Transcript
Jake Shubert (00:00) boom.
Jake Shubert (01:08) Hey, Tom. How are you?
15708071065 (01:12) Good afternoon. Hey, good afternoon, guys. I’m good.
Jake Shubert (01:16) Good. Glad to hear it. Hey, Andrew. How are you? I’m good. Thanks. I’m good. Nice. Thank you both for hopping on today. How have the last few weeks been… busy? Did you guys fill out a bracket this year?
15708071065 (01:40) I didn’t no, I haven’t done that in several years now, but I do watch a little bit.
Jake Shubert (01:47) Yeah, Andrew, how about you? Hello? Oh, hey, Glenda. How’s it going?
Glenda Mack (01:55) Good. How are you doing?
Jake Shubert (01:56) Doing good. How have you been?
Glenda Mack (02:00) Crazy, but I’m good.
Jake Shubert (02:03) Yeah. Well, crazy, hopefully just making the weeks go by faster.
Glenda Mack (02:08) That is for sure. My days go really fast.
Jake Shubert (02:10) Yeah, yeah. Awesome. Well, we can jump into things and start Sam and Nicole from our side. Let’s say they’re joining right now. They’re coming off another call. Hey, great timing. Nicole and Sam. We just mentioned.
Glenda Mack (02:22) It, sorry back to back kind of day.
Jake Shubert (02:25) Yeah.
Glenda Mack (02:26) I’m having that too. So, okay, we’re all on the same page then. Yeah, yeah.
Jake Shubert (02:32) And it’s great for us to meet when we’re finally past the it blockade I saw you guys were able to like actually accept the calendar invites this time. We.
Glenda Mack (02:40) Can actually see you now.
Jake Shubert (02:41) You can see us. I mean, it’s what a world. Yeah. When I first saw you guys accept the calendar invites, I was like, wow, what about the miracles of technology? Well, sweet, we can do a lot of things for today’s. Call. We had a 30 minute setup. Does the 30 minute still work for you guys?
Jake Shubert (02:59) Yes. Okay. Awesome. Well, really our plan as we last met, it was a few weeks ago. Now, it was like the very beginning of March. We did a demo of our platform… and for today’s, call, really what we wanted to do was we wanted to just chat through sort of where you guys are at? How the last few weeks have been, you know, your evaluation criteria, answering lingering questions that you guys have. Is there anything else you guys wanted to see in the platform? We can cover that as well, but then also wanted to do a little bit of a covering of like what your current state is what the future state would look like with medallion as well as some turnaround time comparisons. That was our plan for today’s, call. But was there anything that you guys wanted to make sure we covered today?
Glenda Mack (03:38) No, that’s good. That’s where we are mentally right now that.
Jake Shubert (03:42) sounds great. Well, I guess with that in mind, since it has been a few weeks, maybe Glenda, I’ll ask you like what have the last few weeks been like in terms of internal conversations, your evaluation process? Just curious how it’s been going?
Glenda Mack (03:55) So I’ve been having a lot of meetings with different platforms and reviewing them to see what they offer. I think we are past the decision of knowing we need to invest in a credentialing platform. We know we need to do it. So it’s really about at this point. It’s the interoperability that we might have and what that looks like. You know, we could we’re potentially CGM if we stay with them, they have a credentialing platform within their system that we could use. And we wouldn’t need to add on the challenge is going to be with like if we went with waystar for example, they do not have a credentialing platform. So we would have to bolt on something. And I guess my first question would be, how do you work with that kind of process? Because waystar seems to be able to integrate with pretty much anybody out there. From everything I can tell, have you integrated with waystar in the past?
Jake Shubert (05:01) Yeah. So just curious to sort of tie in with what we talked about interoperability. We’re obviously speaking directly about integrations. So sort of curious, what would be the kind of things you guys? It sounds like, you know, waystar, but also maybe paylocity we’ve talked about in the past, sort of curious like Glenda, what would be sort of on the table for you guys from like an interoperability perspective?
Glenda Mack (05:20) That’s a great question. I’m not sure. I know 100 percent the answer to it. I know that, I want a credentialing platform to interact with paylocity in the sense of being able to bring over new employees, all those kind of things and give the information back to paylocity once someone’s credentialed, but I also need somehow to make sure that the credentialing communication is occurring also to our billing platform and to whoever’s managing our billing structures. And so, however that dialogue occurs between the systems.
Jake Shubert (05:54) It.
Glenda Mack (05:55) just has to happen and it has to be fairly seamless. And, the other piece of this is that contract management side of it with just thinking about our insurance contracts and those kinds of things. And do we have a platform to manage that effectively as well? Yeah, a few.
Jake Shubert (06:18) Follow up questions there. And then I think I can take like a stab at answering all of those. You talked about. Some of the data that would be interacting between paylocity and a system like medallion any sort of credentialing vendor. When we talk about ways to start like going down to the billing, I imagine that’s probably just sending like the provider effective dates to that system. So that is that kind of in line with what you’re thinking about Glenda? Yeah?
Glenda Mack (06:42) Yeah. So that for every insurance that we have, we know what providers at any given point are credentialed and who’s coming on board essentially.
Jake Shubert (06:50) Cool. That’s perfectly straightforward. And then on the contracting side, I guess what kind of contracting support are you looking for? Is it getting new contracts? Is it? Yeah, I guess maybe I’ll sort of zoom out of the question. What kind of contracting support do you have?
Glenda Mack (07:06) In mind it’s contract maintenance and I think waystar will do some piece of that Andrew and Tom, you guys chime in here, please. But one of the things that I’m not sure we’re 100 percent doing well right now is making sure our contracts get updated routinely and it’s documented and that we’re validating. We have a system way to validate that what we’re actually getting paid is what our contract says, we should be paid. And there has to be some system support for that somewhere. And I think waystar’s going to have a big chunk of that. If we were to go with waystar, we’re with CGM right now and we still have some gaps, but I don’t want to speak for Tom because that’s more Tom’s wheelhouse than mine. So I want to give him a chance to chime in here.
15708071065 (07:57) I mean, that is part of the issue that we’re trying to find out is, you know, again some of the things that Glenda did say that we’re trying to determine is the revenue being recouped on the right percentages and so forth. We don’t have a platform to identify those types of differences and, you know, whatever that could be provided waystar you know, maybe would provide some of that. But, you know, biggest thing is we’re having difficulties in certain areas where the insurance companies are everybody’s offshore, nobody’s communicating everything’s AI, you know, we’re trying to get in touch with their contract management people. Nobody responds. You can’t get any updates and, you know, we need leverage there to, you know, healthcare is one great one to determine that is, you know, we’ve been trying to leverage that one for a while to get a rate increases with that and nobody’s responsive. It’s very, you know, healthcare is not unresponsive at all. Yeah. And.
Jake Shubert (09:09) I know that’s extremely frustrating. That was really helpful context. So, thank you. Glenda and Tom I’ll take the first stab at the same and then definitely let me know if there’s any color that I’m missing. So the gold pieces there’s, the interoperability, and there’s the contract management piece. So let me touch on both those interoperability. We have a fully open API. So integrating with tools like paylocity, paycom, et cetera, that’s maybe the most common workflow that we see. So there’s really paylocity has a good API. We have a good API. I don’t really see any barriers to entry there. So, I know you guys are doing if I remember correctly, like the end of March was like your paylocity go live if I’m remembering that, right? So.
Glenda Mack (09:50) Our first punch is April eight.
Jake Shubert (09:52) Perfect. So, yeah, with paylocity being up and running, I don’t see any reasons why we couldn’t integrate with paylocity. So that makes total sense. And we’re also happy to share API docs after this call. If there are tech people on your team who would like to review those kinds of things. So there’s that then there’s the RCM piece integrating with something like waystar. Obviously, that’s probably the second most common integration tool or workflow that we see is sending out that provider effective date. So that’s definitely something we can do there’s a few different ways to do it. It can be in bulk exports. It can be in real time updates, event based triggers. There’s a lot of different ways that can work. But the long and short of it is, yes, that’s something we can support as well. The next piece is the contract management. I think that answer is a little bit more nuanced. So when it comes to things like storing of your group contracts, revalidation requirements, things like, that is absolutely something that is covered inside of medallion. When we get to things like the fee scheduling, that is more of an RCM workflow. So that would be more of outside of the scope of what medallion covers. But I guess Sam on interoperability or contract management, any nuance that we should be adding here?
Glenda Mack (11:05) So I guess my question would be you said you’re comfortable it’s routine for you to integrate from the provider date effective those kind of things.
Glenda Mack (11:16) Is there an ability? And I’m probably asking a stupid question because I’m not an it person. So please just kind of take it with a grain of salt. Is there an ability for the contract management portal? That piece of it to integrate as well with the RCM? So that rates those kinds of things can be pushed to the RCM date, effective dates of contracts, changes in contracts can be pushed to the RCM. Can that happen? So?
Samantha Bouchard (11:49) Glenda. Just based on what I heard is that waystar would have kind of the RCM and the contract management. All in one. Is that what I heard or are you thinking about potentially doing a third system with the rates and the fee?
Jake Shubert (12:02) Schedules I?
Glenda Mack (12:03) Don’t want to do a third system. Yeah, I know that. And this is probably I have a call with waystar at four. So I’m going to ask them a similar question just so you’re aware. Yeah. So I know they have some payment integrity functions within waystar where they’re validating payments against charges and against what we’ve negotiated. What I don’t know. And a question I need to ask him is how does that information get into RCM into their RCM to actually do the work? If that makes sense? Yeah, I think that’s a, where is it coming from? Where does it live?
Samantha Bouchard (12:40) Yeah, I think that’s a great question for them.
Samantha Bouchard (12:43) So like I think the way you can think about where medallion comes in is like we’ll hold the, we can store like your group level agreement, but it’s more in regards to, okay, we were contracted with Aetna with this tin and this is the effective date of that. And then simply, it’s usually like the first page honestly of like the agreement. And then it kind of tells you when you’re due for like revalidation of that group contract, which is another important piece. So we would store all of that group enrollment data in the system along with those revalidation dates. And then we’d be able to push the status of those group contracts. So when they are revalidated into waystar in addition to that individual provider, par status by location, so that you’re able to instantly know when they’re par, you don’t have any of the scenarios like waiting two months to find out.
Samantha Bouchard (13:45) Okay, we can release claims. So I think you can think of like medallion and waystar, like working in partnership where we’re going to manage the revalidations, the enrollments, the par status, and then they would really manage more of that fee schedule checking and validation as like an added layer.
Glenda Mack (14:04) Yeah, that makes sense. Tom, where do we store that information today?
15708071065 (14:12) The contract information? Yes. Yeah, Kiki has that. Okay.
Glenda Mack (14:18) So Kiki’s manually tracking it?
15708071065 (14:21) Yeah, we don’t, there’s no spreadsheet or anything like that. That is obtainable?
Glenda Mack (14:28) Is she using a software platform?
15708071065 (14:33) For that? No, okay.
Glenda Mack (14:36) So if I went and I said Tom, can you tell me give me a list of all the contract companies we’re contracted with. Where would I get that list?
15708071065 (14:47) Kiki will be able to provide that.
Glenda Mack (14:49) Okay. But you don’t know how, but is she maintaining a spreadsheet with due dates and those kind of things and validation dates? Yes. Okay. All right. That’s what I’m trying to get to so she could potentially send me a spreadsheet. Okay. All right. Well, this really helps answer my questions. What I, what I know for sure is we’re going to do something and we’re going to make a decision in the next probably two weeks. Yeah, hopefully by the end of March, I want them to make the decision by the end of March. As far as patient timelines. One of the things that I wanted to ask you all is even if, so let’s say we’re going to move away from stem, we’re going to move to waystar, but that’s going to be a few months down the road. Can we go ahead and get started with you on the process and implementation? And then when we move over to the new system that integration occur?
Jake Shubert (15:44) Yes. And that would be the best practice, right? Which would be getting you guys up and running, onboarding, all the historical data, historical enrollments you guys have, making sure the platform is fully fleshed out and then having those bolt on integrations coming on during the next phase, that would typically be like the crawl walk run that we would see. So, yeah, we’re thinking about that the same way.
Glenda Mack (16:02) Okay. So remind me what the onboarding time is for medallion? Yeah.
Jake Shubert (16:06) Sure thing. So onboarding timeline, I like to break it out in two different ways. The first is getting you guys fully live, including all historical information that typically takes about eight to 12 weeks. However we can start seeing value in medallion within the first week or two by processing any new enrollments. You guys have any new providers? You guys have things like that can get started immediately without us needing to fully onboard the entirety of your providers, the entirety of your historical data. But to get fully up and running fully going live, we would say eight to 12 weeks. Does that make sense? Yeah.
Glenda Mack (16:46) So during that eight to 12 weeks… are you saying that medallion would not be able to manage that information from historical? We would still be during that eight to 12 weeks, we still would be maintaining our spreadsheet process that we currently have for historical until it’s fully operational. I’m trying to understand what that means.
Samantha Bouchard (17:10) Yeah. So I can lean in here, Glenda. I actually came over from our implementation team. And so really when it comes to our implementation, the big milestone is like ingesting your data. So we have an import template super basic, really easy to kind of like understand and use. If you have this information in spreadsheets, it should seamlessly kind of copy and paste over. But essentially, what we recommend is, you know, sending that import template over to you all as soon as you’re interested, you all starting to kind of see like what’s compatible? If you have that spreadsheet ready for us on day one, we’re off to the races like we can move really quickly. It’s just if there’s gaps there’s information that needs to gather that kind of is what can bottleneck out that timeline. But I mean I’ve implemented a group in as quick as like five to six weeks like completely because they had their data ready right out of the gate. And so there are ways to like if you have different enrollments and flight that you’re tracking, we can kind of load those and we can take those over from like a follow up perspective. So we could definitely scope that so that you’re kind of not in between two systems. So, yeah, there’s lots of different ways and we can definitely have like an implementation scoping session to make sure you’re kind of comfortable with what that exact kind of timeline and milestones would look like. Okay?
Glenda Mack (18:38) Yeah. And then awesome. And.
Jake Shubert (18:42) Then Glenda, you said you asked a dumb question before and it was not dumb at all. But now it is my time to ask a dumb question. If you’ll if you’ll allow me, you mentioned trying to make a decision in the next two weeks. And it seems like, the buckets you’re evaluating are kind of like, you know, full RCM versus, you know, medallion owning credentialing, and then, you know, maybe waystar owning RCM and I guess I’m interested in like again, this is where the dumb question comes in. How are you going to make that decision?
Glenda Mack (19:13) There’s it’s by this grid right here that you probably can’t read. I’ve got everything. I’ve got it based down on what the platform is, how do we manage the personnel? What’s the cost of the personnel? What’s the total cost to me? All in. So if I’m going to bolt you onto another system and then what labor cost do I have attached to that? And then it’s pros cons from there. And what is, what’s the risk level? What’s our risk tolerance with that situation? So… and what’s the risk of staying where we are, right? Yeah. So that’s my grid and I just like a picture, and show you my grid if you want. But I’ve got basically five different scenarios laid out. We stay exactly where we are. We don’t change anything. We just completely move everything over to CGM, everything from a labor standpoint. They just take it over completely. That would be all of our credentialing all of our prior off, all of our everything. Then then we have this idea of keeping that system, adding on their credentialing teeth to what we currently use and then taking all of the people part in house instead of having an offshore and an onshore just taking everything in house. And then we have this idea let’s just if we’re going to change, let’s just change everything and start fresh with new systems, fresh systems that are updated and intuitive. And we could do that. And that would essentially be like taking a waystar and bolting on a medallion and potentially bolting on a practice management. If we can’t get our verity system up and running to the level we need it by that time. And then with that, we could say having some of it offshore in that new system or we could just again be completely in house and take all that back in under our control. So that’s essentially my five scenarios. And I’ve been going and meeting with team members individually and saying, you read through these and tell me what you think and what’s the risk level? What’s the pros and cons. And, you know, how we’re going to manage the personnel, those kinds of questions. And it really is going to come down to, that collaboration. And I’ve got to present it to our owner and she’s ultimately going to say, yep go for this one or that one.
Jake Shubert (21:41) Yeah. And I guess if you don’t mind me asking, how is medallion stacking up so far on the grid?
Glenda Mack (21:46) I mean, medallion definitely has presented as a superior platform credit for credentialing just based on my research, and digging into some other platforms so that there’s, I could see going forward with medallion. If we’re going to do bolt ons, if we end up staying with CGM, then it doesn’t make sense to do a bolt on when they already have an integrated contract management and credentialing system. So that’s it ultimately decides which path one of these paths we decide to go. Sorry, it’s ultimately based on which one of these paths we decide to go down? Yeah.
Jake Shubert (22:25) That absolutely makes sense. And I guess just like… I guess, would it be helpful at all for us to speak to our experience about what we see for groups who leverage, you know, sort of full service rfcm companies for credentialing I think it just, it might be helpful just to share a little bit of our pov, I, I’ll call it that. I don’t want to come off as like too salesy when I’m saying this and don’t want to like diminish.
Glenda Mack (22:51) Hey, you’re a sales Guy, I am.
Jake Shubert (22:55) At least at least I pretend to be with Nicole on the call. But… as far as the RCM companies go, like there’s obviously, you know, there’s always those always value in like a, you know, one stop shop integrated solution. Like, I won’t pretend that there’s not any value there. But what we often see is like, and, you know, I’m sure you guys know this, but credentialing is like a really tough nut to crack. There are quite a few like very large RCM companies and also like ehr companies who actually like have already or are in active conversations to like purchase medallion services that way. Just sort of black box. We can be the ones managing their credentialing efforts. And then, you know, of course, they like upcharge our services and all that kind of thing. But like the bottom line that I just try to want to express because we’re you’re talking about sort of like risk tolerance and what things look like is that RCM companies overall do not typically do credentialing very well. And there’s not a ton of visibility, or data. It’s a lot more of like throwing things, you know, over the fence and kind of just waiting. They don’t really have built in slas in their contract either, which is something that we do, we contract to specific outcomes because this is all we do as a company. And they’re also never going to prioritize things the way your in house team, or vendor like medallion would, right? Like you’re going to likely see slower turnaround times and longer delays and lags between communication and action items being tackled. And again, I don’t want to disparage this completely because there’s there is value to that. I won’t pretend that there’s not, but just wanted to share our pov, because we do have a lot of groups who have had similar sort of fork in the road decisions and have found a lot of value in working with a tool like medallion. So, yeah, if you didn’t mind me sort of like, you know, chewing your ear off a little bit, but yeah, I just wanted to share and.
Glenda Mack (24:51) You’re not expressing anything that hasn’t that in some conversation I’ve had over the last couple of weeks hasn’t been said, yeah, where the risk is. And, and Andrew and I were just talking about it today that this idea of just handing things off to CGM completely and saying you take it soup to nuts, and do this really creates anxiety for us as an organization because then we do lose full control and to your point, where are they going to put their priority?
Glenda Mack (25:22) There’s going to be some priority because their fees are based on a percentage of collections. And so they’re going to want to collect, right? So there’s going to be an engagement from that perspective. But, you know, I’m a, you know, 40,000,000 dollar contract and they’ve got a couple 100,000,000 dollar contracts out there who’s going to get the most attention that’s where my biggest concern lies?
Jake Shubert (25:45) Sure. I appreciate you sharing. We have about five minutes left here. I unfortunately do have a hard stop because I have another call at the half hour with, you know, sort of the two week timeline. You want to figure out the decision by what would be like the best next steps here to support your decision making process, whether it is medallion or a different vendor. You end up choosing like what would be the things that would be most helpful on our side to make sure that you can come to, you know.
Glenda Mack (26:10) Your final decision. So if you could send me some information about contract terms that you typically use in your contract and then pricing again, you know, where would we be with pricing? That would be, really helpful kind of a one pager, you know, something like that where you can just give me a feel for your contract term. Primarily, I know we discussed cost a little bit already, but… is this a three year contract? Is this a five year contract? What do we pay during implementation phase? Those kinds of things I would really appreciate. Yeah.
Jake Shubert (26:50) Absolutely. So contract terms, we can send over our msa… and have all that information there. I can send over like a questionnaire as well that we can use to get the inputs we need to present you pricing. And then Glenda, maybe it would make sense for us to just connect next week and we can review a more detailed pricing proposal, but then also answer all the questions you have about terms, contract structure, things like that. So you have that information?
Glenda Mack (27:16) Yeah, we can do that. I would like to even before that just to get a broad because I’m trying to make these decisions based on cost and I’m making some assumptions on what your costs are. So, it’d be nice. It doesn’t have to be an exact number, but is it 25,000 dollars a year or is it 75,000 dollars a year? Right? Yeah, just a ball, at least get me in the ballpark of where you think we’ll end up? That would be appreciated.
Jake Shubert (27:44) Yeah, 100 percent. And we’ll just need some of the inputs from you guys first, so we understand sort of the overall scope of work. So I can, like I said, I can send that over email and then from there, what we can do is maybe share like a rough pricing estimate for you and then have that call where we walk through the estimate, answer questions you have and make sure that like, you know, everything you need to make that final decision. Okay, cool. How would maybe end of next week work for you?
Glenda Mack (28:13) So, Friday is good Friday. I’m going to try really hard to take that day off if I possibly can, we can.
Jake Shubert (28:21) Do Thursday if that’s better or we can do Monday the sixth?
Glenda Mack (28:27) Thursday would be fine. I actually have, a couple big blocks of time open on Thursday. So if you stay away from nine am, 10 30 and two, then I’m good. Yeah.
Jake Shubert (28:40) How about three PM eastern? So noon, pacific?
Glenda Mack (28:44) That’s fine. Okay, perfect.
Jake Shubert (28:47) Well, I will send over that calendar invite. We’ll send over the questionnaire as well, and we’ll get you some inputs before then, so, you know what to expect coming into that conversation. And if any questions pop up in the meantime, just let us know.
Andrew Harnish (28:58) Hey, Jake. Real.
Jake Shubert (28:59) Quick. Oh, Andrew. Yeah.
Andrew Harnish (29:00) Yeah. Would you mind also including that literature you mentioned about the API that you have, so I could get better for our tech team, just for review. I’d appreciate that.
Jake Shubert (29:09) Yep. Great. Paul. I perhaps write that down. Yeah, thank you, Andrew. I can totally do that as well. Cool. Awesome. Well, again, thank you so much team looking forward to chatting later next week.
Glenda Mack (29:19) All right. Thank you. Bye.
Jake Shubert (29:20) Everybody have a good day.