Transcript
Angela Opalak (00:00) sorry, hi.
Mallory Smith (00:01) Hi.
Erica Lloyd (00:04) Good to meet you, good.
Angela Opalak (00:06) To meet you too. I’m sorry, I was just choking on a piece of cheese. I did not get lunch today. So I’m like,
Mallory Smith (00:12) feel free to eat.
Angela Opalak (00:14) Yeah.
Mallory Smith (00:17) If you’re going to choke on food, at least it’s cheese like that is like the best, you know, I just, I have five different types of cheeses a day. I love it. I’m a cheese.
Angela Opalak (00:27) Person too for sure.
Erica Lloyd (00:29) When.
Mallory Smith (00:29) charcuterie boards became a thing, I was like get out of my way right now.
Erica Lloyd (00:35) So, yeah, you can we understand back to back? Feel free to snack on a call with us. Well, great to meet you. Thanks so much, for jumping in. We can, we can hop right in.
Erica Lloyd (00:48) I know you’ve seen medallion before I took watched the call, from our last from the last conversation. So we’re up to speed. I’ll do some intros and then we can kind of jump right in if that sounds good.
Angela Opalak (01:01) Thank you so much. Yeah.
Erica Lloyd (01:03) So, my name’s R colloid, I’m an enterprise account executive here at medallion, been here for a little over a year and I’m based in New Jersey outside of New York.
Mallory Smith (01:14) And, and I’ll go next, Angela. So I’m a solutions consultant here at medallion. I’ve been here coming up on two years. Now. I’ve been in the pdm space though, for a number of years and I’m based in Nashville, Tennessee.
Angela Opalak (01:27) One of my favorite spots, do?
Mallory Smith (01:29) You like country music? Do you just like the music scene in general?
Angela Opalak (01:32) Love, love country music, but Nashville gives it a whole other dimension for sure. So.
Mallory Smith (01:39) Absolutely. I do have to ask. Have you heard Ella langley yet?
Angela Opalak (01:44) Yes.
Mallory Smith (01:45) Okay. She’s she’s like on top of the world right now, she just hit like a record number was like number one on the billboards longer than Taylor swift was for a female country song, and I’m just like you go girl. I love it.
Angela Opalak (01:55) She’s amazing. We’re going to see her in a few weeks. She opens for Morgan Wallen in gainesville, Florida hold.
Mallory Smith (02:02) On Morgan Wallen, is Erica’s favorite, and you’re telling me she’s opening. Wow, that’d be incredible.
Angela Opalak (02:11) Yeah, it’s going to be a great show, cool.
Mallory Smith (02:14) Well, so that’s me a pleasure to meet you. If you wanted to introduce yourself.
Angela Opalak (02:19) Yeah. So I’m the VP of revenue cycle here at commonwealth. I’ve only been with commonwealth less than a month. Definitely not new to the pain space or healthcare. I’ve been in healthcare probably… but I’m based in Florida, but our company headquarters is in Kentucky. We operate in seven states and I do have a great knowledge of medallion just doing an implementation at my prior company… implementation was rough but the product is great. So I was asked to look at some credentialing options in my interview process. So it’s definitely been on my radar to get started because we do have a credentialing team in house but it is not great. We kind of inherited the staff through acquisitions that we did and they’re kind of young and inexperienced and it’s taking them excessively long to get credentialing completed. There’s just a lack of structure and, you know, I think we’re just too big to handle it in house. To be fair. We’re just too big and we’re going to continue to grow and I just don’t think it’s I just think there might be another way to manage all of these providers, so.
Mallory Smith (03:46) Absolutely.
Angela Opalak (03:47) Yeah.
Erica Lloyd (03:48) Okay. That’s really helpful. Thanks for that context. So, and it’s funny. Mallory and I were talking and we heard that you had one manager and three ftes managing the process for 120 providers, hiring around five providers. That seems like actually a relatively lower volume.
Angela Opalak (04:06) For that, yeah, we don’t have enough help and I don’t think they use the Healthstream, whatever that is correctly. Like I cannot make heads, I’m pretty smart and, that is it’s not good. And I don’t think it serves like there’s no transparency to the clinics to our scheduling department, like they can’t see anything. And so it’s just held in the credentialing team. I’m like guys like if no one else can see it, I can understand why we’re seeing patients that are out of network and that, you know, there’s just a lot of, I think revenue gaps, with payr and just a lack of organization, you know. So we… need a solution. We need a solution and we need it quickly. So I said, let me reach out to medallion. Let me see what we can do contractually. I mean, I, you know, I just have it’s one of my top three things. I have to get done in the next, you know, 60 days or so.
Erica Lloyd (05:16) Okay. That’s what we can move at your pace. What just curious, what are the other two? They could, they could align to where we can take this? I.
Angela Opalak (05:25) mean, so one has hold on. I got to read it because I don’t so one is a third party company that uses the credi app to manage the data but they do the work. And then I don’t like modio and then I have a friend who referred me to another like third party company that uses a proprietary system. You know, they have about 20 plus years experience, but I haven’t spoken to them yet… you know? So you guys are the second people actually the first people I reached out to, but the second, the two of three. So I said, let me just go out because we can’t keep it in house. I mean, there’s no, financially, it doesn’t make sense from a just an overall work perspective. It doesn’t make sense. And I need a, I need a pretty powerful system. Like I said, we have a lot of clinics, we operate in a lot of states and we have a lot of providers. And so, and I have athena which, you know, I have a smaller revenue cycle team. Athena is a co source. So I need a system that my revenue cycle team can also have access to. It’s. Just a lot of moving parts here and a little bit disjointed and unorganized. So, yeah.
Erica Lloyd (06:51) Okay. That sounds, it sounds like you’re in the right place. So I guess modio would not have services.
Angela Opalak (06:58) With it, no.
Erica Lloyd (07:01) I know you’ve like I said, I know you’ve gone through implementation. We’ll try to make it as less bumpy as possible. We did, we did hire a new technical solutions manager or head of technical solutions who oversees all of implementation. We will try to give you. If you go with medallion, we will try and make, give you as much help on the back on the front end before getting to implementation to try and make it as easy as possible.
Angela Opalak (07:30) Yeah. Just to be fair, I don’t think it was all medallion’s fault. I think I’ll be honest. Like at the sales side, they said we’ll just take it. We’ll take an export from modio. And then, and then I think something changed and there was a shift saying, well, the modio export is, we have found is not very clean and it’s pretty bumpy. And then they sent us this like spreadsheet with all the tabs on it. And the truth is we had multiple tax ids, multiple entities, lots of providers. And I think that’s what made it horrible. It literally took us five months to complete that spreadsheet of 16,000 plus lines. So if that tells you how messy it was, I don’t think it’s all medallion’s fault, but I think the sales team just didn’t wasn’t upfront about the fact that we couldn’t just take an export from modio and start the process. It was just bulky because we have a lot of entities, a lot of tins, a lot of providers. We had a couple ipas thrown in there, a lot of locations. I mean, you know, this is a bigger organization, but I have a single tax id number and a single npi and that makes it so much easier for you guys. So that’s why I was like, I won’t repeat the same mistake again because it’s very different here. The structure is different. And so I think this structure aligns better with your platform. And so they had to do a lot of moving and grooving in the platform to make it work for us. And I had a great Guy. I don’t remember his name, who helped us with the spreadsheet. And he was like an excel genius, but, you know, it was helpful. I think it was just too late to bring him in. Like I wish we would have had him from the beginning because I think it would have made it better. But I don’t blame medallion for that, which is why we’re having this conversation because it was just how we were structured… that made it difficult. You know, the fact that we do operate in a singleton environment here will be a lot easier to manage. I think at medallion. Okay. Yeah, I don’t really want to take anything out of that credentialing anything because I don’t know that it’s accurate or correct. So I really want to start fresh, okay?
Erica Lloyd (09:53) Do you know, from a budgeting standpoint, do you know when it’s up for renewal? Like would you reallocate that spend? I?
Angela Opalak (10:03) Would reallocate the spend. I just don’t know what the spend is, but I also know that I’ll be able to shed some staff, certainly three or four ftes, but I’m not so much worried about the spend as I am about the revenue I’m losing right now because the credentialing’s not done like, I feel like it might break even at some point, but, I don’t because this organization is set up differently than my other organization. I don’t want to make an assumption about what medallion’s going to cost me. So I just said to my CFO I’m like just let me get a quote and let me see where our starting point is with medallion and we’ll go from there. So that’s kind of how I left it.
Angela Opalak (10:45) So, yeah. So I do need to do the math. I mean, that’s we know we need to make a change, but I also know that I’m going to probably shed a few full time employees and I’m going to get a pickup in just getting the work done faster so that I do know.
Erica Lloyd (11:04) Yeah. I mean, I think you’re thinking about this all the right ways so exactly we can pick up some opex there, recover some revenue. It sounds like you’re not doing a significant amount of hiring from a provider standpoint in this year, is that?
Angela Opalak (11:18) We’re not, we’re not, you know, I think we have a few providers that are pending. So there will be some follow up tasks for you guys… and maybe some potential re credentialing, but it shouldn’t be a lot. I think for me this year, it’s more about moving to the platform and getting away from what we currently have. And, you know, some follow up tasks for providers that we’ve submitted credentialing on and are waiting to hear back. And then if we have some de novos that we should stand up between now and the end of the year, then it would just be one off either replacement providers or additional providers that we add because we’re adding a location somewhere. So we’re not looking to make any material moves acquisition wise. We’ve done about what we’re going to do this year. So I don’t anticipate a huge amount more growth this year, but I’m sure, re, credentialing is going to come up for some providers or some provider replacements or apps that we add. You know… I think that’s another thing where we’ll see like maybe most of the work is I have some incident ii billing going on and I think that’s because they’ve not had the staff to credential apps with all the plans that allow it. So I think that might be where you guys are going to be tasked to say if the app is not credentialed with the payer directly that we want to do that.
Erica Lloyd (12:59) Okay. So we’re saying there’s people that are on staff right now that are not fully to in network with all the plans they could be.
Angela Opalak (13:06) In network?
Erica Lloyd (13:06) Okay. Gotcha.
Mallory Smith (13:09) Supervising and collaborative.
Angela Opalak (13:10) Yeah, I think there’s going to be a thing Mallory where I would like you guys to maybe ping the plan and say, are you showing everybody on our roster? Do you have everybody on the roster? And if you don’t then let’s get the credentialing done and add them?
Mallory Smith (13:27) Sure. Yeah, that’s the standard skew for us. We call it par analysis and basically, you just let us know which providers you want us to check in with which plans and we’ll get that done for you. And.
Angela Opalak (13:37) For me, it’s like I can’t take anybody’s word for anything right now. So all providers, all plans is how I’m looking at it? Like I want to make sure that we start with a really good foundation because I don’t feel like I have that right now.
Mallory Smith (13:53) Okay. I think you’re taking the appropriate steps to get there.
Angela Opalak (13:57) Yeah, at.
Mallory Smith (13:57) least, yeah.
Erica Lloyd (13:59) Let’s so let’s go into before we go into scoping because that’ll inform the proposal just quick question. Because I know you’re new to the organization and, you know, we’re reporting to Michelle who’s you know, trying to get something within 60 days. Can you help us? And let me just give you some visibility here. I was going to ask, can you help us just the procurement process? So we’re in lockstep. Okay. So as we’re so we’re kind of going very quick and accelerating through this. So we’re in like kind of solutioning, we can show a demo, if that’s important, but we’re kind of, in this, we’re scoping solutioning demo disk discovering.
Angela Opalak (14:45) Yeah. What?
Erica Lloyd (14:47) What is your process there?
Angela Opalak (14:51) I mean, as far as like, I feel like, I mean as where I’m at here like the demo, I don’t need the, I don’t need to get, I don’t need to get Michelle’s executive alignment. She’s aware that we need a solution. A lot of which solution we pick is going to be budget related. Meaning, I don’t know what I don’t know as far as you guys are concerned only because where I came from was set up very differently. We had all the products, you know, all the offerings, but, you know, it was pretty pricey, but I know why we had a lot of tax ids, a lot of entities like it was very convoluted, so, and we had a lot of needs right out of the gate. So, I, I’m okay with also taking this in steps to your point, Mallory, if there’s a way for us to say, is there a cost for you guys to assess how I’m doing? Meaning? Like, is there a way for you guys to say, for us to go out to the payers and do sort of a deep dive to see which providers are credentialed with which payers? Is that something we can like kind of take step by step? Or do I have to, you know, can you customize that solution and say, okay, once we get that done, then we move to getting… the platform up and running? You know, I don’t know how that works. Do I need the platform before you guys do the deep, you know, the checking of all the providers at the payers. Like how does that, how could that work? Because we didn’t do that, where I came from, but I feel like we need it because I don’t know what? I don’t know, no.
Mallory Smith (16:36) Absolutely. So we’ll ingest your provider data. You basically send us a spreadsheet that lets us know which providers, which plans you want us to check for. We’ll start doing the cross check on that. We’ll need at least the shell profiles created for the providers somewhere that we can store the results. So what we’ll probably need is basic provider information. We do not have to invite them immediately to the platform, but we’ll need things like their npi number, their tax id, of course, the plan locations, the plans that we’re checking lines of business. And then, so we will have part of the platform initiated, but we won’t have to have a full complete profile to start that process. So under this new implementation leadership, they are doing what we call like a P0 priority. So we are able to perform some services while we complete implementation and he’ll go through and build out a presentation flow with you using clickup that basically says like for this number of weeks we’re going to import the data.
Mallory Smith (17:36) This is when we can initiate the next step. Concurrently. This is what’s happening at the same time. So we’ll have all of that and like a diagram for you as well. Okay?
Erica Lloyd (17:48) That’s new to me.
Mallory Smith (17:50) Well, I guess your job would know, so it’s okay.
Angela Opalak (17:53) Let’s come down to the proposal Erica frankly, because I mean, I will need to review obviously the master service agreement with legal that won’t take me very long, but I really think it comes down to the proposal. I mean, I need to know where I’m at cost, you know, what’s it going to cost me for the rest of this year? And then like what do we think that looks like next year? But I won’t be able to move forward without knowing like costs. And I don’t know how that’s going to compare to where my other practice was because it’s so different here. It’s singleton, single npi, multiple locations, of course, and more providers. But I really that’s what it’s going to come down to move this forward is I just need to know the cost. And then I’ll go back and say, okay if I, if I’m offboarding these employees as we move through medallion implementation like it may pay for itself. I honestly don’t know. I.
Erica Lloyd (18:57) Expect it would. So we have consumption based model like you were used to paying specialists. So, Mallory, I’ll let her go through and just, we’ll make sure we have, we’re accurate on consumption that we can give you a proposal.
Angela Opalak (19:07) Okay, perfect. All.
Mallory Smith (19:09) Right. Give me just a minute to pull up the scoping. We’ll just run through these live. Okay? I.
Angela Opalak (19:15) will say I have a hard stop at four, but if we can’t finish it, Mallory, I’m happy to get back on. But they added this compliance call at four o’clock and I can’t miss.
Mallory Smith (19:25) It, oh, you can’t miss that. Nobody’s non compliant of you to miss that. Okay? So I’ll tell you what we’ll run through as much as we can. I can email you the answers that you gave. And then the remaining questions, I’ll highlight and then we can go from there. Okay? So we know you’ve got about 120 providers. Those are billable providers for insurance plans. Okay? How many providers are you adding per year? Did you say about five?
Angela Opalak (19:49) I would say five is fair. Yeah.
Erica Lloyd (19:52) But then, do you know how many? I guess we have to do the par analysis. I was going to say how many do we need to enroll? But that’ll be TBD, well.
Mallory Smith (20:01) How many plans do you have per provider that you normally enroll?
Angela Opalak (20:06) Oh, my gosh. Somebody asked me this the other day and I did not have the answer. Okay? I can get you. I can get the list though, like, yeah, I can get the list, Mallory like average number of payers that we enroll each provider with, right? Yes, number of payers. Okay? And,
Mallory Smith (20:30) just the plan name itself. I know that they have a lot of different lines of business underneath it, but, if it’s just medical enrollment, then we’re able to submit one application and cover all lines of business part of the group. Okay. Just looking through how many states do you operate? Is it just one? And then, what about credentialing? Primary source verification, just like your internal credentialing, maybe for ncqa delegation purposes. Do you perform that on providers?
Angela Opalak (21:00) Not on all of them. Okay?
Mallory Smith (21:03) What’s the differentiator?
Angela Opalak (21:05) They just don’t have a structure. So, some providers get screened and some don’t.
Mallory Smith (21:12) Okay. All right. That’s fine. And then what about since we’re talking about cred, delegated agreements. Do you have any of those that you manage for payers? Well?
Angela Opalak (21:21) They asked me about this the other day, the roster, right? Roster versus individual applications. I asked about that. I don’t have the answer yet. I don’t know how many are roster based versus having to do individual providers. Sure, absolutely. I did ask Alex for that. Okay?
Mallory Smith (21:41) You do have the volume minimums to have delegated agreements with payers in place. If you think about it from a financial perspective, what does it mean for you if you’re seeing somewhere between 60 to 120 days for par participating status with your plans for providers, we can credential the providers to three days and then they’re rostered within 30.
Mallory Smith (22:00) So huge upside potential there when we think of accelerating your revenue, I’m thinking, Erica, we probably put together a multiple quotes and we kind of do different packages based on if we did the crawl walk run. Phase one could just be par analysis. Phase two could be delegated credentialing, and then we could add an additional. So just something to keep in mind there. I.
Angela Opalak (22:21) Love that idea.
Erica Lloyd (22:23) Awesome. You know what? Now, while we’re going through this in the last because let me, just as she’s completing that, Angela, let’s just get some time to make sure we can walk through the proposals, the options. Yeah, let’s see. Do you want to do tomorrow or we can do Friday? I mean, it might be safer to do Friday but.
Angela Opalak (22:41) I think Friday is just a better day for me. Tomorrow looks like today and it’s terrible. So I think Friday would be better. I’m available anytime after 12 eastern on Friday.
Erica Lloyd (22:53) Let’s do two… 30.
Angela Opalak (22:58) That’s fine. Yeah.
Mallory Smith (22:59) Okay. All right. Just.
Erica Lloyd (23:01) Want to make sure before we off to run off.
Angela Opalak (23:03) No, no, that’s thank you.
Mallory Smith (23:05) Good call, Erica. Okay. So you’re going to get us the payer list? Just get us a general number, so we can go through and price it out per application per provider. We know you’re bringing on about five providers annually managing 120 right now. What’s your attrition rate? Do you know how often that they’re leaving not?
Angela Opalak (23:22) Very often, I mean, I think that’s one of the reasons why I love this organization. They have like a two percent turnover. Yeah, they’re adding providers, it’s because they’re either acquiring or they’re you know, we’re growing. So it’s what we said. It’s it’s just, they don’t have a lot of provider turnover which I really love.
Mallory Smith (23:43) That is incredible. In this industry, we’ve heard anywhere all the way up to 30 35 percent before. Oh, yeah, organizations, I know.
Angela Opalak (23:51) This organization, not, they spend a lot of time on the front end on recruiting and just making sure they’re finding the right people. So, they don’t have a huge turnover here. I was very surprised actually, but.
Mallory Smith (24:03) Awesome. Okay. So, you’re gonna use payrlist, just normal group provider enrollment. There’s no facility enrollment, anything like that, correct? No.
Angela Opalak (24:16) No facility. Yeah. Okay. And,
Mallory Smith (24:19) then the other service that we offer that may be of interest is licensing. So we can apply for licensure for your providers cross state. Is that something you manage currently?
Angela Opalak (24:30) I would like to get a quote for that, only because I don’t think we do a great job of managing it. We have a lot of providers that have, that operate in more than one states sure, one state. So I really, I think that is something that will be valuable here. Okay?
Mallory Smith (24:48) So, the core platform itself will track all of the expirables. So, when we’re thinking of different licenses expiring, it’s, gonna send automatic notifications to you as well as the admins and the providers. So, do you, does your team currently, you mentioned you’re not doing a good job of it? Do they renew the licenses for the providers? Do they just track the expiration dates they?
Angela Opalak (25:10) Just track expiration? They kind of put everything back on the clinics, which is another thing that I just don’t think is working. Okay?
Mallory Smith (25:17) So then we’ll get you a quote for that. So, you mentioned some providers do have multiple different state licenses if you had to estimate how many renewal applications or new license applications we would need to submit for a provider or just annually for your number of providers?
Angela Opalak (25:35) I don’t think it’s a lot. I think it’s probably less, it’s probably 10, 10 or 15 percent, just like it’s interesting if you look at them at the map, we have a lot of providers that straddle Kentucky and Indiana, and that’s really, where it shows the most, but otherwise, it’s not really, they don’t need reciprocity. And it’s mostly the Kentucky Indiana providers. Okay? Yeah.
Mallory Smith (26:02) Thank you. And that state licensure. Do you also monitor and renew their deas and their CDS csrs?
Angela Opalak (26:09) They do their own, they.
Mallory Smith (26:10) Do their own. Okay. All right. Well, that’s everything that I need just to be able to get you some general pricing as far as volumes go. And then if you can get us that payer list that’s the last piece that we’ll need to be able to get you at that point.
Angela Opalak (26:23) Well, I’ll get that from Alex. I had asked her for that. And then if she has any insight into like the roster versus the individual provider credentialing, I’ll get that from her. But I will hopefully get that for you by the end of the day today, thanks.
Mallory Smith (26:40) Angela. I like the way you do business quite frankly. So if you ever need any help in the future, you let.
Angela Opalak (26:45) Me know, yeah, I probably wouldn’t be this comfortable if I just didn’t leave a new medallion place, but I was just talking to my staff who’s still, I mean, they’re over there, not my staff anymore, but they’re like it’s like going fine. Now, I think like I said, once we got past implementation, we were moving and grooving so I’m happy because I do like the platform a lot. I think it just creates a lot of things especially when you’re dealing with so many providers, it will clear up a lot for us. So I’m looking forward to hopefully the pricing will line up and I can just get this done very quickly because, I don’t want to look at another vendor, you know, but that’s my goal. And one of the vendors is a friend of mine and I’m like look, you know, like she’s done a great job. I’ve known her for about 15 years and I always send her my problem people, but I just like the medallion platform a lot. And so I just, yeah, so I hope we can figure something out because, I really need you guys over here. So, okay, well, do you know where we need to be from a pricing lens? I would tell you, I honestly don’t and my CFO is kind of open but we’ve… spent a lot of money and I’m certainly going to have to off board my staff, my credentialing staff quickly. So it’s going to be a really fast thing, but I, we need it. I mean, it’s just costing us a lot right now, Erica and like not knowing the plans, not having transparency like we’re turning patients away that we shouldn’t be like it really is messy and I’ve got to clean it up. That’s why Mallory like you’re speaking my language when you talk about just checking the payers and making sure that we know like who’s on what plans and what products. And like the credentialing staff just doesn’t have all of that in one place for us to work from. And it’s I think we’re losing patients because of it. And that’s problematic. You know, they just weren’t prepared for all the growth in the last two years. And so, you know, I think having that sort of foundation of knowing which providers are on which plans and which products and then going from there, it will only do better after that. So, and then having the transparency out to all of our clinics and our scheduling team and hopefully I can integrate with my AI platform, that would be fantastic, you know, so. Yeah.
Mallory Smith (29:21) Absolutely. And I think we don’t want to make you late for your meeting, but we’ve really improved with the AI like in the past, year and a half.
Mallory Smith (29:28) So, even if we have a demo just for formality, just to show you like what I can do now, always happy to do that too.
Angela Opalak (29:33) Oh, thank you. I appreciate that. So, I look forward to hearing from you guys. I look forward to seeing you on Friday and figuring something out. So, thank you. Thanks for the time today. I appreciate it. Yeah, of course. And I’ll send you those missing data items in a following email. Thank you so much. All right. Thank you guys. All right, bye.