Transcript
Anu Vora (00:00) hey, Cameron.
Cameron McCormick (00:01) Nice shirt.
Nicole Campbell (00:02) Thank you.
Cameron McCormick (00:05) Oh my God.
Nicole Campbell (00:08) I was just on the worst SC interview ever really. It was so bad. Yeah, the Guy didn’t talk to us for 40 minutes. He didn’t ask us one question. He didn’t even give us like roles.
Cameron McCormick (00:24) Oh, it was a mock call. Nice. Good, good.
Nicole Campbell (00:30) Yeah, that was bad. Hopefully, this will go better. So, yeah, we sent everything over on Friday. I think you were on that email thread. So we’re just waiting for her feedback. And then I have the STC SLA numbers for the five pairs, which is 70 days. And then for the eight pairs, we would give her 80 days.
Cameron McCormick (00:55) Where is that? Can you?
Nicole Campbell (00:57) It’s in the thread, but here, Jake just wrote me up something this morning as a… there we go.
Nicole Campbell (01:09) It’s in that giant thread about it. And then you can see the reason we pulled Molina out.
Nicole Campbell (01:27) The only thing that she may ask questions around too from the questions she asked last week around the pair, adding when a new location is added with a pair group, before she jumps in, we added that in at like 70 dollars per demographic update. Okay? But we did mention it could be covered by ski flexibility, but that’s the only other thing she might have questioned then. Okay, she’s here if you’re ready, yep.
Nicole Campbell (02:07) Hi. Good afternoon.
Anu Vora (02:10) Good afternoon. How?
Nicole Campbell (02:11) Are you, are you in the office today?
Anu Vora (02:13) I am.
Nicole Campbell (02:14) I’m like a new background every time, just trying to figure out where you are based on that. This?
Anu Vora (02:20) Is my desk? This is where I normally live. Well, how are you guys doing?
Nicole Campbell (02:27) Good. How are you doing?
Anu Vora (02:29) I’m good. I don’t have many updates for you. So I’m wondering if you guys have any updates on my end?
Nicole Campbell (02:35) So, I just wanted to follow up. I know we sent you over the order form on Friday. We sent the msa. We had some answers. So wanted to kind of, we kept this as a touch point just to see if there was any questions based off of the contract. I think you saw the biggest piece is we matched revalidations to the payr enrollment line item. We did the adjustments based off of the scope that we talked about on Friday.
Nicole Campbell (03:00) So contract total values gone down, light item values gone down. And then we just added only like a five percent growth year into year two, like a small and reasonable growth accepted. So that wanted to touch base there. And then I have the STC SLA update for you. Yeah, first on the contract piece. Do you think we’re kind of like closer? Well?
Anu Vora (03:25) We understand the five percent piece. So you’re saying the actual quantity increases by five percent?
Nicole Campbell (03:31) Yeah, that’s what we like you said we could, yeah.
Anu Vora (03:34) Yeah, correct.
Nicole Campbell (03:35) Exactly. Except for revalidations because that won’t be necessary to grow revalidations at the same rate.
Anu Vora (03:43) Makes sense. And.
Nicole Campbell (03:46) All prices are equal. Unit prices are equal to year one.
Anu Vora (03:49) Yeah. And so my apologies on Friday was back to back and I haven’t heard back from legal. And so I’m looking at this now… I’d like to understand.
Anu Vora (04:08) Implementation and onboarding. Are we able to distribute that over the course of the first year in payments? Great?
Nicole Campbell (04:16) Question if we’re able to pull that one light item out. Normally, I would believe, no, we’re not allowed to, that has to be included because we’re also doing all that implementation work up front in year one as well. So that’s why it’s kind of like included in that annual cost?
Anu Vora (04:31) No, no, no, that part is not what I’m wondering about. I’m wondering if we can pay for it monthly versus paying for it up front.
Nicole Campbell (04:40) Yeah. I don’t think we would be able to do that. We don’t have any monthly payment terms on especially like individual line items or any kind of monthly terms built out in our payments?
Anu Vora (04:51) Okay. Got it. So because it’s a per unit, you would need a 15,000 dollar kickoff fee?
Nicole Campbell (04:57) Yeah. And that could be that’s part of like the annual cost, yeah, fee?
Anu Vora (05:02) Okay. So talk to me about how the billing works. So you want us to pay 117,000 dollars and how so?
Nicole Campbell (05:13) Right now, the terms are built annually with net 30 terms. So they’re right at the top of the contract. So basically each year is one year annual payment.
Anu Vora (05:23) So let’s say we sign the agreement March 30 first by the end of April, you want us to send you a check for 117,000 dollars?
Nicole Campbell (05:34) Yes, that’s this terms. Yeah. Are there terms your team is more comfortable with or is this something your finance team would sign off on?
Anu Vora (05:42) They would not sign off on this. So I think we would need to my understanding was, very different. So it’s good. We figured out like the per unit pace piece. Now we get into the nitty gritty of how do we actually partner? We would want to pay off of our utilization because for what we were sold on is like if let’s say you do a lot more in year one than in year two… your effective cost goes down to me. This is based off of utilization. Once we are implemented. Once we have people actually using medallion, once, we like, you know, do our like caqh management that’s a monthly bill that we would expect to see for a number of people that are actually enrolled. But it’s going to take me a minute to get everybody enrolled. They’re not going to be all 100 percent on medallion on day one. And so I would imagine we’re not the only customer that would want to use to pay what we use as we use it. And then at the end of the first year, we could say here’s how far we made it into our year one, year two here’s, we have to make up. And at the end of, you know, that contract period maybe on an annual basis or what have you, there can be some settle up or something like that for the contract term?
Nicole Campbell (06:59) Yeah. Unfortunately, we don’t build out our model that way. So, the most flexible payment term option we could offer you is quarterly. In terms of that. We don’t base it off of that. And there’s no flexibility around that. In terms of our model, we offer that skew flexibility. And also, we’ve scoped it down to almost like the most minimal amount that you’ll be using in the first year and then second year. And that’s kind of what we based off of. So the skew flexibility allows you to move the basically minimum payment almost like, hey, if we don’t use all your spend this year and you have bigger growth next year, you can move it in. But most likely what we normally see is, hey, we’ve grown quicker than we thought we were going to. So you can pull spend in from year two into year one without needing to sign anew contract or add on to the contract. So like we said, you may be growing 100 providers, but we didn’t want to scope out the contract for that much. We’ve scoped it smaller for you. But the most flexible terms we could offer is quarterly invoicing?
Anu Vora (07:59) Okay. Got it. And so I’ll have to talk to my team. We’ve never done that on our end and I don’t know that my finance team will sign off on that. So let me go talk to them and figure out what we could make work. I understand you’re saying you were not flexible.
Anu Vora (08:14) I’m saying we’ve never done that before. Yeah, we don’t have tons and tons of cash sitting on hand to write 117,000 dollar check up front. That’s like impossible for us.
Nicole Campbell (08:24) So we definitely could move that to quarterly. So that wouldn’t be what you have to bring to your.
Anu Vora (08:28) Sure, still a huge amount to spend all at once and we’re managing our cash as our insurance payers come in like there’s just a matter of like that’s a really big bill at once every quarter, I struggle to see how we would do that. I’ll talk to them and see if I’m missing something. But, and assuming you’d want it at the top of every quarter too.
Nicole Campbell (08:54) It would be on net 30 terms with whatever billing date we align to.
Anu Vora (08:59) Yeah. And so there’s I… think that’s going to be a challenge. The cash piece is a challenge. Let me see… 106,000.
Anu Vora (09:19) Can you also walk me through how… you arrive at 392 for your revalidations?
Nicole Campbell (09:27) Yes, let me pull up the payments sheet.
Anu Vora (09:35) Also, hey, Cameron, we’ve been doing all the time.
Nicole Campbell (09:39) So here we go. I’m going to share my screen and just show you. And this would have been from like two emails ago. So I’m going to highlight out the payr enrollment revalidations. So this is what we based it off of and you can kind of see the map there. And that’s also where it says kind of flat. I’ll give you a second to read through that.
Nicole Campbell (10:12) And I can like re forward this to you as well, just so it’s top of mind. I.
Anu Vora (10:18) Have to check with my team as to when a lot of these validations were done because I have no idea if we will actually have.
Nicole Campbell (10:28) Yeah. And this was based off of the numbers like Tiffany and Charles gave us and like what?
Anu Vora (10:33) We, for sure. I just don’t know when the timing will hit. And obviously, since we’re talking about almost like 100 dollars per revalidation, that does make a big difference. Yeah. And so I was focusing so much on the enrollments piece and the overall numbers that I think for revalidations… I need to spend some more time with the team, but I’ve been trying to do as much as I can with you all before I go to them. So we’ve got a 1,000,000 more back and forths. I see that number doesn’t increase from year one to year two, which makes sense, correct? And then enrollments goes up slightly caqh goes up.
Nicole Campbell (11:21) Yeah, it should only be based off of that five percent growth.
Anu Vora (11:24) Yep. Makes sense. That’s not the issue to me. I think we just have to work out the revalidation math on our end and just make sure that we don’t have like a bunch of people we just did on the same timeline because of how we bought the business. We have hundreds of people that have certain dates where this is all happening when we took over the practice or things like that triggered. Yeah. So there might actually be moments and I don’t know how that’s going to time out. So that’s like a very detailed question. I’ve got to get in with my credentialing team on and.
Nicole Campbell (11:56) That’s a quick one. We can always just quickly update that.
Anu Vora (11:59) Number? Yeah, exactly. Yeah… I guess, from my end then besides the msa which my legal team has and it’s quite short. Yes, I don’t have anything else. So I should hopefully have an answer from finance and legal, no later than Wednesday… and assuming that they can take a look today and tomorrow from.
Nicole Campbell (12:29) Finance and legal. So we should expect potential red lines on Wednesday. Yeah. And then, yeah, I think the financing is like from my side, the biggest like concern like because hey, if this is just a no go in terms of we no longer have any more flexibility on our end. So we can’t even like get creative. Yeah, it’s quarterly.
Anu Vora (12:48) I really am curious if you could, if there is no customer that has ever done monthly payments. We.
Nicole Campbell (12:55) have never and Cameron’s been here since like inception. We do not for any monthly payments.
Anu Vora (13:00) No, I believe anything you tell me. It’s just a matter of like that’s wild to me because we, right now how it works for us is we use over the year and whatever however many applications are submitted that’s like we get a bill for that on a monthly cadence that’s it. Yeah. And.
Nicole Campbell (13:21) there’s definitely different business factors, why like true up models versus like upfront like commitment cost, and like also the best like customer experience, long term, like sometimes especially with, as we scale up to larger health systems, the true up model becomes kind of like each other chasing back and forth as they do so much work. So that’s why we went with a more standard billing model. But in terms of legal counsel, is this inside or outside counsel because we’re always happy to also jump on a call with the team to make it even easier of a process where kind of the lawyers can just run through red lines together pretty quickly.
Anu Vora (14:00) Yeah. So it’s inside counsel, and,
Anu Vora (14:09) the only thing I want to understand a little bit more is the SLA, yes.
Nicole Campbell (14:13) So that was what I was going to share with you too. So we sent that over before we built it in. We got approval for we have two options. So I wanted to run them by you. Yeah. So with the five payers we originally started out with, we can agree to an STC SLA of 70 days. So that was your original ask and that’s concentrated on the top five payers, or we can include up to those eight payers that you sent on that revised list, but that would change it on the STC SLA, it would go up to 80 days. And just because of, the different payer mix that we have inside of there, so.
Anu Vora (14:48) Who’s bringing our numbers down? Which payers? So let.
Nicole Campbell (14:52) me, pull that up for you quickly. Sorry, one second… I can send over a follow up on exactly which payers are kind of affecting those numbers a little bit more. I think it’s humana medicaid is one of the bigger ones that’s impacting that right now. Ohio’s humana medicaid. And that was part of the second group of the last, like additional ones that you sent over. But we can send over a little bit more insight into there. And then you can decide kind of which route, but we have two options there for your STC SLA, and you can decide which one fits better, what?
Anu Vora (15:36) Does STC stand for?
Nicole Campbell (15:39) That one stands for submission to completion.
Anu Vora (15:43) Okay.
Anu Vora (15:48) And just so I understand the contractual like back and forth, if for the top five pairs, we go beyond 70 days, for all five to be completed, then what happens? Yeah.
Nicole Campbell (16:03) Cameron, do you want to jump in there? Yeah.
Cameron McCormick (16:06) So the way that our slas work is we have not, it’s essentially measured quarterly. So you would start submitting your requests and then once they come through completed, you’ll be able to see what the average turnaround time is across the pairs that we’re creating the SLA for. And so if more than five percent of them come back, any that miss above five percent of the requests that are completed within the quarter, you don’t pay for them, you get a consumption credit for any of those enrollments, so they’re essentially free for you.
Anu Vora (16:46) And so I guess my question is that means that still counts toward my numbers, but I’m getting a discount on my bill. Is that, yes, okay. Got it. And in the event that we, well, we’ll definitely most likely end up having to do quarterly if we can swing that. Otherwise we can’t do anything. But assuming we do quarterly, then you’re saying every quarter we can true up and say, hey, then this, what happens if it was not more than five percent? What happens if it was like five people or, you know, for five people or two people, we missed this? How do you credit it back? Is it, I get five different? Like I get a credit of five percent. Do you have to pay your enrollments for that one person?
Cameron McCormick (17:35) Because it would be for whatever the lot, whatever it’s on an enrollment basis. So, if you do 100 and a quarter, just making up a number and we miss three of them, you don’t get any credit. If we miss seven, you would get seven enrollments credited on your invoice.
Anu Vora (17:56) Okay. There’s a five percent margin of error for you, correct up to five percent. Okay. Yep.
Anu Vora (18:09) And my question to you is, why not just credit us for isn’t the whole point of the SLA that you guys are guaranteeing. We think we can do it in 51 days for these top five payers. We’re already adding a 20 day margin on top of that. So shouldn’t it then be any one that we miss. Well?
Cameron McCormick (18:30) There are certain circumstances where payers will have delays that are outside of our control or they change their process, and we need some time to react to that and essentially like start following their new process.
Cameron McCormick (18:44) So there’s a bit of a buffer baked into it, which is why it is triggered at 95 percent. I can go talk to our team about tightening that to maybe like 98 percent so that you feel more comfortable, but I would want to work through these other issues first specifically around the msa review and the invoicing terms.
Anu Vora (19:07) Yeah, makes sense. Okay. That would be great, 98 percent. And then are there any other warranties I don’t see them, in… our msa, but you’re also pointing… to an external like services agreement. But what are the, I guess the terms under which if medallion doesn’t perform X that we would have the right to terminate?
Cameron McCormick (19:39) Yeah. Do you have the msa in front of you? Yeah.
Anu Vora (19:43) So,
Cameron McCormick (19:44) if you scroll to five two, let me just pull it up here.
Nicole Campbell (19:51) I was like, I can share my screen in one second. I’m pulling it up too.
Nicole Campbell (19:59) Here we go. I’m gonna share.
Cameron McCormick (20:04) Yeah, Nicole, do you want to just screen? Share the msa? Yeah.
Nicole Campbell (20:07) I think it’s not. Yeah, I’m like I don’t think it’s five two. Sorry, I was trying to find the exact line item.
Cameron McCormick (20:14) Yeah. So, Anu, on five two, there’s mutual breach for like any breach of the contract without remedy, either party can terminate. So the most common breach on the customer side would be like non payment or usage of the software in contrary to the terms of the msa. So we could terminate. And upon 10 days written notice if you don’t care. And the same for you. So that’s like a broad mutual termination provision. And then Nicole, if you scroll down to… all the way to the SLA section yep.
Anu Vora (20:54) There. Okay, there.
Cameron McCormick (20:56) It is. So we also have this SLA here for payer enrollments. So there’s going to be two slas in the contract. The first one is when you request a payer enrollment, and we have the information from the provider that’s needed. We’ll submit it within 10 business days that’s the first SLA. And then the second SLA is not in this msa, but it would be the submission to completion SLA. And so if you scroll down, Nicole. Yeah. So this is where you would be able to terminate if we miss these slas, either on the application submission or the submission to completion timeline three times, three quarters in any four month period, you can terminate the contract. So there’s multiple protections for you based on performance as well as the broader category of material, breach of the agreement.
Anu Vora (21:55) Got it. So you… guys have to have three strikes before we can terminate.
Cameron McCormick (22:03) Yeah. So the reason that is structured that way is like the, so if you take this scenario for 100 enrollment applications and Nicole, how many payer enrollment lines are in the first line?
Nicole Campbell (22:19) We have, I think we have 302.
Anu Vora (22:22) Or two.
Nicole Campbell (22:23) 250? Sorry, we’ve gone back and forth if I’m off.
Anu Vora (22:26) A little bit. Yeah, 252.
Nicole Campbell (22:27) 50? Sorry, 250? Okay.
Cameron McCormick (22:29) So 250 divided by four. So that’s 62. We’ll just call it 63 pair enrollment requests per quarter and 95 percent of that is basically 60. So if the margin for error to trigger a breach is pretty small here, which is essentially like six pair enrollment lines per quarter, miss either of the slas, and it doesn’t matter how long the SLA miss is, it would be, it could be like one day. So instead of, you know, 70 day submission completion at 71 that’s a very tight provision for triggering a material breach of the contract which can result in termination?
Anu Vora (23:16) Okay. My ask is, can you all put in writing exactly like what we would get charged for given that you have our full payer list or our top eight payer list? I’m happy to give you our full payer list we had mentioned like anthem, medicaid, anthem, commercial, anthem, blah, blah blah are all going to be charged just like one payer enrollment. Can we get a list to you of all of our payers and you can help us consolidate what would be considered one? Because I think that that’s the place where I don’t want there to be a surprise of any kind where maybe for humana… you’re breaking it up into commercial and not that humana is doing commercial behavioral health anymore, but medicaid. I just don’t want there to be a surprise around how you’re thinking about it on a per plan level and a per payer level. Does that make sense? Yeah.
Cameron McCormick (24:06) Yeah, totally. So if you send us the payers and the lines of businesses, we can put that together and send it over to you.
Anu Vora (24:14) Okay.
Anu Vora (24:19) And then I guess for us, let’s say that there is. And, you know, obviously, I think you guys are going to do great. That’s why we’re having these conversations but we have to think about what happens, what are our options if things aren’t going well? So there’s… not a whole lot of immediate action that we’re able to take in the event that we’re not getting the results that we were expecting. So what you’re saying is there’s a small margin of error, but you have to wait three quarters which is basically a year to be able to make a change. And I’m wondering, well, what happens if we’re seeing that this isn’t working before, then? What options do we have?
Cameron McCormick (25:02) Can you paint a little bit more context around like, what your, what the scenario?
Anu Vora (25:07) Is, let’s say you all are taking, you know, on average 10 business day up the, to the maximum amount that you have to actually submit the applications. Like we do the work, we get everything ready. We don’t hear anything. Technically, you have 10, up to 10 business days that’s quite a bit of time like two weeks to press submit after we’ve given the information. How often does that happen? I guess let’s start there. How often are you taking the full two weeks?
Cameron McCormick (25:34) Not often it’s usually less than 40 percent of that time to submit that application, but there can be some outliers, which is why, the SLA is two weeks, but the attain our attainment against the SLA is significantly better than that.
Anu Vora (25:52) Okay. Got it. And so let’s… say you take the full 10 days and because you know, that you’re going to get it done in 51 days after that, and, you… know, you’re still going under the 70 day limit but we’re not optimizing it as much as we can.
Anu Vora (26:12) That’s money being left on the table for us. Let’s say we bring it up and week after week in our calls with medallion like, can we get to this faster? We get an implementation manager that isn’t responding to our feedback? This has happened with vendors that have, you know, sold us with their products before. So, I’m speaking from some scar tissue here. Technically, you’re not breaching but I’m leaving money on the table every day that we don’t get that submitted faster. And we’re hitting the 10 day limit or we’re not getting like the level of service we want or there’s a surprise, gotcha. Whatever it looks like. I feel like this is a little bit one sided and that it doesn’t offer me a chance to give feedback where we have this many days to remedy it or else we’re terminated it’s like you have this many days to remedy it until someone materially breaches. And in this case, material breach is more than 10 days to submit and… three quarters of lack of performance to the SLA?
Cameron McCormick (27:16) Yeah. So I hear you there.
Anu Vora (27:20) Yeah. What if our feedback isn’t working and like our business is like is suffering for it. And I think.
Cameron McCormick (27:28) I’m having a little bit of a hard time with like that point because the, what is in our, what we would be contracting to in the worst case scenario is based on my understanding, like significantly better than your current process for doing enrollments and credentialing based on the conversations that Nicole and Jake have had with your team. So I guess like if you’re getting your enrollments done in 70 days and, you know, they’re being submitted within two, two days. That would be in my understanding like a really big improvement over the current state.
Anu Vora (28:06) Definitely. We’re sold on 51 days. We’re saying it can’t be worse than 71 days. I understand you’re baking in 20 days of margin to make sure you get paid. Yeah, we’re accepting that. So, I think, in my, from my viewpoint, like if you’re coming in at 70 days, you’re right? That’s a slight improvement on some of the payers or a significant improvement on some of the payers. But I’m still getting some people seen with like medicaid, medicare that’s coming in like 30 days. Yeah, not all the payers, right? So it’s a matter of like what if we’re not being heard when we have certain feedback or we’re not being able to use the product to the fullest I mean, there’s I can maybe spend five more minutes and come up with like five specific scenarios in which like we could have an issue with medallion. What I’m hearing is the only breach from your end is if you don’t meet 10 days to submit. And if you don’t do for 95 percent of the cases, 70 days or like more actually not even because that’s only for my top five payers, right? So I.
Cameron McCormick (29:09) think what we could do is put in a clause in the slas, where there’s like an egregious miss, which essentially allows you to terminate, drops it from three to two quarters out of four. So it would be like… two quarters, it would be 180 days. But yeah, like outside of that, there’s not a lot that we can do to insert more performance based terms.
Anu Vora (29:37) Into the contract, I think the only that two quarters is helpful but it would need to be for some and the egregious miss I think would be if we’re not getting our like all of our payor enrollments on average, not just the top five but all of them done in like less than 85 days because that’s like the… thing at that point, we should never have switched to medallion. So, I think when we look at just the top five and 70, sure that’s a good improvement for those top five and that’s a decent amount of our business concentration. But for all of our payors, I guess pick a number that still gives you that like significant margin for error. And then it would be helpful to say, all right, we’re not missing every single thing here. Does that make sense? Because what if we’re just you guys focus on the top five, nothing else, how?
Cameron McCormick (30:36) Many, how many payors is the entire universe?
Anu Vora (30:42) I think it’s like 30 or so.
Cameron McCormick (30:48) And what percentage of, I guess like this, these eight payors, what percentage I’m open to doing that? I just don’t know if like the juice is worth the squeeze based on the revenue that you’re driving across those entire.
Anu Vora (31:04) Yeah. And I want to make sure you understand my job, my goal is not to make anything difficult. We’ve come a long way. The point is just when I’m trapped in an agreement, I’m very uncomfortable if I don’t know that if my business is not being served, I have the ability to take my business elsewhere. And so I’m trying to because we were such big fans of your platform. I’m trying to be like, well, what is that situation in which I would need to have flexibility? And maybe I need to think about it with my team some more to come back to you and say, here are some ideas we have because maybe you’re right? Like we don’t need it for all 30 payors. Let me pull up what Jared sent.
Nicole Campbell (31:40) Yeah, because I thought it was the top eight were kind of sitting at around like 87 percent.
Anu Vora (31:45) Correct. That’s. Why I’m like the top eight makes sense to me. But 70 and 80 days is also like a huge jump. Yeah. And so my hope was we could just get 70 days for those top eight payors and.
Nicole Campbell (31:57) It really is that humana? Oh, because your average or your median turnaround time from that payer is 109 days right now and from them. And so like those are the ones where it’s that payer has a much longer turnaround time as well as like bringing… that one in. So maybe if like humana also isn’t how much is that one one that you’re actually getting? Yeah, how much percentage is it taking out of your top eight? Could be a conversation we have as well? I.
Anu Vora (32:33) think you can just take humana out of it. If you can take humana out of it and make it seven, seven days, then that would be that’s.
Nicole Campbell (32:41) something, we can bring to our team and kind of bring back. I think… one thing I think we are super willing to do is like have these pieces of the conversation I guess like once again, Anu, my biggest concern is we’ll.
Anu Vora (32:54) we’re really hard the invoicing piece.
Cameron McCormick (32:55) Yeah.
Nicole Campbell (32:56) Is that, yeah, is your finance team going to sign off on this at all? Yeah. Is, is my question in terms of, hey, we have some flexibility here. Cameron and I can work on some of like the details here and there for the STC piece. We want to build in the ability there’s. We build in a lot of ability for you to break the contract if it’s not performing the way we want because we’re very convinced that it will, and you have a strong implementation team around it. But yeah, my concern is your finance team wants a consumption model, we will not be able to have that at all. So that that’s.
Anu Vora (33:31) my harder takeaway like the thing that would make me most comfortable to present this to the team is if we figure out the warranties in a way where if a serious egregious miss to use Cameron’s language happens in one quarter, the next quarter, we’re not like night and day improvement, but it’s like it’s barely moved the needle. And now we’re in a world of hurt like that’s it. Yeah. So.
Cameron McCormick (33:57) I think the best here’s what I think is the most efficient path to getting you to a place where you’re comfortable. So I think it’s basically going to be removing that one pair. I guess it’s human and medicaid, yeah, dealing, the turnaround time for the SLA. And then we can add in an egregious miss that limits that drops it from three to two quarters where it’s basically like, okay, if we’re missing on either the submission of the SLA, the submission of the application that requests the submission SLA, or the submission to completion SLA, like 85 percent, I think is what we’re going to have the best chance of getting approval on instead of, you know, like there’s missing which is 95 percent pretty high bar, like we can reduce the bar and give you a quicker out if that’s happening where we are missing the SLA, like more frequently and it’s you know, not improving over that time period. That is, I think the best strategy here is to take that. But what do you take that path?
Anu Vora (35:04) Forward. But what do you? No, I’m with you, I think. And as I talk to the team, I’ll figure out if there’s anything else by way of warranty where we know you’re going to succeed. But if we’re worried like this could really hurt our business. I can put it in front of you and say what’s our solution?
Anu Vora (35:19) If this happens, perhaps there’s already one baked in that the agreements support the operations support. But the invoicing is directly tied to like can we find? I mean… ultimately, you’re looking at the person who funds the business. So that’s a question for me and my personal finances of how much money and cash I want to outlay every month because if we have a bad month, we have to make that payment. Now, it’s not a monthly payment. Now a whole bunch of cash is due in a different order. So finance team only has so much say this is about me wiring a check. Yeah.
Cameron McCormick (35:58) Yeah. And I to be super clear like if you don’t feel comfortable with the quarterly invoicing terms, like we would be happy to revisit this conversation in six months or 12 months as the business continues.
Anu Vora (36:12) For sure, I would be much more comfortable if I knew that I wasn’t stuck if I wasn’t getting the performance. And so for me, I think that’s where to your point about efficiency? I don’t know this is a complete, I haven’t yet spoken to my attorneys. I haven’t yet spoken to my finance team about this offer. So once I get clarity from them in the next like 24 hours, I’ll come back and say, listen, these are the warranties that we would, that would make us comfortable with this quarterly payment because it’s a lot of money. If there’s for any reason non performance… then we can help further define for now. I’m good with this. I just want to reserve the right to be able to come back and say, yeah, and I do just that’s.
Cameron McCormick (36:51) helpful. But I do want to set expectations like we’re not going to change our msa with and add additional warranties. Like the dimensions with which we’re operating in are requests to submission of applications and submission to completion, which is like the decision made by the payer is rendered and the provider is in network.
Anu Vora (37:15) Yeah, that makes sense. That helps straighten it out. Those are the two things where if there’s let’s define what a miss would be, and then what the remediation pathway looks like. And then what us getting out because we don’t want to switch vendors again, this is a whole bunch of work, right? Like we’re not looking to like vendor hop. We just want to make sure that if God forbid something happens, we’re not stuck or trapped somewhere, yeah, with our heart or.
Cameron McCormick (37:39) Not, yeah, which is totally fair. And just for context like that’s why we have this submission to completion. There are no other vendors that offer this. They say, no, that’s out of our hands. Like we’re not, it’s up to the payer, we can’t do anything on that?
Anu Vora (37:55) Can I ask like how many customers churn in a year or have churned?
Cameron McCormick (38:00) Yeah. So we have over 90 percent logo retention over the last couple of years. So less than one in 10 and our net dollar retention is over 110 percent. So like, if you look at a cohort of our customers in any given year, like the total starting contract value, like they’re not only renewing but also increasing their spend.
Anu Vora (38:30) Yeah. And one more question for you is, you know, when they do churn, why are they churning? Yeah.
Cameron McCormick (38:39) So, a lot of that has to do with like changes in business strategy. So we have customers that, you know, use medallion for getting providers cross state licensed. And so like a lot of our churn especially over the past few years, like less so now because we’re more focused on insurance credentialing. But the beginning of our business, you know, six years ago was based on cross state licensure during kind of like the covid telehealth boom. So a lot of customers of ours will get their provider network, cross state licensed in 30 or 40 states. And then they don’t need additional cross state licensing. So they’ll either contract their contract spend or churn entirely. And then there are other instances of like companies being acquired or divesting parts of their business and they no longer want to pursue like in network credentialing, they’ll go partner with one or two payers specifically. And so most of the churn is driven by like business changes rather than performance.
Anu Vora (39:43) Okay. Got it. And what are some of the things that you all didn’t used to do as well as you do now that like you learned by churn, what are some of the hard won lessons from your end? Because obviously, maybe 90 percent is because of their own issues, but there must be 10 percent where there was an issue with medallion. Yeah.
Cameron McCormick (40:00) So I think like just the best answer to that question is the operational complexity of specifically payer enrollment in multiple states is like as, you know, a very like burdensome difficult process. And so we have invested like our engineering product and design team is over 85 people now, and we’ve raised additional capital and the majority of that capital goes into further automating processes as it’s related to specifically payer enrollment. So, our cvo credentialing product is almost 95 percent automated, but we are continuing to make advancements and strides on the payer enrollment side. And I think like some of the churn that has occurred in our customers historically has been like we were not ready for the scale of their business. So companies like villagemd which is not, they’ve not churned, they’ve been a customer for four years, but when we initially partnered with them, you know, like the scale of enrollments that they’re doing was very high compared to what we had done previously. And so like the continued investment in our product and automation team, has, I think solved a lot of those problems and helped us learn exactly like what is needed to handle high volume multi state payer enrollment projects.
Anu Vora (41:27) Got it. That’s very helpful. Thank you. As you can tell my brain goes finance first. And then I’m like these are the core operational questions because the team has been asking you product questions and I’ve been just, I just come in when there’s a check to sign. And so to me, these are some of the things where now that we’ve gotten through the lion’s share of it, I’m like, okay, wait, these are the final check marks that I need to understand. I.
Cameron McCormick (41:55) Totally appreciate that. I think what we should do is set up another call like either tomorrow or Wednesday. We can send you some additional information on the STC SLA. We’ll remove humana, Ohio medicaid because it seems like that’s driving like the turnaround time up. So we’ll send you what the STC SLA is, and then I will check with our lawyer to confirm with her what the scenario for an egregious breach over two quarters is, and we can send that to you as well. But.
Anu Vora (42:26) it would be helpful to understand like how does it work? So like let’s say like we start contracting on March 30 first and so like end of it’s helpful. Because then like end of Q2 is our first quarter together. And let’s say, we knock it out of the park. End of Q3 this year, we don’t do so well. End of Q4 improvements. Not there that needs to be seen to go back to killing it like first quarter that we work together. Does that mean after December, we’re done? Or, you know, it would be helpful to understand how, not only what does egregious breach look like? But what does the timeliness to respond look like? What happens if there is not a significant improvement? And then at what point is the contract then terminated? Just so it removes any doubt whatsoever if there’s a, if we, if any of us miss anything, yeah.
Cameron McCormick (43:19) We can spell that out for you. That would be great. And one other question is like are, assuming we get to clarity on these points. Are you confident that your legal team is going to be able to turn around? Yes, because all of these concessions are as, you know, tied to the end of this month?
Anu Vora (43:38) I know we’ll get there, don’t worry.
Cameron McCormick (43:41) I’m a little worried. I’m a little worried but it’s my job to worry. So anyway, I’ll let Nicole coordinate calendars, but, yeah, I’ll work with her this afternoon and we’ll send you over kind of like the bulleted scenario, the timeline and some more information on the STC piece. Yeah. Did.
Anu Vora (43:59) you say you just raised more capital or you’re raising more capital? We?
Cameron McCormick (44:02) Raised more capital about six months ago.
Anu Vora (44:06) Okay. Got it. And are you guys profitable today?
Cameron McCormick (44:11) Close to, we could be if we wanted to, but we’re still focusing on growing top line revenue.
Anu Vora (44:21) Awesome. Makes sense. Well, let me know if you guys are raising again?
Cameron McCormick (44:26) Yes, yes, I’m.
Anu Vora (44:29) not asking as a customer. I’m asking as an investor. Yeah, I.
Cameron McCormick (44:33) do have to jump, but yes, let me coordinate with you. Thank you.
Anu Vora (44:38) Unlike, so I will get you our top… like all of our payor list and just make sure we can get some level of like for everyone. We know, we’ll be able to hit this amount of time. Yeah. And like what’s the worst case from our top seven… or top eight payors is now top seven payors. And we’re basically going to boot humana, Ohio medicaid out. That’s fine. Yeah. And I don’t think there’s anything else on my list. Oh, Cameron was going to come back with a 98 percent SLA provided. Yeah.
Nicole Campbell (45:18) That’s where he’ll work with him with our legal team and we’ll come back with that. If we don’t get all of that signed off on today, I’ll at least send over some of the payor information and the STC SLA might wait till tomorrow morning for the legal, correct? Okay. I.
Anu Vora (45:35) get the sense. I’m frustrating you both and I apologize for that.
Nicole Campbell (45:39) Don’t, oh my God, don’t apologize. You are definitely not, it’s more. I think for us, it’s so hard because we just feel like we don’t know what we can all get approved like as quickly. So we’re just wanting to make sure that.
Anu Vora (45:50) We’re winning the race until this call today. I did not realize that you were expecting annual payments, yeah. And,
Nicole Campbell (45:55) definitely, like we just want to make sure from our end, it’s more like I don’t I feel bad taking your time too if I’m not bringing to the call what you need to hear.
Nicole Campbell (46:04) So, I’m like this is good. Like I want to make sure like we’re using your time wisely too and not like, and I don’t want to feel like unprepared for you, no.
Anu Vora (46:12) Worries. Yeah. I mean, I wish it was monthly payments. If you ever do start accepting that. I would really like to know. Yeah.
Nicole Campbell (46:22) I think.
Anu Vora (46:23) That, can, we have a handshake agreement. I don’t need to put that in the contract. But if anyone starts taking monthly payments like that would be, very, helpful because I’m not sitting here with venture dollars backing me? Yeah.
Nicole Campbell (46:34) That totally makes sense. And I definitely understand that. I’m like definitely would be something that I wish I could. That would be an easy one. If I could offer that. I’m like that’s frustrating that I can’t.
Anu Vora (46:44) no worries. Yeah. Does it?
Nicole Campbell (46:46) Make sense to put a stopgap on Wednesday just as we’re communicating async or what would make sense for when you’re going to be able to talk to the team?
Anu Vora (46:56) I don’t know, Wednesday is like a really bad day for me. Okay?
Nicole Campbell (47:01) What’s a, how about?
Anu Vora (47:03) Thursday? So, why don’t we do like end of day Tuesday cause, you know, Cameron’s worried I guess about our ability.
Nicole Campbell (47:10) I mean, Cameron, that’s his job too. Like he’s got a, he’s got to worry all of us, you know, it’s end of quarter that’s his role.
Anu Vora (47:17) What’s his title again?
Nicole Campbell (47:18) He’s the VP of sales, VP of sales.
Anu Vora (47:21) Yeah.
Nicole Campbell (47:21) So, that’s his job, to always push a little bit of that worry down.
Anu Vora (47:25) Yeah. Got it. You guys have a good sales this quarter. We’re having a great.
Nicole Campbell (47:29) Great quarter. Yeah. And thankfully, our team, my team is like number one in the org right now. So we love to see that. Yeah, nice.
Anu Vora (47:39) Yeah. How do you break up the territories or is it just by like sales?
Nicole Campbell (47:42) It’s it’s kind of across the entire country and it’s just based off of, we build out account books. We have three teams inside of medallion and we have so three sales leaders. One of them being me and then there’s two other sales leaders inside of the org. And then we all roll up into Cameron.
Anu Vora (47:59) Okay. Got it. Yeah, I’m building out a sales infrastructure for one of my portfolio companies right now. So I’m sorry to.
Nicole Campbell (48:07) Distract you. No, I was like if you ever want to talk offline and have questions, I’ve worked, I’ve been doing startup sales and have been through ipos acquisitions and like multiple funding rounds and have been like salesperson number three as well as like first sales leader. So if you ever have a question, I’m super happy to answer them.
Anu Vora (48:24) I’m going to text you a job posting if you know anyone.
Nicole Campbell (48:29) Yeah, that would be amazing. I actually have someone, right? One of my friends right now looking for something. So if it aligns, I would definitely.
Anu Vora (48:36) Yeah, it’s enterprise healthcare software. So, she.
Nicole Campbell (48:38) Literally. Yeah. Okay. Cool. Great. What is tomorrow afternoon?
Anu Vora (48:42) At four 30 eastern? Or?
Nicole Campbell (48:45) That actually works. I was just going to offer that one. Okay. Four 30 eastern, I will send over the invite and hopefully we will, if we don’t get everything emailed over by tomorrow, we’ll definitely have verbally some answers for you and we will go from there. But excited, yeah, text me that. And if you ever have any outside questions on scaling for any of your portfolio companies, I’d always be happy to chat with them just as like a good faith effort. Yeah, that would.
Anu Vora (49:17) Be awesome. Thank you. Have a good one. Yeah.
Nicole Campbell (49:19) You too. Talk to you tomorrow. Bye bye.