheets to manage our data and looking to streamline and move away from that. So anything you can tell me that might be helpful for us to help decide whether or not this might be a good fit.
Cliff Marg (02:20) Definitely. And Antoinette, what is your role specifically?
Antoinette Flores (02:23) Well, I’m just a credentialer?
Cliff Marg (02:26) Okay. She.
JAHI006 (02:27) Is our credentialing team? I mean, let’s be honest. Yeah. So really the way I look at it, and again, I’m like I have no skin in the game specifically other than that, you know, like I manage our payer contracts. Yeah. And I know how integral making sure that credentialing and enrollment activities are done is to making sure that we get paid for the services that we provide, but, you know, I think it’s one of those things where it’s like, you know, I don’t we’re facing, you know, like real constrictions on our funding. So, I think it’s like, how can we make sure that our mighty team of one can really, truly be as mighty as possible?
Cliff Marg (03:16) Yes, absolutely. Are you guys sitting right behind each other? Yeah, we share an office. I like it caught out of the corner. I saw James on the computer behind him. I was like, oh,
Antoinette Flores (03:26) I see. Okay.
Cliff Marg (03:28) No, I think, that makes a lot of sense. And so, and so, yeah, it sounds like today, you know, processes manual spreadsheets really Antoinette. If you, if you get sick or something, I don’t know if the show, if the show goes on or not. The other thing that, yeah, that kind of caught my attention from your last call was just in terms of like scale. I understand you guys went from, you know, a couple few 12 practitioners to, you know, 100 plus. And I think you mentioned James like going to see that increase pretty significantly. I guess, what do you forecast on that front? And I guess what is the result? Like, what is that growth coming from specifically?
JAHI006 (04:08) This is what I want you to almost not record the conversation because we don’t really have, sort of, yeah, that would be good.
Cliff Marg (06:06) Like what’s the relation between northpoint, and kind of the fqhc?
JAHI006 (06:10) Northpoint is the fqhc. So, like, any other sites that we would bring on, would they would get, set up in a way so that they are, also, fqhc?
Cliff Marg (06:24) Understood understood. Okay, that’s super helpful. Okay. And then with that obviously comes, will you have to re, will you have to re, enroll those providers under your tax id, or no? It’s just new providers that maybe come onto those primary care?
JAHI006 (06:43) Well, the nice thing is that it’s likely that, those providers are probably already enrolled, with payers. But then, you know, it depends on how, amenable the payers are to working with us in terms of those enrollment. Like, they may be cool with a spreadsheet, you know, or we just say, hey, these are the providers and sites that are tied to us and then they would just, you know?
Cliff Marg (07:11) Like a roster submission, yeah.
JAHI006 (07:13) That, I think that would be the hope, but still, I mean, the idea of, I mean, worst case scenario is they’d be like, no, you gotta submit whole new applications for all of these people. Yeah. And so, I mean, one of the things that I think of for Antoinette is like, how can we keep her from wanting to curl up in the fetal position?
Cliff Marg (07:35) Yes, that’s very nice. Okay. Yeah. Got it. It’s like, how do we make sure, that we have that our small but mighty team, of one scales efficiently? Because that’s not how it’s set up today.
Antoinette Flores (07:45) Right. Yeah. Okay.
Cliff Marg (07:48) I think that makes a lot of sense. And I guess it’s worth clarifying Antoinette when you talk about credentialing and like the work, that you’re doing, I assume that is strictly like submitting these applications to payers and not like the, I don’t know, internal credentialing, like none of the primary source verification or, any of that, but it’s worth clarifying.
Antoinette Flores (08:13) No, for sure. So, I do a lot of the psvs for the providers. We, so I manage that… and we, you know, we have our own committee that we present practitioners to when they’re up for initial and recredentialing with north point. Got it.
Cliff Marg (08:33) So, it is making sure, you know, that licenses are verified that they are, you know, Sam, oig, npdb, like all the things are coming back all right. And then committee votes on it, and then assuming that provider is good to provide care, then you are submitting these enrollment applications to.
Antoinette Flores (08:52) The payers correct? Correct?
Cliff Marg (08:54) Okay. That is very helpful. Yeah, I think, actually, my, no, I think, from medallion’s perspective, like, we very much see ourselves as a technology company. I can show you a couple of slides and I think a couple of examples just in terms of like, where the technology approach really will make an impact for you all. But essentially, like a little background on us. We, you know, we’ve been around for, about five plus years now. We’re based out of San Francisco, you know, a couple 100 employees here. And I think more importantly, like 350, customers and that’s really across, the country. So, we work with a lot of telehealth companies. We work with hospitals, health systems, fqhcs, primary care associations. So, it really runs the gambit, and I would say, like we’re working with pretty much every payer under the sun on behalf of our customers. And of course, new payers are popping up left and right? We, you know, we have a team that’s dedicated to making sure that, we understand, and, our platform understands like, what are the requirements for these, payers? And, and, you know, using technology to help, stay on top of those things. And so, if you want to see some lego customers, I’ll send this over to you. But I think like ultimately, our observation and the way that we’re trying to help organizations is like credentialing, is a beast, by nature, right? And I think most orgs struggle with one of a couple of things. One is like, the time that it takes to do all of this stuff. So it can take 20 days to pro, to collect information from providers, kind of back and forth, submitting applications, doing all of those primary source verifications. I think depending on how any organization is set up, like if there’s a lot of manual process that can lead to, you know, errors or resubmissions, hopefully not in your case, or claims being denied. And then it can also get expensive. It’s like you typically either have to consider, do we clone Antoinette, and the cloning technologies come along a long way, but it’s also very expensive. Or do we, you know, start to bring in, some systems and, things like that? So it can get costly. I think those are the three things that we’re trying to solve for Antoinette. From your perspective, timeline wise. I mean, is that something that you’re struggling with today or it’s good for now. But if you think about adding scale that’s where it may suffer like, yeah.
Antoinette Flores (11:26) For sure. Right now, it’s manageable. I mean, I think standard even just for pay enrollment the 30 days, sometimes less is kind of where we’ve been seeing those things, our applications being approved, but we’re not necessarily, you know, that’s not the primary issue. It’s just managing all the different, yeah, yeah.
Cliff Marg (11:45) Yeah, fair enough. Okay. So, so yeah, I think again medallion at our core like we are a provider data management system, but we’ve kind of built in and made a big push into leveraging AI and automation to help. I think the ratio that we typically see with our customers is like one credentialing team member can scale with a provider network of about 500 providers. And so it depends on the organization. But like we can really help across the whole gambit of like doing ongoing monitoring, helping, you know, automate some of the payer enrollment workflows. It doesn’t sound like you guys are probably have any delegated agreements but we are also an ncqa certified cvo and then it doesn’t sound like licensing or privileging, is relevant. Either the thing that I wanted to show you or I was excited to show you was like, I think what will likely make sense is Antoinette to walk you through a demo of medallion and really kind of show you like compare and contrast what you’re using today to medallion. But we have some cool slides here and I can at least give you a sense for what I’m talking about with regards to automation. So like when you think of about like onboarding a new provider, right? I assume you’re sending them some sort of welcome packet, you’re trying to gather as much information as possible. There’s like a long back and forth. So medallion does try to help eliminate a lot of that back and forth and kind of decrease the time it takes just to get information from providers and get them seeing patients as quickly as possible. A big part of that is we have a unique integration with caqh… where we don’t need provider’s username and password. We can just pull everything directly, which really allows us to pull in like 70 to 80 percent of all of the information that we need from them. And then medallion’s platform says, OK, based on their provider… you know, based on the provider type here’s, the additional things that we need. And then we leverage AI phone calling, emails, text messages to, you know, nudge the provider and say, hey, we need these last couple of things from you. And in medallion, we have, you know, if you go to a restaurant, you scan a QR Code, you get the menu, medallion has something similar where if we need them to upload, you know, their Coi or something like that. Take a picture with their smartphone, medallion QR Code. Then on their iPhone, take a picture of that document. And then medallion’s technology will take what’s transcribed on that. Document and put it right into medallion. So that’s one example of just like reducing provider abrasion there. Yeah. So here’s kind of the screenshot I wanted to show just around extracting data from documents and really eliminating like the hands on keyboard work for you. Antoinette… let’s see. Yeah, this is kind of what I was alluding to when we talk about like just the number of payers that we’re working with is like in the medallion platform, this is kind of behind the scenes. What fuels all of our automations is what we call these payer process guides. So we know for, you know, this payer, you know, if it’s medical behavioral health, dental, essentially, all of those requirements, right? Are there any dependencies? Do we need a medicaid id before submitting this enrollment, et cetera? So, because we’ve done all that legwork upfront of gathering all of that provider data, we can then just map that directly to the enrollment application and then get that out the door and you can kind of track and manage it from there. Okay?
Antoinette Flores (15:29) Do you have a way to track the initial applications… track or payer enrollment? So, is there like somewhere here or in the database where I could, you know, track the application? Like?
Cliff Marg (15:44) Who’s enrolled with? Who? Right? Yeah, yeah, absolutely. You’ll have full visibility into. Is that what you’re saying? Like which providers are enrolled? With which payers? Well?
Antoinette Flores (15:54) Yeah, just kind of like, so when I, if I am, you know, enrolling a new provider with a payer, is there somewhere here that I can enter? Okay, this is the date where I submitted the application. This is where, yeah.
Cliff Marg (16:05) All of that will be tracked into medallion. So we can show you that on a demo. The other thing is like anything that is expiring medallion will track those expirables. And sometimes if like it’s just a recred that needs to go out like medallion can just automate that. It’s on autopilot. So you don’t have to worry about things getting expired and providers seeing patients where they’re maybe not going to get reimbursed for those services, things like that.
Cliff Marg (16:36) And then the other benefit that you can see on this slide is because of the scale of medallion’s operation, we have relationships with a lot of payers, where a lot of times instead of having to go through that traditional enrollment process, sometimes we’re able to just either submit a roster to them, which makes the process go much quicker or sometimes we’ll even have like API access or connections to their backend that basically allows to do like a pseudo roster submission as well. So just some ways of hopefully decreasing the overall turnaround time when you think about new enrollments question.
JAHI006 (17:15) On that for you, cliff, Minnesota is something of a beautiful and unique snowflake in the healthcare sphere largely built on the back of Minnesota legislation requiring any hmos here to be nonprofits. That requirement was rescinded. I want to say sometime like 2016, 2017. But still, so we have kind of a unique environment here. There are payers that we have here who don’t really have those connections. So like the bulk of our revenue is really coming from besides medicaid and medicare, a very limited number of payers that are kind of unique to Minnesota blue cross, blue shield of Minnesota medica, health partners. And really this will be the last year of ucare. But currently, ucare, and wondering if you guys have like sort of if you can dig into seeing if, those payers are sort of on, your roster of?
Cliff Marg (18:24) Yeah, absolutely. So we may not be able to submit via some of those like secondary methods to some of those payers, but we’re definitely working with them. I was just working with a therapy group based in Minnesota. And so a lot of those names are very familiar from like a couple of months ago. And I remember like pulling some of our turnaround time data for those payers for them. So very confident like, our medallion will have all of those like payer requirements built into the platform for all of those payers that you all work with. Yeah.
JAHI006 (18:57) Well, and, you know, another piece to that Minnesota side that makes this such a unique market is, you know, like basically everyone else in the country has used caqh for, you know, decades now whereas Minnesota because of the kind of cloistered environment that we have, we had like a parallel system called it was developed through a collaboration of providers and payers that’s called the Minnesota credentialing collaborative called applysmart. So it’s not something I don’t think at this point that we would have an expectation that you guys would key into, but it’s just like it’s another piece to the weird little Minnesota puzzle interesting.
Cliff Marg (19:42) Yeah, I do. I will say I work really closely with a member of our solutions consulting team who’s a little bit more of like subject matter expert. So they’ll likely have some more familiarity with that. I think most likely, I mean, I’ve been here for two and a half years. I’m not intimately familiar with it. But I think most likely, if you know, a lot of this data is not coming from caqh, it’s just a matter of medallion like being able to say great, nothing came back from caqh. And then the platform will set up, you know, it’s like more tasks than, maybe, you know, some of our other customers because that data lives in caqh, but that’s all totally and.
JAHI006 (20:21) Honestly, this is one of those times where we’re probably lucky that uhc is operating directly in the market because from what I understand, well, they’re basically like, yeah, that’s great that Minnesota has this history of applysmart but we’re still using caqh. So.
Cliff Marg (20:38) Yeah. So maybe we can still hop a little bit there. Yeah.
Antoinette Flores (20:40) Okay.
Cliff Marg (20:43) What other questions do you have? We’ve got about 10 minutes left. We can chat through next steps, but I want to make sure that we’re answering.
Antoinette Flores (20:49) Any questions, you know, I think my questions would more come. I’m sorry, I think maybe I just was misunderstood, I thought we were, this was a demo or somewhat of a demo today. No, it’s okay. And being that we only have 10 minutes, I think maybe if we can go through a full demo to kind of see what the software offers, that would probably be best.
Cliff Marg (21:10) Definitely. Yeah, absolutely. I think that sounds like a good plan. I.
JAHI006 (21:15) Think the one takeaway that at least I have from the what week and a half? Now that I’ve been kind of digging into some of this stuff is that there are a lot of.
Cliff Marg (21:30) platforms out.
JAHI006 (21:32) In the market to assist with this. And the thing that I’m excited about for Antoinette is that to a degree, I’m like she gets to kind of pick, you know, budgeting and all those kinds of issues aside, like she really gets to kind of survey the field and say, you know?
Antoinette Flores (21:51) Like this is.
JAHI006 (21:53) The one that I really like. So, let’s do what we can, to go with that. So, yeah… but I, but also, at the same time, I’m kind of like all of these platforms have a lot of advantages over just the spreadsheet situation that we currently live with. Yeah, yeah.
Cliff Marg (22:13) Yeah, definitely. I think, yeah, you’ll get a sense for, you know, maybe, which platforms are overkill, which ones get you from like point a to point B, which, you know, it’s like there are a few different flavors, a few different ways of, to skin the cat. And so, I think that’ll be helpful, when are you available perhaps?
Antoinette Flores (22:36) To, how much time should we plan for that ideally?
Cliff Marg (22:39) 45 minutes? Okay?
Antoinette Flores (22:44) If we’re looking at, are we looking at next week?
Cliff Marg (22:48) Or we could potentially look at this week as well? Okay?
Antoinette Flores (22:53) Well, Thursday or Friday works good for me… works better for me?
Cliff Marg (23:04) let’s would… you be able to do, let’s see what time is it for you all right now? Is it about to be four o’clock yep.
JAHI006 (23:13) It’s we’re Central Time, so, okay, it’ll be just about four. Could we?
Cliff Marg (23:16) Do, two 30 your time on Thursday?
Antoinette Flores (23:25) This Thursday? Yeah, this.
Cliff Marg (23:26) Thursday, that’ll.
Antoinette Flores (23:28) work for me. Okay?
Cliff Marg (23:31) Okay. Not that I’ll.
JAHI006 (23:31) have anything useful to add to the proceedings, but that’d be awesome thoughts for me too.
Cliff Marg (23:36) Okay, perfect. Let me send this out and then I will make sure that, that we are ready to go for a demo on Thursday, okay?
JAHI006 (23:50) Sounds good. Okay, hopefully.
Cliff Marg (23:51) This was, this was at least helpful just in terms of like introducing medallion. And then, I think by the end of the meeting, Thursday, like we’ll have a pretty good sense for, you know, a mutual fit.
Antoinette Flores (24:02) Sounds like a plan. Okay. Enjoy your time. All right. Nice.
Cliff Marg (24:05) Meeting you both appreciate it.
JAHI006 (24:06) Yeah, me too. Take care, cliff bye.
Antoinette Flores (24:07) Bye bye.