Transcript
Jeremy Walker (00:00) hey, Derek.
Derek Kamajian (00:01) Hey, Jeremy. How are you?
Jeremy Walker (00:03) I’m doing well, man. How about yourself? I’m.
Derek Kamajian (00:06) doing fantastic. Thank you for taking a short notice meeting of.
Jeremy Walker (00:10) course, I saw it pop up in my calendar and I was like, hold on a second. I need to figure out who this is and what they’re after here. So no worries at all. You’re based in Tampa, right?
Derek Kamajian (00:22) I’m based in Tampa, and one of the companies that I’m working with is in Las Vegas, Nevada. They’re in a bunch of different states and I just took this initial contract to really help them. They’re in a growth phase and they’re going… to be able to hit probably 45 states in the next few months. There’s a couple states that telehealth is pretty difficult in like California and New York, and we’ll save those for the last ones. But yeah, they definitely need some help. Yeah. And then I got your organization’s name from gemini. So I used to work for united healthcare for like 10 years and… I instructed some of the AI models.
Derek Kamajian (01:11) I’m like this company is using an excel sheet to manage their providers, between their 20 and 40 providers. We cannot do this. They’re wasting labor. I’m not credentialing or they need some support. So anyway, thank you very much for sitting down with me. And if you could just tell me what you guys have to offer and I think you guys already will be, I’m sure a great partner. Anything better than excel that we can utilize?
Jeremy Walker (01:36) Yeah, I think we’d love to one question before I share my screen and show you a little bit more about medallion, but I think would love to know. I think, is it Susan? She’s the one running credentialing today, and it’s pretty much just her, right? From what I understand.
Derek Kamajian (01:51) I’m not sure. They sent me their org chart last week. I’m not exactly sure.
Jeremy Walker (01:55) Okay. From what I could find like LinkedIn wise and things like that, it sounds like it might just be one person doing credentialing and enrollment and licensure today, which is what’s got them to where they’re at, right? But when you’re thinking about more than doubling the states, makes sense that they need some external support there. So, how much do you know as far as like because I know you might be coming from an outside in perspective? How much do you know about like where this desire to grow is coming from? Like from the executives of the company? Like what’s the goal? Obviously, I’m sure part of it’s revenue, but like where, why 20 26? Are they all of a sudden thinking about, hey, let’s go from 20 to 45. Do you have insight on that by chance?
Derek Kamajian (02:37) No. So I had an initial meeting with the CEO and I have another meeting with her. Her name’s Francesca tonight. So we’ll dig a little bit deeper into that. I’m not, the why is pretty important. But for my brain, I’m just thinking operationally which is we talked a little bit about the financing. They’re doing very well financially. They’re not PE backed. She owns the company and this is just something.
Jeremy Walker (02:59) That she.
Derek Kamajian (03:00) and then when you normally have a founder like that, that’s she’s like a she’s got her law degree, something with psych degree. She owns the company and she was forward thinking enough to go from right before covid, they were just in vegas for her to say, screw it. We’re going to just own all telehealth. We’re gonna just expand try to figure this out ourselves when somebody’s like that. I’m like, okay, you’re at 1,520 states, let’s get, we’ll get you to the 50 states we’ll figure it out.
Jeremy Walker (03:31) There’s no, there’s no question. Yeah, just hearing that quick summary of who she is. They’re gonna make it happen. It sounds like so that’s really cool and excited for you that you got to partner with them alongside that journey. So let me, I’ll share a couple slides. I think I have like two or three for you here and then we’ll just keep the conversation going. I’ll try to honor the 15 minutes that we set up here so we can set up next steps if necessary. But let me start by just that might be the wrong one. Give me two seconds here. All right now, we should be good. Okay, cool. So essentially, right? You heard about us unitedhealthcare. We also have backing from optum, Google, sequoia, why did they invest in medallion, right? Why would they give us tens of millions of dollars? Because the process that you just described, right of spreadsheets, you would be surprised at how extensive that process is across the entire landscape of medical staff, credentialing and payer enrollment. Even for very large 1,000,000,000 dollar companies. A lot of them are still doing it with spreadsheets and paper. And so in our CEO, Derek also named Derek decided there’s got to be a better way. He was interviewing a bunch of his friends who are providers that are complaining that credentialing takes 120 days, right? And so that’s when he developed medallion. With the focus being how do we bring in modern technology? And how do we bring in AI into this antiquated space, right? Historically, right? From a revenue cycle perspective. Credentialing payer enrollment, licensure has been viewed as like a utility bill. It’s just something that you have to pay. But medallion tries to partner with RCM leaders with chief financial officers, with operations leaders to switch the narrative to, hey, every day that a provider is sitting on the sidelines, that provider is not generating billable revenue for your organization, right? So every single day that we can accelerate that process, not only is the provider happier because now they’re seeing patients sooner. But you’re also happier because you’re generating revenue faster, right? And so that’s.
Derek Kamajian (05:34) I think, and that’s a beautiful point. And that’s I think the number one selling point to any of these organizations which is whatever the cost of medallion is, you just match that up to the time saved, times the number of providers, times the billable hour, the billable weekly revenue. And then that’s money saved.
Jeremy Walker (05:50) Do you know, because that’s exactly, I mean, you’re describing the business case that we put together for, you know, over 400 customers that we have today? Do you know how providers are paid at insight today? Is it per visit? Is it like a contract? Are they W twos? Like help me understand that?
Derek Kamajian (06:04) The only thing that I understand is that most of their providers are 10 99 contractors. Okay? That’s the number one. And then when we meet today, I’ll get more of what’s the average billable, how much is each one generating all that fun stuff, right?
Jeremy Walker (06:19) For sure. So that’s helpful.
Jeremy Walker (06:21) And then I think kind of on that vein you’re talking about. So do they do any work with government payers? Or is it just commercial payers today?
Derek Kamajian (06:30) Well, I believe they have, they’re with about 20… commercial payers, you’re talking about government payers, like medicare and medicaid?
Jeremy Walker (06:40) Yes.
Derek Kamajian (06:41) Yeah. I believe they take medicare and medicaid as well. Okay?
Jeremy Walker (06:48) Awesome. And you said 20, about 20 commercial payers, and that’s across, you know, that would be 20 per state, correct? If I’m hearing you, right? Yeah.
Derek Kamajian (06:56) I believe they have, and we’ll talk more later that they have these national contracts. So they don’t have to start from scratch, state to state. I think they can just, you know, upload and communicate with the payer and then get whatever provider they have credential in that state that’s one. And then the other item that we’re looking into or that I’m looking into is, and remember, these are all psych providers. There’s, no MDS or dos, these are all psyds PHDS, social workers that there’s many state compacts that they’re not leveraging as well, right? So you can have one provider and then get them enrolled in it’s like 150 dollars per state. And it takes like 10 days to get them enrolled in whatever compact licensure is set up for whatever your license is, whether it’s a MD, do psy whatever it is. Most of these payers, I think psyds and PHDS have these as well. Okay?
Jeremy Walker (07:48) Perfect. That’s super helpful when we start to think about like potentially scoping all this out. We’ll have a ton of follow up questions on that, but that, I think that lays a good foundation of notes that I can give to my technical counterpart. So I appreciate that.
Derek Kamajian (08:01) And I think they’re organizing like with their payers, it’s on an excel sheet. So it’s Jeremy walker PHD. And then I think they just have a list of 20 payers and it’s red or green. I don’t think there’s like any way to organize the data or show who’s where really.
Jeremy Walker (08:17) Yeah, eventually we’ll you know, again if it makes sense to continue in next steps like we’ll give a full demo and show a little bit what it can look like when we integrate AI and workflows and automation. So appreciate the additional context. One story as I was kind of going through our customer database that I thought would be really relevant based on the email that you sent with me is family care center. So they came to us about three and a half years ago now and they were in a very similar position where they said, hey, we only have about five clinics today. We only have about 120 providers. We’re about to quadruple in size, right? In the next 18 months or so. Since partnering with medallion, they have been successful in doing just that. They’re now at 45 clinics and 650 providers here’s, the story that I think is directly relevant to insight is in that significant growth period, they have not had to add anyone to their credentialing payer enrollment and licensure team. So they started with two and they still have two people running all of those functions because of the automation. And, you know, kind of support that medallion is able to provide for them when you also look at, okay. So that’s the opex kind of side of things, right? Scalability without headcount right there’s. Also the component of accelerated revenue, which is what we talked about, right? The number of billable days that we’re saving. They were seeing a 90 to 120 day turnaround times with medallion. We’re averaging 45 to 60 days. On top of all of that, I don’t know what about delegation you’re you know, focusing on here, I think they’re a little small for now. But we were also able to get seven delegated agreements for them in the first year. So really it tells us the story of right? We’re going to reduce turnaround times, get your providers billable faster and generate revenue quicker. We’re also going to use automation to scale the organization without adding headcount, and without continuing having to go back. And, you know, hire people and then build out a team and then find a manager, promote someone. And so really it’s just, you know, decreasing the complexity of scale really. So is this relevant and helpful, Derek based on what you.
Derek Kamajian (10:26) know this is all beautiful. And as an operations lead, I think this is the best time before you have to migrate hundreds of providers. This is probably the best time to set up the system. And even if they’re not ready, which they are, this is still the time to do it because you don’t want to have a broken process and waste those days. So, I’m going to 100 percent push for this after I get I’ll during my fact finding and interviewing this week with all the leaders in the organization, I’ll get the average time it takes to get a provider to billable, I’ll see whatever pain points they have, and then I can share those with you as well what’s the average cost of integrating this into an organization the size of insight?
Jeremy Walker (11:10) So one thing I just wanted to have clarification on, I wanted to make it abundantly clear is, you know, we’re an end to end provider, right? So again, there’s absolutely a seat and a role for Susan in this equation, right? Some organizations they’re inflated with regards to the number of individuals they have, like some people have 10 people doing credentialing for a 1,000 people. And the play there is, hey, we’re going to bring down, you know, from 10 people down to two people or whatever. And so just so we’re clear, right? Because you talked about what’s the cost of implementing it, there’s an initial cost of course, but there’s also an ongoing services cost because we are, yeah, just wanted to make that clear for you. So really the cost is volume based. So again, what we would do is we would sit and we’d say, okay, you’ve got, you know, 40 providers today that you would need revalidations for every three years. You also plan on adding X number of providers in the next, you know, year, right?
Jeremy Walker (12:06) We extrapolate that out. All of our agreements are three years, right? So we try to do our best to forecast what the hiring trajectory is going to be for three years. And then we just line item how many payer enrollments are you going to need? How many credentialing? And at what tier of credentialing do you need your providers actually credentialed to? Right? With that comes our base software costs, right? Which includes the automation, do we need to do caqh management? So all of that as we start to do more of like the technical scoping of this will come out very clearly. And so I’d love to even put a pin on a number. But as it stands right now, I mean, what I’ll say like between you and I is because opex is really not part of the equation here. We’d found, you know, we’d make the foundation of the business case on that revenue acceleration component. And I can assure you we’ve never done a partnership that didn’t make sense for the organization financially. So we will ensure that we price and scope accordingly so that the juice is worth the squeeze. And if it’s not, we’ll part ways as friends and we have seen that happen before. So I guess as we continue to know each other, we’ll make sure it makes sense. Yeah.
Derek Kamajian (13:13) But that’s super helpful if you would like. It would be really helpful to me if you want to shoot me a list of questions that you think would be beneficial that I can ask the credentialing, any of that stuff that I can go, basically dig that up for you guys that’d be awesome.
Derek Kamajian (13:29) And then I don’t need an exact, you guys obviously have a formula but a basic range. So I’m putting together some financial documents where I want each one of their providers to… get compacted to get licensed through the compacting. That’s like it’s like 5,000 dollars per provider to get them registered in each one of these 30 or 40 states. So now that’s 100 and something 1,000 dollars plus we need to modify the contract so it doesn’t need to be exact, just some type of range. It’s totally okay if you get that after I send the doc, some of the answers to the documentation you have, I’m not going to share that information with anybody. So then we can actually get a real number after, but I would like to know just so we don’t you know, waste time.
Jeremy Walker (14:15) Absolutely. And just, you know, obviously the biggest lever is I’ll send you a scoping document that sometimes we review live on call. We’d be happy to do that. Sometimes we can just send it over and you can fill it out on your own as well. That’ll help us get, you know, a pretty close number. Is this budgeted? And if so, like what time frame are you trying to move forward? The only reason I ask is, of course, as, you know.
Derek Kamajian (14:38) Right. No, nothing’s budgeted, right? So this is a company that has lots of money, but they didn’t have the structure on large businesses like optum business cases, any of that, right? So we’re bringing the business cases and the scope and what the projections can be to them. That’s one of the reasons that they, they’re working with me to help them get that.
Jeremy Walker (14:59) For sure. Yeah. And one thing that we talked about earlier, I know you mentioned like you’d go and get, the turnaround times from the team today. And then we can kind of build a delta between where you’re at today. And then one thing I will talk about too is we actually have guaranteed slas for credentialing turnaround time. So essentially what that means is if we miss the market, what?
Derek Kamajian (15:20) Does SLA stand for?
Jeremy Walker (15:22) Service level agreement. So it’s essentially between medallion and insight, we would contractually agree with revenue bounds, you know, revenue on the table that we’re going to turn around credentialing files in five days, right? So we’re going to get providers credentialed in five days. And then there’s also what we look at on the back end, our average turnaround time for end to end provider enrollment is 54 days, right? So as I was doing my research, I actually found and I don’t know if this is up to date and current, but I actually found that today at insight, you know, for recruiting purposes, you’re promising providers that they will be credentialed in two to four weeks and that they will have a full schedule in one to two months after that. I was curious what insight you have on that. Is that still something that’s current today? And if so like how is the business doing against those promises to providers?
Derek Kamajian (16:21) Yeah, that’s a great question too. So that’s something else I can come to them with. I’ve never seen that short of a time period to be able to get a provider credentialed and up to billing in four weeks. So we’ll see what happens when I have my discussions today.
Jeremy Walker (16:34) Yeah. I was going to say because that’s I mean, the reality is like if that’s the case and they’re doing well against this SLA, that they have right to providers. I think the story really that we might help insight tell is that growth without headcount growth, without complexity and just the ability to continue to honor those slas and those agreements that they’re promising to providers.
Jeremy Walker (16:58) And so that’s how I’m thinking about like formulating the business case here. Is there anything that I might be missing? You know, the CEO, obviously, you’re going to talk to her later, but how else might she be thinking about, you know, return on investment for something like medallion?
Derek Kamajian (17:14) Yep. You nailed the, how quickly we can get a provider contract to build. And then the second is.
Derek Kamajian (17:25) Appropriate check off systems to go live in new states. Okay? So we just, we sent an offer to a new therapist and do we have any systems to make sure before that provider sees anybody that they are background check, caqh, license check and up to date with all the payers, and that’s part of whatever playbook system that we’re building, right? So saying that, hey, this is no longer a human thing. You don’t have to worry. You could lose all of your staff tomorrow. This is now structured where anybody can take over is extremely important to her.
Jeremy Walker (18:05) Makes sense. Okay. I love that. Well, let me show you. Do you got a couple more minutes? I know we’re yes.
Derek Kamajian (18:10) I do. Okay.
Jeremy Walker (18:12) I’m going to pull up… did you?
Derek Kamajian (18:15) Say they said they could get it to one week, one month, they can get a provider from hired to seeing patients. Is that?
Jeremy Walker (18:22) What you found? So they said, so I’m sure there’s like some gray area in here, right? But the promise was two to four week credentialing, so that’s just simply essentially primary source verification, right? And then after that two to four week commitment, there is a one to two month commitment that they would have a full schedule. And again, I’m sure there’s gray area and the business is protected from a legal perspective. But to me it sounds like have you ever seen anything like?
Derek Kamajian (18:47) That, have you ever seen it? The credentialing can be done relatively quickly. Your system can do that. But getting them up to date to be able to see patients and make sure that they’re registered with the payers, that takes more time than a month or two, correct?
Jeremy Walker (19:00) So the problem is correct. The problem is regardless of how efficient you build a process. And I’m speaking from a medallion perspective where there’s AI integrated everywhere in the system, you are still at liberty of the payer. So if they don’t want to respond or give updates or ask follow up questions, they’re not incentivized either way. So, medallion has built processes where we have automation and follow up. We’re actually piloting right now the ability to call payers with AI. And so it really truly is sadly the squeaky wheel gets the grease. And so those are some of the systems that we have set up because at the end of the day, once the credentialing packet is sent to the payer, it’s on them. And so we can only do what we can do. We also have lists of which payers respond, which day the best. And so all of that’s integrated into our system. But yes, you’re right? Oh, I had not seen that before where.
Derek Kamajian (19:58) Especially manual. If you have a human being sending packets emailing and then calling a random black hole at blue cross, you’re not getting any attention at a small thing like this. So that’s going to be interesting to speak to them about as well. Maybe it’s a marketing thing. I’m not sure. Maybe it’s older. Maybe that was true when they had two providers and they were changing it. Yeah.
Jeremy Walker (20:19) Exactly. So that’s kind of why I asked you. So I’ll send you a list of like the summary of our conversation today, a scoping document that you can kind of review with the team to try and forecast what the pricing might look like. And then with that same scoping document that will give us the ability to actually put together like what we call our business value assessment. It’s just essentially it’s a business case and I think after we get through that process, that’s probably the right time to maybe loop in your CEO so that we can review, hey, here is all the different areas that medallion is going to with guaranteed slas and with averages streamline the process right here’s the value. And then at that point, we would introduce to her formally like the price and all of that. So we’re a couple of steps away from that.
Derek Kamajian (21:08) We have to prank before we introduce to her.
Jeremy Walker (21:11) Yeah, for sure. Yeah.
Derek Kamajian (21:13) You’re the hero. We’re looking for Jeremy, you’re the one that’s going to save the business and let them scale. So I think that’s awesome. And this is what they need, right? You can’t build these processes off of just individual human knowledge. It doesn’t work that way you.
Jeremy Walker (21:29) Can, but it does not work and there’s a lot of complexity in doing it. And so I won’t say you can’t build it because people do. But this type of vision of, we need to find ways to do it faster, better, cheaper with automation and AI. And these types of companies like insight are the ones I think that are going to do really well in the next coming year. So excited to see what the impact could potentially be as we work on this. So just look for a couple of follow ups. I will ask, do you have availability next week? We can follow up and review like first glance at the business case and then introduce pricing?
Derek Kamajian (22:06) I love that. All right. Yeah. Let’s what do you want to do? Let’s see… can you do same time next Monday?
Jeremy Walker (22:20) That would be 11 30 eastern. I can do 12. I can’t do 11 30. Let’s do it 12 o’clock okay. I’ll put 45 minutes for us there just in case we need the extra time. Awesome. Well, Derek, great to connect.
Derek Kamajian (22:38) One more thing if it’s okay. I have, a part of my team. I have a credentialing individual that I may not in their company, but for my company, I might invite him as well. His name is Joshua. He can sounds.
Jeremy Walker (22:53) Awesome. Yeah, we’d love to have him. I’ll just because you’re adding him, I’ll throw on my technical counterpart as well. Mallory smith, who she’s been in the payr space for about 15 years now. So she knows everything ins and outs. So if he has any like technical questions that go above my head, we’ll have her on a resource as well. So, awesome. Well, looking forward to it, Derek and we’ll talk next week.
Derek Kamajian (23:15) All right, Jeremy. Thank you so much. All.
Jeremy Walker (23:17) Right. Take care.