Transcript
Bryan Wilkinson (00:00) hi, Kirsten.
Kirsten Neville (00:01) Hi, Brian.
Bryan Wilkinson (00:03) Hey, how’s it going?
Kirsten Neville (00:05) Good. Is this your first meeting?
Bryan Wilkinson (00:08) First meeting here we go. Yeah, let’s go. Oh, yeah. So we’re going to have, we should have Jake on as well. He’ll be joining us. Great.
Bryan Wilkinson (00:27) How many have you and Kyle had together so far?
Kirsten Neville (00:32) Quite a few like not 10 but like between five to 10, they just don’t all flip. So it’s been good practice to like understand how they work.
Bryan Wilkinson (00:45) Fair, fair fingers crossed for this one for sure. Jake. Good morning. Yeah. Good morning. How’s it going? Have you met Kirsten before?
Jake Shubert (00:56) I don’t know if we’ve officially met, but it’s great to meet you.
Kirsten Neville (00:59) Yeah, you too. Jake. Oh, all right. Jason’s, here. I’m going to let him in. I just realized I’m cam off here we go.
Kirsten Neville (01:21) Hey, Jason. Good morning.
Jason Gassett (01:23) Good morning. How are you guys?
Kirsten Neville (01:25) We’re doing well. Thanks. How are you? Good. Thank you so much for being here and making the time.
Jason Gassett (01:32) Sure.
Kirsten Neville (01:33) Appreciate it. Appreciate.
Jason Gassett (01:34) It.
Bryan Wilkinson (01:35) Jason, you’re based in Georgia, right?
Jason Gassett (01:38) That’s right? All.
Bryan Wilkinson (01:39) Right. Terrific. I’ve been to Georgia one time. My one Georgia story is we got lost because we didn’t realize how many streets had peach in the name. It was like peachtree Lane, peachtree drive, and we ended up totally the wrong place that we intended to go to, but that was my one experience in Georgia.
Jason Gassett (01:58) Oh, yeah. Everything’s peachtree of some sort here. All right?
Bryan Wilkinson (02:03) There you go. Well, Jason, we appreciate you taking the time. We can jump into introductions here in a sec, but real quick before we did just wanted to ask you, I know we’re the ones that sent over cookies reached out to you. But other than the cookies, was there anything that had your interest peaked in meeting with us today that you wanted to share up front?
Jason Gassett (02:23) Yeah. Well, I googled you guys to kind of see what you guys offer and everything, what you guys do. And we do probably have a need eventually for some of that. So just kind of want to get an overview of what you guys offer and, you know, just return the thanks for the, I don’t know. Was it cookies or donuts? I don’t know, I need to ask you what it was. I won’t say it was donuts almost, but I think the team enjoyed them. They said they were good. So.
Bryan Wilkinson (02:47) Oh, sorry, if you didn’t get to enjoy.
Kirsten Neville (02:49) One yourself, Jason, we didn’t realize that you might not be there, but.
Jason Gassett (02:52) That’s all quite. All right. Hey, I got you a call. So I think it was a good what’s your return on that. How many times have you sent treats and not gotten any kind of feedback or response? Especially in the south. I mean, you send treats. We’re like we’re like it’s a blue. I mean, we got to be like, thank you so much. You know what I mean? Type deal?
Bryan Wilkinson (03:12) More than you think, to be honest, we get no response. So at least I’ve done that six of those and, you know, we have two folks yourself and one other that we’re meeting with. So most of the time still not hearing from people, but, hey, that’s how it is.
Jason Gassett (03:30) Well.
Bryan Wilkinson (03:30) Jason, we can kick off with some introductions. And based on what you shared, let’s just say the purpose of our meeting today. Let’s work together to figure out if there’s some legitimate value that’s meaningful to you and upson. Hopefully, we can find that if we can’t or if you say, hey interesting, but not that interesting. No problem. If we can find something awesome, then we can go from there. But does that sound like a good use of your time today?
Jason Gassett (03:56) Yeah, that’s fine.
Bryan Wilkinson (03:58) Okay. Terrific. Well, Kirsten, I will pass it over to you to kick off introductions from the medallion side then.
Kirsten Neville (04:05) Yeah. Thanks again, Jason for being here. My name’s Kirsten. I was doing some email outreach with you. I’m on the business development side of things. So, I work closely with Brian on account research. Okay?
Bryan Wilkinson (04:19) Terrific. I’ll go next, Brian Wilkinson, I’m based in southern California. I’m responsible for upson. I’ve been working with large healthcare organizations for about the last nine years, fairly new to medallion, which is why we’re ganging up on you a little bit today. I apologize. I phoned a friend and I’m bringing Jake in. So I’ll let Jake say hello as well.
Jake Shubert (04:40) Yeah, Jason, great to meet you.
Jake Shubert (04:41) I’m also on the west coast out in Portland, Oregon. Yeah, just on the partnerships team here, trying to provide a little extra support. So, yeah, anything you need? Just let us know.
Jason Gassett (04:51) All right, thanks, Jason.
Bryan Wilkinson (04:53) Would you like to tell us a little bit about yourself, your time at upson?
Jason Gassett (04:57) Sure, definitely. Yeah, Jason gassett, CFO here at upson, basically all things financial report under me. I’ve been here going on 12 years previously. I came as the controller, of course, worked my way up to CFO, been in this role for back. Our CFO retired back in fall of last year. So I’ve been in this role for about six, seven months so far. But upson’s a, great community hospital, great rural place. I’m actually from the community here, I grew up here left to go to college with my wife and decided to move back and raise a family in the rural area.
Jason Gassett (05:36) And just a great hospital. We’re a, you know, 115 bed licensed facility. We run around nine on beds, staff, nine on beds… but we do everything from general surgery to general medical, orthopedic urology. We even do have a Cath lab and do some interventional, cardiology, no open heart surgery, anything like that, but just a wide variety of services and employ several providers and physicians.
Bryan Wilkinson (06:06) Okay. Very helpful overview. By the way, belated congrats on the promotion and awesome that you get to spend time at a place where you grew up. I guess one of the things maybe we could jump off with, that would help us start to get a sense. I did see in doing research, just saw a number of things that look like signs of you guys expanding. So I saw, the 40,000,000 dollar investment in expanding the icu and then also a couple of partnerships that you guys launched last month. I believe it was a cancer partnership and one other would you like to share about those and how they may be related to the growth plans you guys have?
Jason Gassett (06:45) Yeah. So basically, so the construction essentially is we’re building a new OB, mother, baby suite. Essentially, our existing space was very old and did not really fit the needs of the current environment. So really just replacing those rooms with new expanded areas that are bigger and larger in size and just meet the current… process. And then the icu, we were moving that from 10 rooms to 12 rooms. So just increasing our capacity there and modernizing the space and new areas. We did have an intent agreement with a cancer organization to provide more cancer services closer to home. So our patients right now drive an hour or so to get any kind of infusion radiology, or any kind of radiation services for cancer. So we did enter into an intent to form a partnership with an organization and we’ll be providing those infusion services here in upson versus those patients have to drive an hour away to get those services. Got.
Bryan Wilkinson (07:57) It, okay. That’s helpful. And obviously some of these things we’re thinking of through the lens of medallion being a provider data management platform, helping folks like upson with credentialing. So thinking through where some of those kind of low hanging fruit places that we could help you guys would be, do you know if in those partnerships, will that result in some of those providers needing to be credentialed with upson definitely?
Jason Gassett (08:20) Yeah. So right now we can’t I’m not sure what you guys’ credentialing was what spectrum you guys are on whether you do the payor part or a more medical staff part. So, right now, the way our functions work here is we have a medical staff office who handles the medical staff credentialing part of it, you know, all that kind of making sure their CV, all the stuff that they do that I wrote a lot about. And then my team handles the payor credentialing part, making sure we’ve got them on credential with the payors and what we can bill and get paid for them. And we’ve got a part time person and a full time person that kind of handles that process. But it’s a very disjointed process and it doesn’t work very well to be completely honest with you and transparent. So that’s what kind of piqued my interest when I was reviewing, you guys, tell me what functions you guys handle from the credentialing space?
Bryan Wilkinson (09:08) Absolutely. Yeah, very helpful context. Appreciate that. So at a high level, we handle everything from a provider getting hired to getting that provider to parse status. So that could be credentialing primary source verification. Like it sounds like the other team handles that’s. Also licensing. And then that would be payor enrollments. Like it sounds like falls under yourself. So what we essentially do is we use a combination of AI and automation and where necessary for compliance human in the loop to accelerate how quickly we can get physicians, providers, et cetera. Credentialed… enrolled with payers. What we find is a couple of things as far as what would I’d imagine would be valuable to yourself? We can reduce the time that it takes to get providers enrolled with payers in certain scenarios, we can help our clients get delegated so they can get delegated with those payers so that substantially speeds things up. And then we can also help to reduce the amount of claims denials related to that credentialing taking a long time. All those serve to accelerate revenue. So you typically, when we’re talking to people like yourself that’s priority area number one, if there was a priority area number two, it would be reducing op. Ex. So sometimes we have teams say, hey, we’ve got people total between credentialing and payer enrollment. And we’d be interested in being able to scale with technology as opposed to headcount that’d be a secondary. But hopefully that starts to give you a sense of what we do and I’d welcome your feedback.
Jason Gassett (10:44) I’ve had people say, yeah, definitely. I mean, we haven’t we’ve never used a credentialing service from the payer side or payer enrollment side. We’ve always done it in house but we’ve grown to a size where it’s definitely something we’re interested in looking at to see what, how that will work and kind of what the cost structure would be associated with that absolutely?
Bryan Wilkinson (11:03) Are you using a credit like a self service credentialing system today that your teams are using?
Jason Gassett (11:09) Yeah, we use medicred, I think is the actual database they use to track the information. But then our, essentially, we’ve got a couple of different folks. We’ve got an IPO, a physician organization that’s kind of associated with the hospital that they do some of the commercial payer credentialing for us because all our physicians are part of that organization. And then medicare medicaid and all that our in house folks do that part that piece of it.
Bryan Wilkinson (11:37) Okay. Got it. That’s helpful. And I guess related to that, circling back to you mentioned that there were some process breakdowns and just, it sounded like some challenges related to the payer enrollment. Is there anything else you’d like to share there or focuses of yours that you’d love to change improve et cetera.
Jason Gassett (11:55) Well, I will say the amount. So we have because we’re a rural hospital, we have several tele services. So we have tele intensivists for icu. We’ve got tele neurologists for neurology, stroke consults, and so, and radiology, tele, radiology. So the radiologists are not on site. So those we have for the… neurologists, I think they have a panel of like 100 or so physicians that can, you know, see patients and sign on and see patients here. So keeping up with the way those come in and come out, those are not employed. They’re just contracted so that we’ve got a heavy volume of changes with those that happen pretty frequently. So that’s a, that’s just an area of the area of issue for us keeping up with it.
Bryan Wilkinson (12:49) Okay. That’s helpful, Jake, do you hear any alignments specifically in that of where medallion can provide value? Yeah?
Jake Shubert (12:57) I mean, I think there’s a lot of areas there if you guys are handling a heavy volume of contractors like it’s a lot of administrative lift and complexity across payers. So having a group who’s going to standardize all that process would likely have a lot of efficiency gains. I guess what I’m curious, Jason is like downstream when you guys are submitting enrollment applications out to your payers. What are your average turnaround times look like right now? You know, across both commercial and also government payers. Yeah.
Jason Gassett (13:23) I don’t know to be honest with you, I couldn’t tell you. I could ask our folks and they could give me the, but I don’t have a gauge on it right now. I know we’re talking about, you know, someday sometimes we’ll hold claims. We have a new position come in. We may hold claims for nine days or so at minimum before we start submitting claims waiting on that stuff to get approved with the payer. But I don’t have a gauge as far as what the current average return timeline is, And.
Jake Shubert (13:50) What is the, I know this is outside of your direct purview, but for the medical staff credentialing side, what does that process look like? How many folks are involved there? I’m sort of curious to learn more. Yeah. So there’s.
Jason Gassett (14:00) one, one processor basically, and she has a backup. So basically one and a half processors, and then of course, there’s a committee that needs to approve them once a month and everything based on the way those applications are processed.
Bryan Wilkinson (14:18) Got it. Okay. That’s that’s helpful. Well, Jason, how about this? Appreciate you sharing some info. I can go ahead and share a little bit more info on medallion. I’m sure that’s something that you came to learn. I’ve got a couple of slides that I can show you not to bore you but hopefully to provide some illustrative info and we can continue talking through this. And obviously, if there’s hopefully we find an area within this that is, you know, interesting to you. All right. So we talked a little bit through some of the background. So I’ll jump into, you know, the medallion piece. So essentially as I shared briefly medallion provider data management platform primarily driven by AI and automation. So we do keep human in the loop for let’s call it 10 to 15 percent of the process. Essentially, what we’ve done is look at both the credentialing and the payer enrollment in the various states. As you can imagine every state is different. Every payer relationship is different in each one of those states.
Bryan Wilkinson (15:23) We’ve basically as an organization over the last five years, taken each one of those processes, broken it down to 50 different steps. And then said, alright, how can we automate one step? How can we automate a second one and continue to do that to the point we’re at today where we’re about 80 percent, 85 percent automation at this point. And essentially that applies to credentialing primary source verification, payer enrollments, licensure, when that is something that our clients want us to do, happy to do that as well as helping you stay compliant. I’ll tell you that a majority of our business comes from helping clients with payer enrollments. So awesome that is below you today. And then we talked through these first two categories. But really the main areas that medallion drives value again is the revenue acceleration, accelerating time to par status, helping to reduce claims denials, and preventable write offs that your revenue cycle team may be chasing. Then as far as opex goes, sometimes avoidance of future employees, as the provider base scales or reduction of headcount, this can be a piece. It cannot, it depends on the customer’s preference. We typically see administrative work reduced by about 80 percent. When folks move from a self service platform.
Bryan Wilkinson (16:47) Like it sounds like the one that you have today to working with medallion. And then the last one is something that wouldn’t typically be part of like a financial fit, pro forma type thing that a CFO would look at. But still something we hear from our customers that’s really important to the value we provide which is provider experience. So, you know, current state, a lot of times, we hear that providers are being asked to upload all kinds of documents and information. They also have a long wait time to be able to get online and seeing patients. We help solve those two things. And as a result, providers are happier, some of our clients look at that as a competitive advantage in the hiring market as to say, hey, providers are happy with the onboarding experience here. We avoid losing them mid onboarding et cetera. So, is that how high level? Yeah… and apologies, I interrupted you. Did you have a thought? You’re going to share there? No, that’s good. Okay. So wanted to just provide one example of the type of analysis that we often do. Partnering with the CFO like yourself is just breaking down the numbers on this. So these are totally industry averages. If we were going to use anything like this for upson, what we would want to do is confirm with you the payer mix that you’re working with a lot of the details so that we could give you an accurate number. But just to illustrate how this typically works, we can often drive a substantial reduction.
Bryan Wilkinson (18:25) At us, if we take days saved times, revenue per provider times the number of providers, we get an acceleration in revenue. So that would be the first piece that is typically interesting to folks like yourself. Following that would be any type of credentialing related claims, dial reduction, as well as the opex reduction. But at a high level, this is usually one of the main pieces. And again, if this was something that at the end, you said, hey, this is interesting in a meaningful way. We’d like to pursue it. This would be one of the first things that we would do next with you is ask you. Hey, all right. Who can we work with at upson to get some of these numbers and figure out, hey, does this make sense financially? Is there a real case here or is there not, but that often be a next step that we would look into together?
Bryan Wilkinson (19:22) I’ll give you a little bit more background on the situation today. I know some of those numbers were numbers that we didn’t know, but a lot of the, whether it be from enrollment application submission, credentialing on the other side of the house, et cetera. Things take a long time today. They’re they’re complex. We have a high resubmission rate. There’s there’s challenges with claims so that those are a lot of the main problems that we help to solve. And then one of the things that I think is usually different, like if I think of what surprises clients when they’re working with medallion is, I would think medallion is both software and services, right? So essentially medallion commits to and drives outcomes. So my guess would be, and like from previous roles, working with folks like yourself, talk about technology. It’s often, hey, here are our averages. We’re selling you a system and your folks are using the system. The way medallion works is we provide a system that has lots of automation and AI. We also have the folks in that system. So what credentialing or payer enrollment often turns into is somebody that is really managing the medallion application, submitting for work to get done. But then having the medallion team be the leg work that gets that work done. And what’s great about that is we scale like a utility, right? You can have one person managing the platform. If you end up having a big influx of providers, you have us there to scale with you. And because of that, we can commit to contractually commit to a lot of turnaround times, slas, right? So we can say, hey, we’ll commit to anything that’s in our control, such as the time to submit a payer enrollment. For example, is that helpful information? You, does that start to paint a picture of what medallion does? Yeah. Okay. And then I’ll just share this, you know, to wrap us up, which is that this is a number of the different organizations that we work with. So we often partner everything from, you know, non profit regional health centers, to physician groups, to physical therapy organizations, kind of run the full gamut of those, a lot of telehealth as well. But definitely familiar to working with folks like upson. And yeah, hopefully that gives you, a sense of what we do. And I’d welcome your thoughts so far as to where you see value, whether it would be within revenue acceleration related to payer enrollments, that’s an area that is top of mind for me. But I’d welcome your thoughts. Yeah.
Jason Gassett (22:05) Definitely. I mean, it really depends on the structure kind of how you guys lay things out and, how you price your product really is what it will, what it depends on for a little depend on for us. The kind of that structure? Is it a software as a service? Is it we’re paying per provider or just kind of how it works with you guys? Okay?
Bryan Wilkinson (22:30) Jake, structurally, would you mind sharing a little bit of that at a high level? Yeah, no.
Jake Shubert (22:34) Problem. So, Jason, I’m happy to walk through like our pricing model at the high level and let me know if you have any questions, but there’s really two pieces to our pricing. So the first, if you’re familiar with buying software is just kind of like the software fee platform fee. This is to run medallion as a provider data management tool. And it’s gonna funnel all the automations downstream that power the outcomes and results that Brian was just talking about. And the rest since we do offer managed credentialing end to end, Brian talked about those services we’re really charging based off of the services we provide, right? So we would charge per enrollment application. We’re sending out or per revalidation, we need to do so on and so forth. So what the exercise would be, Jason’s figuring out what is sort of the nature of your work look like, you know, roughly how many providers, how many enrollments, so on, and so forth. And from there, Brian would be working with you and getting you an accurate pricing estimate. Okay? Any questions there? No?
Jason Gassett (23:27) That makes sense. And.
Bryan Wilkinson (23:31) Jason, that rolls nicely into, you know, typically what next steps from here look like. But usually, you know, with folks like yourself, we’re starting with, hey, does this make sense financially? And then if that’s the case, does this make sense technically? So, you know, what we usually look at from here is we’ve got some of those questions as Jake mentioned that will both help us get you a sense for pricing as well as help us get you a sense for what turnaround times we can contractually commit to.
Bryan Wilkinson (23:59) Once we, for example, once we know the payers that you’re working with the workload, etc, then we can come back, give you a much clearer financial picture to say, hey here’s, what we think we can do for you with regards to revenue acceleration, whether or not you’re interested in the opex reduction. And here’s what the pricing would be. So that all rolls under a financial fit presentation. We’d be happy to show you the platform if you’re interested in that. If you’re not really interested in seeing that until, the financial fit is been verified, that’s fine too. But that’s typically where we would go from here on working together. Okay?
Jason Gassett (24:40) I mean, yeah, if you’ve got like a question that you want to send me, I can share with one of our staff to fill out if you have data points that you guys would need to start looking at, giving us pricing, I’m… open to that, you know, I will tell you the current.
Bryan Wilkinson (24:56) Another.
Jason Gassett (24:57) One of the, our managed care consultant basically who kind of heads up this process is retiring probably at the end of this year. So I’ll definitely need, we definitely will have more interest towards that timeline but definitely want to go ahead and at least get a conversation started and kind of start looking at it. So we’re not in a huge hurry. I know you guys probably are in a more aggressive than what our timeline is, but definitely want to get the conversation started and start looking at where you guys will come in as far as pricing and what you can do. Okay?
Bryan Wilkinson (25:33) Terrific. Super helpful to just know the timelines you guys are working around being aware of that person leaving at the end of the year. And then I’m curious, are you thinking of this primarily right now with regards to payer enrollment? Would you also be thinking of this on the credentialing side of the house? What are your thoughts?
Jason Gassett (25:52) Pay enrollment specifically, you know, our credentialing person I’d get with our, you know, that’s on our chief quality officer. Basically, she handles that area. You know, I’d want to get her opinion. Now. She’d probably want to use the system if, you know, if we’re going to pay for the system, she’d probably use it as far as for her files and documents and everything. But, you know, the sense I get is they’re probably not willing to let go of that just yet. And honestly, they’re very, you know, they take a lot of ownership in it. So I don’t see that being an area, they’re willing to let go of.
Bryan Wilkinson (26:27) Okay. And they take a lot of ownership in that system that they’re using today, yeah.
Jason Gassett (26:32) And I say ownership in the process. I mean, we’ll probably get them to take, change the system to use you guys’ system. Definitely. As far as the data repository, I guess if that’s kind of how it functions, that will be, my thought process is that if we could replace what we currently have that we’re going to have a little more limitations with you guys’ software that they could use it. And then maybe on the payer side, us use that same data of course, and have you guys help us with the payer enrollments… would be my initial thought process. Okay? That’s.
Bryan Wilkinson (27:07) helpful. And what I’ll share with that for the credentialing folks too. If you do get with the head of quality, we’d be happy to share. We’d be happy to show how it works so that you will still have folks that are going into that system. What’s been taken care of is really the highly manual part, for example, you know, pulling in provider documents. And some of the much more manual work is what’s gone? You still have the initiation of which providers need to be credentialed or enrolled with payers tracking and visibility into that. There’s still folks actively managing in that system, but happy to share those details if and when there are folks who want to see them?
Jason Gassett (27:47) Okay. Terrific. So,
Bryan Wilkinson (27:50) I know we have a couple minutes left. I can get you over some questions that would help with the financial fit. And then would you like to give me a sense for, you know, when it would be best to get together? I’ll tell you from our side, if we get that back from you, it’ll typically take two to three days on our end before, you know, we’re ready to have another conversation.
Jason Gassett (28:13) Okay. Yeah. Send it over and then we can get it back to you and follow up then on a date and time for another conversation. Okay?
Bryan Wilkinson (28:21) Terrific. So, you would prefer to not put anything on the calendar right now or would you like me to send some kind of placeholder? Yeah.
Jason Gassett (28:30) Just send me the information request. I’ll get it off and start working on it. We’ll get it back to you within a couple weeks and then go from there. Okay, terrific. Were.
Bryan Wilkinson (28:40) There any other big questions you had coming in today that we were yet to answer for you?
Jason Gassett (28:46) Nope, I think that’s it.
Bryan Wilkinson (28:49) Okay. Well, Jason, again, we appreciate the time. Sorry, the suites did not make their way to you, but glad the team enjoyed them and I’ll be following up shortly with some questions for you.
Jason Gassett (29:01) All right. Sounds good. Thanks. Thank you guys so much.
Bryan Wilkinson (29:04) Thanks, Jason. Bye.