Transcript
Phone Caller #3 (00:03) all.
Phone Caller #5 (00:03) right. Guys, here we go.
Phone Caller #3 (00:04) Yeah, and then that way she can look at it later if she can’t all right?
Phone Caller #5 (00:07) And yeah, just in case she doesn’t get to join us, but if she pops in that would.
Phone Caller #3 (00:12) Be great here, she comes.
Phone Caller #3 (00:20) Hi, Holly guys.
Phone Caller #1 (00:22) I’m so sorry, I had a meeting running over and I could not, no.
Phone Caller #5 (00:25) Apologies, I just wanted to know if you stayed in the DM.
Phone Caller #3 (00:28) I.
Phone Caller #1 (00:29) did not, I did come home. How was it? It was beautiful. It was absolutely gorgeous. Nice. No, it was hard to leave. I bet.
Phone Caller #5 (00:42) Well, welcome home. And thank you so much for reaching out. You and I went back and forth. I feel like I already know you a little tiny bit. I just introduced myself to Craig and you are just in time to do introductions and then we’re going to turn everything over to my partners at medallion and let them take it from here.
Phone Caller #2 (01:05) Awesome. Yeah. So, I think Craig hang.
Phone Caller #5 (01:08) On one second, Jeremy, I would, I really like you to introduce or meet Holly, and Craig and let them talk to you about what they do at uvm and then you guys can do your thing. Yep.
Phone Caller #2 (01:20) That was the whole, that was the whole goal. I was just going to say pleasure to connect. And, yeah, I would love for you guys to do some quick introductions. Not only who you are, your title, because we were able to find all that on LinkedIn, but a little bit about what Drew you to the call today and what you’re hoping, to get out of the conversation today would be helpful to understand Holly.
Phone Caller #3 (01:37) You want to start?
Phone Caller #1 (01:39) Sure. I’m Holly turner, I’m the system director for medical staff, services, provider, credentialing and provider enrollment for our six hospital system here in Vermont and New York. I just recently started working with Craig who is helping us come up with some solutions to some of our enrollment challenges… and just trying to figure out ways to streamline everything that we’re doing and, you know, do more with less.
Phone Caller #2 (02:14) Yeah, for sure. I’ve definitely got some follow up questions for you. But Craig, I want to hear from you first, so sure.
Phone Caller #3 (02:20) Chase, I am the new system VP for and… you know, receiver and responsible for the provider enrollment side of what Holly does, you know, certainly ties into accounts receivable and our ability to bill and what have you. And we’re complicated because we’re in two different states with different sets of rules and criteria. I was at catholic health and Buffalo prior to this and had just gone through an overhaul of their provider enrollment because we were having the same challenges there that we have here and really hoping that there can be software that can help us. We, we have software now, but there’s no fancy bells or whistles if you will with it and hoping to see what else is out there in the market. And when the Haney’s piece came, email came out, you know, their newsletter and we saw this. We thought this might be an option for us or opportunity awesome.
Phone Caller #2 (03:18) Yeah, super helpful context. I’ll quickly introduce myself and then I’ll let Mallory do the same. And then I’ve got some questions already written down for you guys. So Jeremy walker, one of the account executives here at medallion, really, the goal is to interview folks like yourself to determine if there’s some feasibility of potentially partnering and then take whatever next steps need, to be take in order to draw closer to a partnership. So with that said Mallory will let you introduce yourself as well.
Phone Caller #5 (03:47) Thank you. Apologies.
Phone Caller #4 (03:50) For that, it’s springtime here in Tennessee. So, no, it’s a pleasure to meet everyone. I’m a solutions consultant here at medallion. I’ve been in the provider data space roughly for about 10 years or so with various vendor credentialing services. And I’m just here to support the conversation from a technical nature.
Phone Caller #2 (04:08) Awesome. Cool. So a couple of things I think you both mentioned and kind of clued into the enrollment challenges that you’re currently experiencing with the vendor that you have today. And before we really get into too much detail, I think what I’ll say is medallion, yes, we have a software and that’s what we developed and our core product is founded in AI and automation, accelerating these processes however possible. But part of the medallion partnership is also the services component. So we are an end to end provider in the space. And so, with that context in mind would love to learn a little bit more about, you know, where maybe the current system, and solution that you have is falling short and what you’re hoping to get from, you know, partnering with whether it’s medallion, or anyone else. And.
Phone Caller #3 (04:56) so before you launch into that, so are you, do you offer software only or you offer only the end to end solution that happens to take advantage of the software you developed?
Phone Caller #2 (05:08) So I’ll answer that question briefly and then I’ll elaborate. We are both. So we don’t just sell software. And the reason why? Okay a lot of organizations come to medallion for one of a couple reasons. But the biggest one that we help with is really accelerating turnaround times and we actually have guaranteed outcomes within our customer agreement. You know, for example, like our credentialing SLA that has revenue bound to it is three days, right? So we’re going to get a credentialing packet out to your payers in three days or less. And so we can’t agree to those slas, if your team is still doing, you know, the bulk of the work. And so that’s a core reason why people come to medallion and partner with us is because of those guaranteed turnaround times. And in order for us to do that, we have to own both the software and the services of it. So again, we don’t want to, you know, force any additional conversations. If you guys are purely looking for, you know, a software only tool, we would probably not be the right fit for you. But if you’re open to exploring what it could look like and of course, still making really good use out of Holly and the team today because we can’t do this alone. We still need leaders and people that, you know, tell us who to enroll in what networks and invite those providers to the platform, things like that. So help give me a sense of where your head’s at regarding that we are not just a software tool.
Phone Caller #3 (06:38) And so how does that fit in? We are… delegated credentialing, we have that role. So how does that fit in with that kind of situation… for?
Phone Caller #2 (06:51) Sure. So Mallory, I can take a quick stab at this and just mention that part of medallion services is we also help expand your delegated networks. So for example, family care centers, they came to us and we were able to add seven delegated agreements for them in the first year. I can speak to what we do when we inherit delegated agreements, but I’ll let Mallory speak to that a little bit.
Phone Caller #4 (07:14) Yeah, of course. Great question. Craig. So we are an ncqa certified cvo. So you would basically designate us as your sub delegate. So the delegated agreements would still rest within your organization. And then what we could step in and do as far as the product service offering would be establish new delegated agreements with payers, credential providers to ncqa standards, automatic roster delegation. So if you’re having to spend multiple hours a week updating rosters to every single payer, it’s a very manual process. We do have a fully automated solution so that we just provide you the rosters on a monthly basis that you then share with the payers. And then the last piece is we also do audit preparation and support. So when you have to do the annual audits with payers, we would be able to assist comprehensively there.
Phone Caller #3 (08:03) I mean, we don’t know what we don’t know. So it’s worth taking a look. So that would be great.
Phone Caller #2 (08:09) Sorry, you kind of cut out there. What was that Craig?
Phone Caller #3 (08:12) Oh, I’m sorry. I had said that we don’t know what we don’t know. So it would be worthwhile taking a look at what you offer.
Phone Caller #2 (08:21) Yeah, for sure. And we didn’t come today, prepared to demo. I mean we could, I would really be putting Mallory on the spot, but I think what we wanted to use our time today for is to discover what the goals are. Again if you don’t mind elaborating on some of the shortcomings of the current process. Holly, you had mentioned doing more with less and those are all things that medallion typically aligns with, but actually quantifying that with a vision of what you would like the future to look like, I think will be helpful. And then we can again, if there’s still a conversation to be had, we can set up a demo for our next conversation. But yeah, I would love to hear from you guys what, what’s broken today, and what would you like the future to look like for your organization?
Phone Caller #1 (09:09) You want me to go Craig?
Phone Caller #3 (09:11) Yeah.
Phone Caller #2 (09:12) Well,
Phone Caller #1 (09:14) I would say the primary broken piece is reporting. So we switched to qgenda credentialing just about two years ago. We might even be celebrating our two year anniversary on that platform. We’ve actually, it’s been a great transition for us in almost every single way. We have a distinct agreement with qgenda to help partner with them to improve their product, to make them top of market. It’s something that we entered into with them. So, we have regular development meetings with them… you know, from where they started to where they are today. I think they would advise that they are definitely… they’re definitely closing in on being top of market in a lot of places. The reporting piece has been one standout for us that we continue to struggle with meeting the demands of our payers.
Phone Caller #1 (10:17) And I think qgenda has continued to fight that struggle with us. They are currently working on some AI assisted development which they had been hopeful to have out the first of this year. I don’t know exactly when they anticipate getting that finalized, but they are working with my supervisor for payr services, on fine tuning that product. She’s actually in use, case testing and things like that with them on a regular basis. I do think I’m being completely transparent, they are not going to hit 100 percent of what we need even when they roll out their products. I think that’s important to call out that.
Phone Caller #1 (11:08) I, I’m not sure that they’re what they’re coming forward with is even still gonna hit 100 percent of what we need. As Craig alluded to, our system is really complex being six hospitals, three in Vermont, three in New York. And sometimes we bill from our Vermont tax ids for our services that are rendered in New York and vice versa. So, so that makes it a little bit challenging. We have a lot of shared providers across state lines. That makes it also a little bit challenging. Lots and lots of providers who have licenses in both states and, you know, all that kind of good stuff. I would say that’s the primary.
Phone Caller #1 (11:54) Secondarily, I would say it just isn’t an enrollment solution. It’s a credentialing and med staff product which has been finagled to work for enrollment. And I do think that they, again, from a development perspective, they are working on trying to make it a, you know, serve all purposes product that I, you know, I’d want to pull in my supervisor for payer services to give you a little bit more of the nuances on exactly where the system falls down. But I think location management and reporting are probably some of the biggest challenges that we have. To Craig’s point we are delegated. So, I’m really curious about how a sub delegation would help us establish new delegated agreements. That one really keys in for me, because we have, we had seven non delegated contracts a few years ago. I think we’re down to three or four now. So it’s not certainly, that burden is not as big as it used to be, but, it’s still a challenge. And tracking those delegate, non delegated submissions, getting… follow up with the payers to actually see things across the finish line is probably another one of our biggest pain points because we have to nag constantly… yeah.
Phone Caller #2 (13:22) That’s really good context again. I’m sure Mallory, I saw you come off, you know, give you a chance to ask a question in a minute here, but I was curious, so, you mentioned reporting, right? And that being a huge part, of why you’re considering making a switch off of qgenda, I’m I would be curious to understand like what is the, what is the outcome on the back end of those issues with reporting that you’re seeing that’s really justifying this search for a new potential partner? And my guess might be that it has something to do with like claims denials and write offs, but I’d be curious to know like on the back end of reporting, and all of the challenges that you have, what are you seeing that’s kind of in the red, and why we’re talking today, if that makes sense? Yeah.
Phone Caller #1 (14:11) I probably would lean to you Craig to say a little bit more about that. I think, from my perspective because I’m not a billing person and I don’t necessarily see all the issues that Craig and his team. Other teams see it’s for us. It’s it’s manual. Like I have a, very small enrollment team and they are manually completing roster templates. They are manually completing things in availity. So that would be, you know, another thing is that we are more and more payers are starting to move to us having to do uploads of data or manual entry of data into their systems. So availity being one of the key ones. And I, and my team is doing that manually. In a lot of cases, they can run reports and get them only so far. And then they have to complete everything else that’s required by typing into spreadsheets, copying, pasting into spreadsheets. Yeah.
Phone Caller #2 (15:11) That’s also helpful and good to know. I think, yeah, Craig, I saw you come off, mute would love like from a revenue cycle perspective. How are you seeing reporting impact revenue cycle?
Phone Caller #3 (15:21) Well, I don’t know if it’s reporting specifically. It is just with the roster management. Maybe that’s part of it. I’m not sure. But I can say that we write off, you know, a couple 1,000,000 dollars a year to enrollment challenges, not just initial enrollments, but in particular, re enrollments where we’ve missed the timeframe and, or we, you know, for whatever reason, don’t have visibility in it and it’s not just payr enrollment, it’s things like, you know, New York medicaid etins, like any of those type of enrollments. And then the other challenge that we have is, and I don’t know if your system even handles this but, you know, we have to enroll for a variety of types of services. So we have part B enrollments, we have part a enrollments, we have dme enrollments, we have individual payr enrollments. So we don’t have currently because of Holly’s very small team. I think she has three people. It’s really tiny for the size of us that can help us get through the enrollment piece. And so that leads the non provider enrollments like the part a’s and the dme being completely decentralized and everybody’s doing something different and that’s how things get missed. So we really need a way to be able to pull it all in too.
Phone Caller #4 (16:49) Thanks, Craig there for the insight. Jeremy. If I could just ask a quick question. Two questions. Sorry. So Holly you had mentioned that if I understood you correctly, you went from seven delegated agreements down to four. Is that correct?
Phone Caller #1 (17:03) No seven non delegated. So we have 27, I think or 29 delegated contracts with our commercial payers. We had seven non delegated when maybe five or so years ago. And I think we’re now down to like just like four that are non delegated that our team actually takes data from our system, pre populates applications and then submits them to the payer and then tracks them through the payer’s credentialing and enrollment process versus us managing it. We’re just managing helping the providers fill out their applications, getting them submitted and then monitoring them.
Phone Caller #4 (17:44) Okay. Thank you. I’m glad I clarified because I thought I was like you lost delegated agreements. Okay? Thank you. And then Craig with the insight that you’re able to offer, I will let you know medallion is fully comprehensive when you think of enrollment services. So whether it’s group enrollment, individual, part a, part B dme, we do group individual and facility enrollments at all levels. And I would say the biggest value point that you would see would actually be this all within the same same system it’s one system providers can access. So your team can access it, you’ll see everything that’s happening that our team is doing on behalf of yours. So whether it is completing applications through availity, which we do have portal automation as well as portal scrapers. So no more having to visually key in any information. And instead of having to check the portal every two weeks, we have scrapers that check it every night at midnight. So that way you’re not waiting two weeks for an effective date that’s just been sitting there. So thank you for providing the information. If we do move forward to a demo, I’ll be sure and show you those aspects.
Phone Caller #3 (18:50) Yeah, I think from the reporting standpoint, you know, the information that the payers want is different, the abbreviations they use for specialties. Sometimes it’s all typed out. Sometimes it’s shortened or what have you. So that variation also really causes us some problems and leads to some of the manual data entering that we have to do. So, you know, anything around making that easier would be really great.
Phone Caller #4 (19:20) Absolutely.
Phone Caller #1 (19:22) Yeah. I would definitely love to see that… you did, you mentioned something about sub delegating or, you know, you could have the potential to expand delegated agreements. I mean we are also an ncqa accredited cvo. So, you know, as far as that goes, we go through the audit process every three years ourselves and, you know, maintain that certification. But how would sub delegating allow us to expand our delegation agreements? Because let me just say because I’m told by our contracting department that the payers that don’t delegate to us are not willing to delegate to us.
Phone Caller #4 (20:10) Absolutely. I think that’s a great call out. So, I think from a technical perspective, how the sub delegation would work, we keep our ncqa certification. You keep your ncqa accreditation. You would basically just put the clause and your policies and procedures that you have with each health plan to say medallion will be doing the actual legwork if you will. So they’ll be actually completing or credentialing the providers, and then we’ll automate the rosters for you and then do on a monthly basis. So one value when we think of an Roi here is how much time is your team dedicating to the roster management? And then that’s something we could just immediately take off your plate. I think the other aspect of it too is Holly to your point, we would definitely have to have conversations with those payers and find out why are you not willing to delegate? Is it based on volume? Is it based on how you interact with each of your different provider groups? So we would just have to explore further there.
Phone Caller #3 (21:04) But you don’t have a magic button or a magic wand that’ll have them participate, right? So it’s not. Okay.
Phone Caller #4 (21:14) It’s funny that you mentioned that because my husband loves a three year old. Well, there you go. And he did put me off a wand. It’s an inside joke. But to answer your question, Craig, there’s not necessarily a magic wand that we do have, but we do have established relationships. And because we do work with payers directly, we do have payers across the nation that are partnering with us on what we call a cred alliance. So not only do we do provider groups as well as hospitals, health systems, we are also working with payers directly to help establish that relationship as well.
Phone Caller #3 (21:45) Okay. And I know that we’re short on time here, but just so that we can look at whether or not this is something we will pursue, what is your pricing model? And, you know, for a system our size ballparking, you know, like big super high ballparking, you know, what does the service cost? Yeah.
Phone Caller #2 (22:11) I think I’ll do my best to answer the question. I think because of the complexity of your system, I promise you, this is not a scripted sales answer. This is just genuinely like there is a lot of nuance in what you described about your process that we do not understand today. I will say with 29 delegated agreements if we were to, you know, pick things up where they’re left off with those and then do enrollments and revalidations for the providers that you have today. You’d probably be looking close to a seven figure investment. However the business case would really be hinged on if medallion brings in automation, that’s going to guarantee we don’t miss revalidations. What is the impact, that has on the back end when it comes to claims denied, right? And so that’s really how I’m thinking about that. Also the acceleration component of revenue where we get providers and network X, number of days faster. How does that translate to revenue? So, and that’s me being super transparent.
Phone Caller #3 (23:10) That’s fine. So.
Phone Caller #2 (23:11) That’s again, we would need to do a lot more discovery. It could be less than that, it could be a little bit more than that. I’m not exactly sure. I think if it makes sense on your end, we’d love to actually give you guys a demo sometime in the next week or two. That way you can kind of look at our reporting, compare it to what you currently have. See some of the automation, the workflows that we’ve built and we could discuss more about sub delegation as well. Does that make sense for us? Maybe like I said next week or the following?
Phone Caller #3 (23:42) Makes sense to me, Holly? Yeah.
Phone Caller #1 (23:44) Absolutely. Okay. I would definitely be curious when we get back together to hear also some, you know, some of your thoughts on, you know, Craig knows, New York medicaid is the bane of our existence.
Phone Caller #3 (23:57) And.
Phone Caller #1 (23:57) you know, we’d love to hear more if you have thoughts on being able to improve the turnaround time enrollment for New York medicaid. We’re.
Phone Caller #3 (24:09) going to need your wand.
Phone Caller #1 (24:10) Yeah, we need that wand Valerie.
Phone Caller #4 (24:12) Bring it out. We’ll bring it… we’ll.
Phone Caller #2 (24:16) definitely be able to pull some data points for that and have a productive conversation there. I’m looking at next Thursday. What availability do both of you have for Thursday?
Phone Caller #1 (24:27) Very little, Thursday is literally my busiest day in the week.
Phone Caller #3 (24:30) How about?
Phone Caller #2 (24:31) Friday? The third is also decent for us.
Phone Caller #1 (24:35) Everything I have on Friday could be flexible.
Phone Caller #3 (24:38) Yeah, any time after, yeah, any time after one P. M is fine.
Phone Caller #2 (24:46) Okay. Let’s do two P. M Eastern Time on Friday. The third, I’ll send that over here in a couple minutes as well as a follow up highlighting our conversation. I appreciate you letting us stay two minutes over and chat.
Phone Caller #1 (24:58) I apologize for being late Benny.
Phone Caller #2 (25:00) Okay. Holly.
Phone Caller #3 (25:01) We’ll make up.
Phone Caller #2 (25:02) For it next week chair.
Phone Caller #5 (25:03) You have everybody’s email addresses. I can forward those to them or?
Phone Caller #3 (25:07) To you. Yes, I.
Phone Caller #2 (25:08) got them in today’s. Calendar invite excellent.
Phone Caller #5 (25:10) I won’t be joining you all. I’m going to hand you off to the, very capable for me. It was wonderful to sit here and listen to you guys talk about it. And it was great to meet you guys, Holly and Craig and I think you’re in great hands and you’re going to be blown away for sure. I was when I met them and they were certainly hands down the best of the best and we interviewed quite a few. So, I hope that you guys have a great afternoon and I can’t thank you enough for reaching out to us so we could connect you with medallion and Jeremy and Mallory and I’m jealous about your visit to the Dominican and I’m going to call you later and get the low down.
Phone Caller #3 (25:59) I.
Phone Caller #5 (25:59) just want to know. Was there a swim up bar in the pool?
Phone Caller #1 (26:04) Absolutely all.
Phone Caller #4 (26:05) Right. More.
Phone Caller #1 (26:06) Than one. There you go.
Phone Caller #3 (26:08) Thank you for putting this together.
Phone Caller #2 (26:10) Yeah, thanks, Terry. Have.
Phone Caller #5 (26:11) A great.
Phone Caller #2 (26:11) Afternoon, thank.
Phone Caller #4 (26:12) You take.
Phone Caller #5 (26:13) Care.