Transcript
Erica Lloyd (00:00) hey, Erica. Hey, Patrick. Good to meet you. Good to meet you too. How are you? Doing? Good, good. Are you down in Baltimore?
Patrick Kelly (00:08) Yeah, I’m in hunt valley area right now. Nice.
Erica Lloyd (00:11) I lived in the DC area for about six years.
Patrick Kelly (00:15) Oh, nice. What area?
Erica Lloyd (00:17) All over, I was in gaithersburg for part of the time. I lived in Arlington, and then we moved out to Reston the last year.
Patrick Kelly (00:26) Nice. Yeah. I have a, some friends. I used to work in silver spring. So I have some friends who still live out that way. My one friend just moved to, he used to live in Arlington, moved to Ashburn. So.
Erica Lloyd (00:41) How it goes, I saw we had a lot of common connections. I was like, we must know each other from the DC staffing world.
Patrick Kelly (00:49) I’m sure. I am sure.
Erica Lloyd (00:53) Well, thank you for carving out some time. Just a quick introduction. My name is Erica Lloyd. I’m an enterprise account executive here at bdallion, and I support customers through everything from the credentialing use case, everything from the time you get, you hire a provider, until the time they’re billable and ready to perform services. Do you mind doing an intro? And then I could just, yeah.
Patrick Kelly (01:16) Sure. Patrick Kelly, VP of ops. I guess now, I started here at healing partners about four years ago. We’re a multi state wound care practice and we’ve scaled up. I think when I started, we were in five or six states. Now we’re in 22. Oh, wow. So we’ve had some pretty big growth. I started in recruitment over recruitment here and eventually got credentialing and payer enrollment put under me and a couple other departments too as well.
Erica Lloyd (01:54) That’s some.
Patrick Kelly (01:55) Background, a lot of healthcare recruitment and startup tech. So.
Erica Lloyd (02:00) That’s an interesting pivot going from the recruiting and talent operation side to then taking on credentialing, how’s that been?
Patrick Kelly (02:08) Yeah, it’s been interesting. It’s been a learning curve for me a little bit. I think a lot of it. I think a lot of it just has to do with like I also own the onboarding process here when I first came in. And the credentialing team and the onboarding team were like not meshed 100 percent well and they’re all both asking for the same thing. Try to like sync them up a little bit better. And, you know, eventually when the manager of, the credentialing team was reporting into a lawyer and it wasn’t going where it needed to go and I don’t think she liked it either. So, yeah. So they, yeah, it’s been interesting. Like I said, learning curve, pay enrollment’s pretty tough credentialing and primary source verification. I worked in a staffing agency. So that stuff’s like I used to have to do that for all my nurses. So it’s not a big push but the payer enrollment’s a completely different world. So.
Erica Lloyd (03:02) Yeah, I guess, yeah, from, for, I guess we could kind of goal is really, I know you let me know you’re using healthstream or Healthstream, I think.
Patrick Kelly (03:13) Healthstream through by verity? Yeah.
Erica Lloyd (03:16) Okay. Yeah. So I think we could just explore like, hey here’s a little bit more about medallion and you have a little bit of knowledge there and really just see if there’s an appetite for anything internally from a change perspective, certainly.
Erica Lloyd (03:36) Yeah, I guess how is just to, how is it going with?
Patrick Kelly (03:41) I mean, I’ll be honest, Healthstream is not my favorite application. It’s built on a very old like SQL style database. So to get reports out of, it does suck for that instance. And I’ll be honest with you. I don’t like it. We’re just very ingrained in it now. So it makes it very hard for me to move away from it because we have an internal database hub operations hub we developed and it feeds a lot of data into it for our operation leaders to look at and for our revenue cycle team, to cross reference, and… you know, some things, it does do well. It does do like monthly checks and all that pretty well and categorizes them and kicks them off. So other than that, I think it’s I think it’s built for… it’s. Built for a hospital system and we’re a doctor’s practice. So it’s a little different there. But, you know, I don’t know, I will say customer service wise. They’re pretty good. Like whenever we have an issue, we put in a ticket and they help us either solve it or, you know, create a custom thing to do. So like that portion, they’re good. I just, I do find it a very like… I guess if I had to like technically break it down, it’s like the database is built off of like three different tables. So like sometimes getting a report that includes like everything you need in it is almost impossible because you’re pulling from like an enrollment table, you’re pulling from a credentialing table. You’re pulling from a privileging table and it’s like, okay, it’s annoying. So.
Erica Lloyd (05:22) Yeah. I mean, it’s a software not necessarily.
Patrick Kelly (05:26) Yeah, the company’s okay, great. And worked well with us. The software itself I think needs update to the 20 first century. So, yeah, like I’ve seen medallion, I like the look of medallion. I just, well, last time we saw medallion, it was like we had to purchase service hours and it like we didn’t want, we have our own shop and they handle the work very well. So we don’t need that necessarily.
Erica Lloyd (05:52) So, okay. Yeah, it’s still, I would say we’ve now, we obviously, so I would say from a like strategic standpoint, we’ve obviously invested quite a bit in agentic AI, which is, yeah, you know, that’s.
Patrick Kelly (06:10) what I’m interested in seeing because I haven’t heard a peep out of like, I just went to an HR tech conference because I also sit on a lot of the tech committee here. And the fact that like onboarding in and of itself will go away in the next year, like it will not be a portal. It will be you chatting with a bot and giving the bot the information it needs and it’ll be filling out, those documents for you. Like really? Yeah, I know it won’t hit businesses our size quite as good, but it’s happening in the larger companies already. And like, you know, even applications, we’re about to launch a website for our career site or refresh. And like you could chat with the bot on there and give it everything you want to fill out the initial application. Like you don’t even need to go to the application. So like agentic AI is getting to the point where it can really do those pretty linear processes very well and credentialing actually… from a couple though because we have looked at a couple like agentic AI, healthcare vendors to look to see if they can help us with stuff. Like I will say, credentialing is the one they all back off of because it is probably weirdly, the most non linear process. Like revenue cycle is much more linear. Like you get the notes, you code, the notes you bill, you send it out, you collect or you have to rebuild. So like credentialing is not quite as linear for when you’re doing enrollments, but it could be so, and it’ll only be a matter of time until I feel like it could probably do some of those items, yeah.
Erica Lloyd (07:50) I mean, we necessarily, we don’t handle any of the revenue cycle and billing. Yeah, directly. We’re pretty much and I’ll give you a slide here. It’s probably expanded since you saw, I.
Patrick Kelly (08:03) Would assume I actually have… access to we’re, we were purchasing another practice and they had medallions. So, I have seen it more recently a little bit on the back end, but it just really gives me reports. I don’t log into it because we’re not sure if we’re going through with the sale and I don’t want to be all up in their data, so.
Erica Lloyd (08:27) Okay. I was going to ask but I guess it’s probably still under wraps on who?
Patrick Kelly (08:31) You’re yeah, I think so. I, it’s mendota. Okay. It’s the name of the clients, a small practice in Minnesota. So, okay.
Erica Lloyd (08:43) Yeah. I’m one of like 30 here. So yeah, I mean, so no, that’s good to know. I would say that’s like a very small one of the value props is obviously reporting, which it sounds like you’re experiencing a little bit of the pain. It’s probably not. It’s usually like an ancillary benefit is the reporting here, but typically where the value where the value really lies obviously using, the automation. So typically, we’re now moved and I don’t know when you looked at it where it was. But now we’re probably around 90 percent automated. Okay, we have, I think like 85 plus engineers on shore that are continuing, to invest. We raised a series D that was led by a crew capital. We have investors from Salesforce, Google ventures, optim, continuing to invest like as you’re saying, it’s not a matter of it’s a matter of, when?
Patrick Kelly (09:39) Yeah, exactly.
Erica Lloyd (09:40) When, so there’s going to be probably be a couple big players in the space. Hopefully we’re one of them of who’s really automating this credentialing process. So we have, I think probably back on privileging and hospital applications where it wasn’t part of our offering the last couple years that’s been relatively new. The process is very similar to payer enrollment. So the follow ups we’re using agentic phone calls, RPA technology for form, filling the phone calls. Are we use like pair process guides to follow up throughout the pair enrollment process exactly at the point when it needs to be followed up to move it. And typically those parent moment timelines. I don’t know what yours are today. Ours are compressed for non delegated around 52 days to part status. We’re here seeing typically for manual teams, 90 to 120 days. Yeah.
Patrick Kelly (10:30) It depends. It’s usually, I think we sit at medicare medicaid where we’re at 30, we’re pretty good at those that’s really good. I mean, some states are more obviously we pop up to 60 in a couple states. But, but third party we’re anywhere from… 30. I mean Aetna’s pretty quick 30 to like some of our blue cross blue shields. And united healthcare is a bear of a thing like 120 at the most. Is what we’re looking at, so.
Erica Lloyd (11:08) Okay. And those are all like your non delegated payers?
Patrick Kelly (11:11) Yeah.
Erica Lloyd (11:13) Yes. Okay. Do you have delegation with any… we?
Patrick Kelly (11:19) Do, okay. We have both payers for both sides. So… we just submitted and we have a lot goes through availability now too as well. So.
Erica Lloyd (11:30) Availability is out like I’m not as familiar. My SE probably knows. Availability. Is that like a contracting software or a platform?
Patrick Kelly (11:39) Kind of it’s like a conglomerate… payer enrollment portal. So like basically like a bunch of insurance companies have bought into a third party where you log in and hook the caqh up to it. But then you also have to go in and fill out any of the extra documents on there and you can like select the insurances on there. So like a lot of times it’s like the blue cross, the Aetna the like there’s a handful of like depending on what state you’re looking at, there’s a handful of insurances already in there, you still have to contract with them separately. But when they go to enrollment, they send you to availability and you do all the enrollments through availability.
Erica Lloyd (12:19) So, okay. Does that make it faster?
Patrick Kelly (12:24) I mean, not really, it’s just a different spot that they want you to go. They don’t most of them, a lot of them are doing away with their enrollment websites and moving to that.
Erica Lloyd (12:33) Yes, I’ve heard there are a significant number of states doing that state by state that are ones that were paper processed, are now going through portals and it’s always fun to figure out which state and which payer is now doing a different process. So that’s something another fun thing that we can that we kind of take off the plate. But yeah, I’d say kind of like value proposition is the antiquated process. There’s really not a lot of automation going on in this process today, taking a really significant amount of time when you’re trying to onboard providers and get them billable to start seeing patients and providing care. It can barely like bottleneck. It obviously, so we’re automating a significant amount. And then we also have the hands on folks for compliance in the areas that you just can’t automate. And then I think just like a key differential is that we have contracted outcomes. So we have slas that we contractly commit to for payer enrollment and credentialing. And those are typically significantly faster than some of those manual processes, delegated agreements.
Patrick Kelly (13:35) If.
Erica Lloyd (13:37) that’s a strategy to get more delegated agreements. We can help with that. And those are typically where we see a really strong compressed timelines anywhere from one we contractually commit to three business days, but we typically can get those applications done in one business day. So getting providers billable really quick, there… government payers, there’s, obviously some X factors there, but those we typically can get a little bit faster. It sounds like you’re pretty quick there, yeah.
Patrick Kelly (14:05) We were pretty good at especially medicare. We’re pretty good at submitting or re… not, if it’s a new person, it takes a little bit longer. But if it’s someone who already has a medicare portal, then we can just go in and move.
Erica Lloyd (14:19) Them. Okay. Do you see is most of your patients, is it pretty?
Patrick Kelly (14:27) Medicare and medicaid are probably like… that’s? Probably like 65 percent of our business. And then medicare and medicaid replacement plans are next and then commercial like pure regular commercial payer. So.
Erica Lloyd (14:44) Okay. That is a pretty heavy mix. So we’re seeing a lot of that.
Patrick Kelly (14:50) There’s so many replacement plans. Now. Everyone would be like got… them for some reason or got pushed into them. So. Yeah.
Erica Lloyd (15:00) Yeah. So I guess the like kind of the how on we, I won’t go too deep into it, but I guess the, how is economies… of scale payer process guides and automation to do it faster? And then here’s really the reasons folks partner with us where they’re moved from, a solution they have that’s a little more manual into a more like 20 26 solution. Obviously accelerate revenue if you’re are, if you’re gonna be significantly hiring, I know you’ve gone through some big pushes of hiring waves of providers. Not sure if those, do you have another one of those upcoming? Or is there something?
Patrick Kelly (15:42) We’ll do we’ll, do we are acquiring a practice out of Ohio that we’ll bring in next month? And then it’s gonna be kind of business as normal. So probably like… 40… or 50… it’ll probably be close to like 60 MPS for the rest of the year after that, so.
Erica Lloyd (16:06) That’s a decent I.
Patrick Kelly (16:07) Mean, we were, we did 200 and some last day, so… it’s a little more downward trend for us. But yeah, okay.
Erica Lloyd (16:17) So yeah, I mean if you’re doing the acquisition, sometimes that comes with a big wave where I don’t know if you just, move the tax id over or if you have to re, credential all those in the new tax?
Patrick Kelly (16:29) We usually re, credential them into our tax ids just because we found that honestly, like moving a tax id into and then doing a change of ownership takes forever in a lot of cases like we did that when we got bought and we had to do change of ownerships, and some of them took almost a year for the medicaid to really truly process them. So they didn’t like the sale documents or they didn’t you know, we had to provide extra information or the doctor who owns the practice who bought us wasn’t licensed in that state. So then we had to go back and get them licensed first and for them to be the owner. So, yeah, there’s a lot of work on that.
Erica Lloyd (17:17) Yeah, that sounds like it. Yeah, I guess the, are any of these value drivers kind of top of mind for you? And I guess the elt, do you report?
Patrick Kelly (17:29) Into, I think preventing write offs obviously and eliminate claim denials and onboarding people faster are always, you know, always here. And then the FT reductions one that we’re looking at because we’re not looking to grow our internal team any further, but we also don’t want to outsource. So we’re looking to bridge gaps with technology if we can. Okay?
Erica Lloyd (17:56) How many folks do you have right now handling credentialing on your team?
Patrick Kelly (18:01) So, I have two teams, a credentialing team, which you can kind of think of as primary source verification. And what we do is our business goes into long term care facilities. So every time a provider has a new facility, they have to go into, we have to go through their credentialing and privileging process. So they kind of fill out all that, all those like employee or provider packets that they want filled out and get over to them and work on emr access and things along those lines. So there’s one team that does that mainly. And then there’s another team that does payer enrollments. So that’s about three people on the payer enrollment team and six on the no, sorry, four on the other team.
Erica Lloyd (18:50) Okay. Four on the primary source.
Patrick Kelly (18:52) I think the problem with the primary source one is we’re filling out a lot of like specific packets that are specific to those places with, you know, it has to be on their letterhead. They’re jco certified things along those lines where we have to provide all the information for them or they have to go get occupational health done. So they kind of do all that. But those packets are usually, unfortunately, we’ve looked at a ton of systems to see if we can like get them uploaded. And we’ve uploaded into our current one and they just don’t ever map correctly. And it takes like weeks and months sometimes for the vendor to map them. So it’s easier for us to just put them into DocuSign and fill it out and send it for signature. So.
Erica Lloyd (19:30) Ooh, that’s a lot. It is. Yeah, that probably leads to some errors that it does occasionally. Okay. So, and then I guess the other question you said to reduce write offs, is that something? Yeah?
Patrick Kelly (19:48) I mean, occasionally we’ll have write offs just due to credentialing issues. We spin our providers up really fast. They’re off training in five weeks. So they’re seeing patients in five weeks. And if we only have a two week lead time on us getting an offer and extension out, then sometimes we can be behind on credentialing. Okay?
Erica Lloyd (20:08) So, they’re seeing patients and then not able to backdate and that’s the write.
Patrick Kelly (20:13) off. It’s a write off or they’re just like, you know, there’s occasional issues just with medicaid and medicare. Medicare usually not medicaid. Sometimes. So where like, you know, they’ll be enrolled but they won’t be fully attached to the entity. And, you know, it sometimes takes another 30 days to get them attached to the entity. So, and they’re already seeing patients. And some states will retro back to when you submitted, and other states will say when we approve is when we approve. So.
Erica Lloyd (20:49) Okay. Yeah. I mean that’s definitely an area that we can like optimize for. I won’t go too deep into these but it’s definitely something is like the write offs bridging the gap with technology. It’s you know, if you’re going to be doing more work but not hiring more people or even if you would be downsizing that team and moving those to other things, whether it’s working denials or just right sizing the team. That can be something unclear if it sounds like probably not an appetite to do some of the manual work of filling out the jco packets. We do have some things in place. It may or may not be applicable for this again. Like these are some of the things just from like a automation standpoint, RPA form filling technology, direct caqh integrations that are proprietary with medallion that’s going to help with the primary source verifications, so that it’s taking it from a team doing it to basically just directly porting over around 85 percent of the information directly.
Patrick Kelly (22:03) And we do import from currently Healthstream does import from caqh. So we do that initially. But a lot of times the providers don’t keep that up to date, correct? So when they fill out their app, we’re like that’s not your app is completely different than your caqh, what’s going on here? So.
Erica Lloyd (22:21) Okay. Yeah. So I guess, is there just giving you kind of like the high level over you? Do you think there’s any area that an area of like optimization just based on the initial kind of overview here? I?
Patrick Kelly (22:37) Mean, yeah, I mean, I think there is, I think if we can accelerate billable… getting billable fast and making sure we’re not writing things off and eliminating claim denials is always going to be good for us. And then the reduction by automating. So, I, you know, I do think like if you guys can add that value, then it would be valuable for us. Okay, just depend on, you know, what we’re dealing from a price point and what it actually looks like when we get in there. We also didn’t we were very close to selecting you guys and we ended up going with like a re implementation because if I can be honest, the previous team before I got here, just turned on the software and didn’t go through the full implementation for a Healthstream. So it was already a nightmare. So we had to do a re implementation to get it to a point where we had working apps and everything. The one issue I think we did have, I’m not sure if it was with medallion or another player is feeding… our internal system… our internal operations hub. I think you guys only had a data pool of once a day… overnight. And I think it was through a data vendor that we were not at the time comfortable with snowflake.
Erica Lloyd (24:08) I’m not sure if we’re using snowflake. Yeah.
Patrick Kelly (24:12) Can you check technically because I know that if that’s still going on and I can’t get my software… Guy who does our internal hub to be okay with it, then I probably can’t move forward on anything. I know snowflake’s fine personally. But the way that Healthstream works is we can hit a button in our operations software and pull over the data immediately. So like we can update it 500 times a day if we want. And that’s kind of what they want because our internal operations hub where it pulls a lot of data from all the multiple systems they’re trying to make it as real time as possible. So that’s.
Erica Lloyd (24:51) interesting because that’s like what we do have real time visibility. I wasn’t sure the vendor they use for it, if or, you know what the?
Patrick Kelly (24:57) Yeah. At the time I think and I know, I don’t I’ll be honest. I looked at a couple different software. So it might not have been you guys. I think, I know that you guys had like it was 50,000 and we had, and it was going to cost us a 1,000 for every enrollment… a.
Erica Lloyd (25:13) 1,000 for each enrollment that’s.
Patrick Kelly (25:15) what they quoted, I think was a 1,000 for, yeah, that.
Erica Lloyd (25:18) Medallion because.
Patrick Kelly (25:20) they were like we can’t sell you without you buying outsourcing hours. And, yeah.
Erica Lloyd (25:26) I mean, there definitely would be like outsourcing that were per SE, like we kind of save it like a hybrid option because you’re purchasing the software, but it really has to, in order for the automation to work, it needs to be, is.
Patrick Kelly (25:42) it real automation then, or is it a team doing it in the background?
Erica Lloyd (25:46) I mean, I would say it’s both. So they do have certain parts of it that are automated. And then they do have, you know, people too, since it can’t be fully and either the goal is to continue moving the needle on the automation as we move because… of how much it costs to build and run software. I don’t know if it’s going to how it’s going to impact our pricing. That’s like an internal conversation we’re figuring out, yeah.
Patrick Kelly (26:12) Because all the AI pricing is all over the place right now. It’s either. And also three months ago, it was nuts, it was like, you know, you couldn’t get anything for under 100,000, but now everyone’s coming back to you with like 30,000 to build a bot and like have it deploy and run up to X amount of time. So, yeah.
Erica Lloyd (26:33) I mean, we’re having, I think that’s like the big conversation is like how much? Because it’s been a, really big investment to build. What do, you know, how do you, what do you do with that? So I think we’re all kind.
Patrick Kelly (26:46) Of, are you comfortable talking your normal pricing structure? Yeah, because I’m going to be pulling a lot of data soon to see what we’re kind of looking like internally? Because we did like Healthstream is, has been, they do a provider… pricing plan. So like we have to keep re, upping the payment with them because every time we get more providers, they… do like provider based on provider headcount. So… yeah.
Erica Lloyd (27:18) So what we would say, we do charge, we have a seat. So provider data management. So we don’t charge for admin users, but we charge for providers, but we have a consumption based model. So I would say to, we would.
Patrick Kelly (27:30) Scope.
Erica Lloyd (27:31) that appropriately, and say, hey, based on the number of providers you have today and the number of new providers that you’re going to be hiring let’s just so you have a flat line on, how much you’re going to consume and you’re not adding folks on, you know, adding costs on. We just scope that and say here’s like the entire package. But yeah, I mean, it says still start at 50,000 for… a baseline package and.
Patrick Kelly (28:00) we, what is the baseline numbers then?
Erica Lloyd (28:03) So that would be with that would be talking about the number of providers. It really would it just that’s like our baseline, but because we have a consumption based model, it would just depend on which products use you’d want to include with this. And I’m happy to send you over a couple like scoping questions.
Patrick Kelly (28:24) Yeah, that’d be great.
Erica Lloyd (28:26) I know we’re coming up on time here. I’m sure you have another call too. But why don’t I send you? Why don’t I send you some of those questions and that way we can scope it correctly. And then do you want to, do you want, do you want to do we could go over like pricing or we could, I could show you a demo with our solutions consultant and go through some of the automation, what kind of feels right for you as a next, I.
Patrick Kelly (28:51) mean, let’s see a demo. But if I can get the like, I don’t want to waste your time. If the pricing is going to be like not within the ballpark of what we’re looking to do. So why don’t you scope up some like some level of pricing for us or you send over your scoping questions and I’ll send back what I have, and then we can go for a ballpark because like, you know, depending on how you’re billing it out, it can get, it can get out there pretty quick pretty high.
Patrick Kelly (29:19) And I know that I know what I can, I know what our team would possibly say yes to. I also really know what they’ll say no to, so.
Erica Lloyd (29:29) Yeah, that’s fair. So why don’t, I send that to you?
Patrick Kelly (29:31) As a follow up, I don’t want to waste your time and you come up with a great demo for us. And then I’m like no, sorry, that’s way out of the range. I.
Erica Lloyd (29:41) Totally can appreciate that. So, why don’t I send you that as a follow on and then we can go through the, we can go through the pricing and like business value. And then if we’re aligned, we can move forward with scheduling out a demo as well. That sounds awesome. All right. Well, it’s good to meet you.
Patrick Kelly (29:59) Yeah, it is good to meet you. And I thank you for reaching out like you’ve. Stayed very consistent and I appreciate that because I’ve never been this busy as I am in this. So, yeah, and… I appreciate you also, you gave the personal touch and that really helped. So, you know, you struck my ego and I appreciate that.
Erica Lloyd (30:23) Automation they have to break through the noise, somehow, right?
Patrick Kelly (30:27) Yeah, I know instead of the like 15, I get a day on LinkedIn that’s like almost the same statement of like, hey, you’re a, this, you want this and I’m like, no, I’m not even over that you didn’t even look at my profile. I have no clue who, like what that is.
Erica Lloyd (30:45) It’s only going to get worse.
Patrick Kelly (30:47) It is before it gets better until it gets really smart. Eventually, it’ll get really smart. And then we’ll be unsure whether we’re talking to people or humans. So.
Erica Lloyd (30:57) Absolutely. Okay. Well, good to meet you and I will send that over and I’ll talk to you soon. See you. Thanks Patrick. Bye.