Transcript
Josh Brunell (00:00) okay. All right.
Josh Brunell (00:37) Hey, Eric. How are you?
Eric Kahler (00:46) Sorry, I just realized I’m on mute. I’m like why isn’t he responding? I can hear you. Hey, I’m well, how.
Josh Brunell (00:52) about yourself? I’m, doing good.
Josh Brunell (01:02) All right. Chris is joining Laki’s on?
Eric Kahler (01:08) Let’s see. Yeah, just Liz from our side, and then we’ll be good. Cool.
Josh Brunell (01:17) How’s the week been going? Good morning. Everybody? Good morning. Hey, Chris.
Chris (01:21) Liz and I just finished a call like 30 seconds ago, so she will be on momentarily sweet.
Josh Brunell (01:31) Now, is everyone here in like the Austin area or Eric? I know you’re in, I think I’m.
Chris (01:35) the only one in Austin? Oh,
Josh Brunell (01:37) okay. Okay. I was just asking because we’ll be out there in a couple of weeks. We have a company offsite there. So just seeing if all sorry.
Chris (01:49) What are you guys doing?
Josh Brunell (01:50) It’s like our, you know, it’s quarterly, business reviews, stuff like, you know, but.
Nicole Campbell (01:56) I was going to say, Chris, I have to take the team out for like, we have a team dinner night and I’m trying to figure out where to go in Austin. So, if you have.
Chris (02:05) Any recommendations?
Nicole Campbell (02:05) Oh, my goodness. I’ll email you after this and just be like,
Chris (02:08) yes, absolutely. I mean, as my mom would say, you can’t swing a dead cat in Austin without hitting a good restaurant.
Nicole Campbell (02:14) I know that’s why I don’t know where to go and I don’t want like josh, you know, he’ll come on this call after our offsite and be like, wow, Nicole took us to this terrible restaurant.
Josh Brunell (02:23) Talk.
Nicole Campbell (02:23) some smack about it went to.
Chris (02:25) Austin and Nicole brought us to the Olive garden. Yeah… I mean, yeah, no, just let me know where you’re staying and I’ll give you guys a sense as to what’s around, cause there’s like I said, there’s a 1,000,000 places, so.
Nicole Campbell (02:37) That’s amazing. We were trying to figure out a way to get us all together potentially in the future with your team and we were thinking maybe if all of you are more located in Austin, but maybe Eric, that’s something we can brainstorm with.
Eric Kahler (02:49) You, we, we’re actually, we’re all going to Austin next week for a quarterly meeting. So, we tend to cause you’re it’s really, there’s not many there’s, a lot of people in Austin, but the group that you’re working with here, most of us are dispersed, but we do tend to get there pretty often. Yeah.
Nicole Campbell (03:09) Okay, great. Well, if you needed us down there next week, we’d be happy to come in person, but also if we want to like look a little further.
Eric Kahler (03:15) Yeah, let’s yeah, exactly. I think that makes sense in the future. Yeah.
Chris (03:20) We’ve actually been talking about with our quarterly director meetings, like having partners come in to, even if it’s just for a meet and greet or something or if we’ve got something to work on. So, yeah, that’s definitely something we’ll talk about here and.
Nicole Campbell (03:34) Then Chris has to play tour guide. Then I don’t have the.
Eric Kahler (03:36) Problem.
Chris (03:37) I like that.
Nicole Campbell (03:39) Okay. Josh. Sorry to derail our conversation.
Josh Brunell (03:42) No, it’s all good. It’s all good. So, yeah, appreciate the time. I don’t know if we’re going to need the full hour. We should be able to, I think get through this fairly quickly within 30 or 40 minutes or so. In case we have great discussion and, you know, things continue to go past the half hour mark. Just want to make sure y’all, have that time available. Yeah. Okay. Cool. Sweet. And Eric, I’m sure you probably teed up this call internally, but just to level set with the team, we had the opportunity to connect Eric and I, one on one earlier this week.
Josh Brunell (04:18) We kind of went through the initial draft of kind of our business case, and the Roi summary that we’ve put together for the team, we’re hoping to review that to get your feedback today, also to get your feedback on a couple inputs as well that we’re curious, to kind of finalize. And then from there, walk through the initial proposal and pricing with the team for feedback and then plan next steps outside of those things Eric coming out of our last meeting or team coming out of the last time we spoke any like pressing questions areas that you wanted to make sure we cover today, or maybe questions to ask or to answer at the start of the call?
Eric Kahler (04:59) Unless Liz has anything for Chris from the credentialing team, then if not, then no, it would just be what we talked about, which is just, yeah, going through the business case and Roi and all that good stuff. Okay. Cool. And I do think your questions, josh that you sent me, I think we can just go through them one by one with Liz and Chris and they’ll actually be able to probably help more than I’m I was going to have to go to their teams anyways to get some of the responses so we can just go through them.
Josh Brunell (05:24) Okay. Cool. Yes, we let’s dive in. And then when we dive into, the scoping kind of data inputs before you go through, the pricing, we’ll cover those questions then. Cool. Sweet. All right. I’m going to go ahead and share my screen.
Josh Brunell (05:49) Can y’all see it? Okay? We just talked through these things but just want to confirm.
Josh Brunell (05:58) Perfect. So just a quick recap. I know it’s been about two weeks or so since we had, our demo coming out of that demo, we kind of compile some of the challenges that we’ve heard through various notes and calls and kind of like the main drivers around, you know, why we’re having this discussion in the first place while we’re exploring a partnership, and what the potential business impact can be by partnering with medallion. So our mission today is just to walk you through kind of what we’ve heard areas that we’re hoping will align with your team and how we’re going to be driving value in this partnership. And then from there going to the pricing… as far as like the main challenges. I mean, it’s very common for what we hear from most teams. You’re scaling you’re growing which is a really good thing for a business. But at the same time, that obviously requires as you’re adding more bcbas, more providers, a larger team from a credentialing and provider enrollment standpoint to support it. And, you know, as you’re looking to automate processes, drive better efficiencies and just faster turnaround times to get providers onboarded. There’s been some challenges with the current system in place using Salesforce spreadsheets, manual processes, right? And so that’s not really scalable. So overall, like some of the areas of what we’ve talked about from an improvement standpoint with the technology is, hey, we’re going to help automate workflows from provider data intake to caqh to provider or payer enrollment credentialing to ncqa standards roster management, follow up end to end. And so what that’s going to allow you to do is obviously get better visibility having a single source of truth and record for all this accelerate revenue and also help prevent on the revenue leakage as well. And I think this is something I was hoping to talk to. I think maybe Liz and Chris and kind of get your feedback on. I mean, one of the things that we see often is that by making the switch to the medallion, there’s a lot better cleanup if you will on some of the data that is around… provider enrollment credentialing as well as the timely submission of work, making sure that there’s no errors or bounce backs that could lead to downstream impact on write offs or claims denials. We had talked about this to a degree. But I mean, do you see that as like a key focus for the revcycle team of like, hey, if we can limit the amount of issues we’re seeing on the credentialing and payrollment side with delays and write offs like that could help us avoid some of the claims denials and write offs downstream. Or is there more to it than just those issues?
Chris (08:46) I mean, well with us, there’s always more to it, but that’s a, big, chunk of it at least from the credentialing side, right? There’s other things operationally that happens outside of RCM that impacts a lot of these things sometimes. But for us, the idea is the more we can do at the credentialing level, the easier it makes the rest of the process go and it will cut down significantly on some of the denials that we’re seeing in those areas for sure.
Josh Brunell (09:10) Awesome. Yeah. And just to talk about some of the outcomes, we obviously walked through the platform. But as far as like the big differentiator between us and maybe some other competitors or other vendors you might be considering in this space, is that we actually contractually commit to speed in our SLA, so how quickly we’re turning around a cred file, how quickly we’re going to be submitting the pay enrollment applications as well as all the way through to completion. And then having obviously this is going to lend to less denials is the resubmission rate if you will. So we have a close to a accuracy rating on our submissions industry. What I see across the industry is typically anywhere from five to 15 percent of applications get bounced back. So we have controls in our platform based off of our payer enrollment process guides to ensure that we’re not submitting an application that isn’t going to be accepted. We know exactly what a clean app looks like based off of the research that our team’s done. And then what we’ve built into the platform to ensure that, hey, for, you know, let’s say blue cross blue shield in Texas, like we know this is the exact data we need in the format that they need to accept this application. And the outcomes. Once again, I kind of hit on these accelerate revenue, reduce operational costs, last one, remove provider abrasion, and as well as administrative abrasion that’s something that’s a little less hard to quantify in a business case. But these two areas here are kind of what we’ve built based off of the data that you shared of projections of how we’re going to help accelerate revenue and how we’re going to help reduce costs. How we’re going to also help avoid revenue leakage from claims analysis and write offs. We built that into a business case based off of the inputs that you shared. Sorry, one last slide. I did just want to share since we’re on this theme, we do have several customers who I’ve seen anywhere from a 50 to 70 percent reduction in credentialing related denials even within their first 12 months of medallion. I’ll happily share this case study with your team after this because I know that’s probably top of mind for the revcycle team, but overall, we have hundreds of customers who have seen these outcomes over 400 plus to date. And as far as the business value case, I wanted to pause here because we do have some questions regarding some of the data that was sent. We made some assumptions based off of what we have here. So I just want to validate some of these with the team prior to us going into the business case and then diving into the pricing. I don’t know if Eric could share this in advance but we know that there is 11 fully dedicated staff across cvo and enrollment. One of the questions I had was it seemed like when we were on the last call, we understood there’s like kind of team leads for the different processes around like I think a team lead for like caqh, a team lead for that just is doing like credentialing roster management. Just curious like is like what those kind of different pods look like as far as like number of resources. And then also like those nine adjacent folks that are involved to in some degree like what their core responsibilities are outside of credentialing. I had sent that overview email, Eric. And.
Eric Kahler (12:50) Yeah, I think what josh is trying. So what I was explaining to josh was there’s about 20 people on the credentialing team, 20 teammates, and that includes Sam corral, Talia, Jamie, I believe it’s like that’s inclusive of leadership. So, so that’s the two two team leads a manager and a director. So that then leaves roughly 16 teammates, 11 of which are, I mean, my understanding is they are pretty much purely doing packet creation enrollment and then there’s I think they’re also the re creds as well, I think, but I could be wrong there because then there’s that would, that leaves five that are kind of outside of that process. And I was explaining, you know, there’s a couple auditors that are doing like auditing both the payer side for delegation as well as Salesforce. And we do have the, what Ruthie that’s more focused on new markets. Anyways. I’ll stop there, but I think he’s just trying to understand like what everybody else, what the rest of the team is doing? Yeah.
Elizabeth Deal (13:54) We have the 11 team members who do the enrollment, stuff, the packets. And then we have two auditors who double check that stuff and then get help, everything get like double checked for the committee meetings, for the delegated stuff. And then we have three project specialists who work on… stuff like just kind of like miscellaneous projects. Some of it is just like cleaning up Salesforce, cleaning up like termed providers, a lot of like cleanup projects. And then whenever we get new contracts, they kind of take that over. And then we have Ruthie who does like the nuco… medicaid, yeah, and new center stuff that’s.
Eric Kahler (14:51) a little bit more like trying to get us prepped for new states on that side. That last one. Okay. Well, also no, I shouldn’t say that also for new states but also we are, we have a weird dynamic where we have two, we’re like under two tax ids. And so we’re having to move some of our centers to another tax id. And so it’s a messy process understood.
Josh Brunell (15:18) And the reason why I ask is because everything we’ve talked about like medallion is all those different functions. Medallion is going to automate to a degree. Some of those functions are like very much so fully automated that it’s going to help reclaim some bandwidth across those teams. And so we’re just trying to see exactly like as far as like those resources like for the, you know, project team, for example, like maybe they get reallocated to other initiatives across rep cycle or other areas of, the business. And so, yeah, because medallion is going to be not only just taking this on from a technical standpoint, having a platform for your team but use an administrator but also driving the end to end outcome. I think Chris walked away.
Eric Kahler (16:07) He’s probably still, yeah, he’s there. He’s still, he’s.
Josh Brunell (16:10) got it in your pod then he could hear us, Melissa, I’m sorry, I was getting hangry. I needed to grab something. Please, please help yourself. My next point was around like payor revalidation. So it sounds like there’s a team that does like revalidations and re credentialing. Are they doing both those functions? Like actually like generating you like cred packets and handling like rosters as well as doing like direct payor enrollments or are those two functions differently?
Elizabeth Deal (16:44) I actually don’t know the answer to that. I think the team that the biggest teams doing the enrollments and the re creds?
Eric Kahler (16:56) Yeah, I’m pretty sure that’s the.
Chris (16:57) case.
Eric Kahler (16:57) I.
Chris (16:57) think it’s all the same team. We just had the folks who are the recredentialing ones are a little bit more experienced. Yeah, I think.
Eric Kahler (17:04) It’s part of the 11 based on the rundown you did because it’s 11. It’s 11 that are doing both direct enrollment and recreds.
Eric Kahler (17:13) Because then you like you said, you have a few project specialists and then the two auditors and I think that kind of gets you close to that 16. So I’m yeah.
Josh Brunell (17:20) Okay. Cool. That’s helpful. And then for revalidations, so you have 1,800 providers, yep, you know, anywhere 10 plus or yeah, 10 plus payers per state on a minimum.
Chris (17:34) Yeah.
Josh Brunell (17:36) When you’re handling it says recredentialing here, I assume that is, you know, every three years for direct just talking direct enrollments, not talking about like… recredentialing and the fact of like generate running another, you know, PSV and generate a new cred packet, but more so doing direct enrollment with the payers, like I imagine that volume would be at least, you know, with it’s hard it’s typically hard, to calculate, I would say in the Aba space in particular because there’s really high attrition that we see in this industry. But like what would you say is a good number to kind of land on as far as like doing revalidations or recredentialing in an annual year across those current or active providers… I estimated 3,500. And so that was based off of taking the 1,800 providers. Obviously, you’re dividing that by three, knowing that event typically happened every three years and then adding in some attrition there on the providers as well, knowing bcbas in particular, like the typically high attrition rate in the industry, but that’s how I got to that number. I didn’t know if that was wildly high or wildly low. I just wanted to get feedback before we kind of dive in. I.
Chris (18:56) Don’t know off the top of my head what specific number is that? Because I know they started to really pick up last year because we were kind of hitting that first round of three year yep.
Eric Kahler (19:08) See, my thought was in maybe in my maybe I’m not understanding the credit mentioning process. I know that with our delegated providers, we have to do it every three years. We have to do the recred process for direct enrollment. Do we have to do something every three years as well? I guess I just never.
Chris (19:22) Knew that the difference is with the directs like josh was mentioning, we just have to, you know, re, reconfirm all of their data with the delegated side since we’re delegated, we have to go through all of the processes like doing all the sanction checks and all that.
Eric Kahler (19:40) Oh, okay. So there is.
Chris (19:41) A little difference that same process for the most part. To your point, Eric, but it’s just since we took on that additional role as the delegated credentialing every time we go through that process, we have to do all of that primary verification stuff up.
Eric Kahler (19:57) Front got it. So, josh, the math you’re doing is basically taking 1,800 providers saying every year you’re doing 600 of them, well, a third basically would have to, but then you’re going to have attrition. So it’s not going to be truly… yeah.
Josh Brunell (20:15) And, and then on top of that, like you’re doing, you have to do those by payer. It’s not like by provider like, yeah, you’re having to do the re, credentialing that’s done at the provider level. You’re having to go individual payers, and.
Eric Kahler (20:26) Got it. You’re doing them 10 X times essentially.
Josh Brunell (20:29) They’re direct. I call them revalidations, but they’re almost like renewals of that original, right?
Chris (20:35) Renewal is probably, the right term for the non delegated ones. Yeah. And Eric, I don’t know what the number is, but I know Sam has a report that she pulls that forecast when providers are going to be due. So we should be able to forecast that out for the rest of this year not. I mean, obviously, we’ve got, the attrition factor to take into account. But just as far as based on who we have in now, we should be able to get a number for how many re creds we have to do this year.
Eric Kahler (21:04) Yeah, we can. Yeah.
Josh Brunell (21:05) That’d be helpful, to see, yeah.
Eric Kahler (21:08) We probably, I mean, because.
Chris (21:09) I think.
Eric Kahler (21:11) I was gonna say we baked that into our staffing model, but I just have never seen it for our direct enrollment that’s where I’m yeah, and.
Josh Brunell (21:18) Another reason why I’m asking the question is because you know, you have 700 providers. This new providers stated as far as anticipated growth this year, minimum of 10 enrollments. So that’s you know, 7,000 enrollments just new enrollments. And so that’s a lot of units of work for the size of the team that you had shared on its own with the caqh management with the credentialing that you’re doing and then adding those revalidations on top of it.
Josh Brunell (21:44) I know it’s usually pretty quick to do the revalidations probably an hour or two, maybe max, but like still like all those different events kind of adding up. I just wanted to understand like… really like where the biggest value driver would be as far as like automating these processes because as Eric, you had talked about earlier this week… probably not going to be a probably, you know, some of our customers when they partner with us, they kind of go all in and say, hey kind of manage everything. The way that I’ve kind of constructed, the proposal is like more so of like a gradual lift of like, hey, we’re going to take on a portion of this work and the volumes up front. And then in years two and three start really taking over everything, all the providers not just like net new, but overall like those revalidations and some of that work. So I’ve scoped out kind of like a kind of gradual stair step agreement. And so I just wanted to make sure like directionally that makes sense also based with how you had shared around like, what are we going to do with the team, in the imminent? Like probably retain and then over time either repurpose some of those individuals to other projects or other higher value work. And so that’s all not going to happen up front. So like that’s the way I’ve kind of structured this and why I’m asking some of these questions on who’s responsible for what, how much volume are they taking on now versus what you’ll probably be seeing in the future with medallion?
Eric Kahler (23:16) Yeah, we can try to get, yeah, I’m looking at another file now, but all I have in there is the delegated recreds cause to your point, those are the ones that take longer, I believe and we have to get those in. Well, I guess you have to get both in but you have to get those in or we’re at risk of losing our contract. So like, but it has to be somewhere.
Eric Kahler (23:40) Okay. So, we can follow up on that piece, okay? Cool.
Josh Brunell (23:45) All right. We can dive into. These are just some of the numbers that we got as far as like current state. So we got the number of providers kind of an understanding of the resources on the left. How long each part of these processes are taking, what you’re seeing from like a claims denials, write offs perspective tied to cred or PE, just the fact that these are very highly labor intensive resource heavy to handle caqh management rosters, pay or follow up. And so future state and we’ll when we, you know, continue the conversation and kind of crystallize some of these numbers. We’ll actually kind of have like a you do versus we do kind of walk through as well. So the team feels confident in like the roles and responsibilities but essentially like the both from an automation standpoint as well as a process standpoint, there will be like kind of the end goal being that like medallion should be able to be administered and operated just with a couple of team members. And so that capacity is going to be freed up. And so that is just one thing that I just want to call out as far as like area of value and something we talked about with Eric, it’s not going to be immediate. But within the partnership, we typically will see that… teams pretty quickly realize that like, hey, we have less of a workload. We can reallocate these to other folks. Other areas of the business from an enrollment submission standpoint, going back to our slas, and what we can commit to like contractually, like we would see meaningful improvement in both enrollment and credential files, getting those submitted out the door and completed. And then as far as write offs due to claims analysis write offs or due to credit errors and payer, enrollment, we’re assuming a 50 percent improvement. And so I’ll dive into what the analysis is in there and how we, how we’re getting to that metric. And then these other three, these are more anecdotal, but I mean, essentially caqh management, outside of the one time linking of caqh to medallion, our team will then handle all attestations on your behalf. We essentially just need an initial signature, by the provider or administrator to give us, the power to do that. And then so that workload goes down by 75 percent. We’ll be managing the caqh profiles on behalf of your providers, handling those attestations. And there’ll be parity between the medallion platform and caqh where we can connect. And we have a bi directional integration to constantly update that so that we’re making sure that we are doing so before we’re submitting applications as that’s a typical requirement for many of the payers that I’m sure you work with on the roster side fully automated. So all we need is just the template structure up front. And then we’ll be loading it and sending it over to your team. The only part that’s not automated is that we would forward it to your team and you all review, check it, make sure it’s accurate, and then send it in to your payers. And then the payer follow up both email and AI or email and phone. We have AI agents as well as staff members who can come in and escalate where needed expert oversight. But essentially that would free up, the payor follow up team as well. And so what this is going to equate to as far as like overall business value, I’ll get into these three buckets.
Josh Brunell (27:17) But as far as cost reduction and avoidance, looking at six, six, 650,000 dollars revenue leakage. I already stated that, but about half of the claims analysis and write offs, we will be able to help reclaim. And then on the revenue acceleration piece by getting your providers in network faster, those 700 new that are starting across… 700 providers across your organization. That would help accelerate eight point 4,000,000 in revenue. And so we’ll dive into how we got to these numbers, the analytics behind it here momentarily. Before I do any questions on kind of how we’re modeling this out as far as business value?
Eric Kahler (28:04) I can just, I can tell Chris, Liz and Laki, I explained to josh that the two point two five there which is based off revenue leakage for denials that get unpaid. I did explain that like a disproportionate amount of that is related to united and that whole dynamic should be changing in the future. We don’t know it could be just as bad or whatever, but they’re just calling out like it’s not like we have problems with tons of payers when it comes to denials. It’s very much usually a few payers and most is united.
Chris (28:40) Yeah. I think that’s fairly accurate although, you know, I think we’re seeing similar things where I think this will help too is little things on the Aetna rosters that we just missed manually will help for sure. But yeah, I would say in that instance, but I think it’s a good timing though because we’re no longer delegated with them. So it’s going to be very application driven at the optum side. So having that stuff get in and turn that around. We’re hoping it gets faster but we’re not all that confident.
Josh Brunell (29:14) Yeah. And in the slide, I know the team had called out like the shift in the delegated contracts. This is an assumption and I guess I didn’t confirm this but I imagine that the goal is to continually add more delegated payers year over year if possible, correct? I.
Chris (29:36) Think we look at them. So as an example, we just are in the process of signing two additional ones. One is with the employer health network, and another one is with carillon. There’s benefits to us. So, I think, but it’s very specific scenarios where we’re getting into delegated. So it might be one a year. It may not be. I don’t think we added any other. We added Aetna last year. So we only added one this year. We’re probably going to add two. So it’ll kind of come in drips and drabs. I think. Okay, sounds good.
Josh Brunell (30:16) All right. So let’s get into how we got to these numbers based off of some of the inputs we gathered. So as far as like cost reduction and avoidance, you know, you have 20 staff involved, 11 ftes fully dedicated. Sounds like there could be more. So like four managers, 16 staff involved to some degree. Other with the project managers kind of facilitating other roles, but with the volume and like what we see as far as like the 700 new providers growing annually, like we, I would imagine very quickly this team of ftes would go in the future years to 13, 15 resources or more with medallion. Obviously we helped shift to a much more lean model and help you scale through technology and then keep capacity down and shifted to a higher value work as far as like where we got this number. So 65,000 dollars, I think it’s not noted here. But as far as like the average salary we took 65,000 dollars, applied it across those resources. And essentially, it can help, this is the area where we’ll help reclaim some of that bandwidth. And so that’s capacity unlocked to put towards other areas of the business.
Eric Kahler (31:31) And the 65 K was including benefits just for y’all’s knowledge. It wasn’t like fully.
Josh Brunell (31:37) Limited basically an average you shared across the.
Eric Kahler (31:39) Team? Yeah. Cool.
Josh Brunell (31:44) On the revenue leakage side, this one’s pretty straightforward because we are optimizing data validation before submission. We see a sub under one percent resubmission rate across both cred packets and then our enrollments. And then on this, the… this is like a conservative number. We typically see higher to more 60 70 percent range. I just put 50 percent in here just to be conservative. Also with the fact that you have that united contract changing, there could be some verity here. But yeah, overall cleaner claim rate, fewer write offs and rework any questions here before I move to the next. Okay. And then, yeah, the last one being the revenue acceleration. So this is more of obviously like a soft savings or a softer value. I think Eric, you had called out, right? Like it is nice to obviously accelerate revenue but this isn’t like a direct cost savings, but I still think it’s helpful because that is obviously revenue that you have access to sooner to help obviously grow the business at a faster rate. So, yeah, we took a 700 dollar a day target as far as like how much a vcba is contributing, knowing that’s like 98 percent of the provider base that we’re working with and essentially saying, hey, we’re going to improve this by 20, a conservative 20 days. Our actual estimates are higher than that. But just like what we’ll be putting into our contract. But even just a 20 day improvement will help unlock eight point 4,000,000 in accelerated revenue. So getting those providers seeing patients and driving better outcomes quicker… cool. All right. And then if there’s no more questions on that piece, we’ll be diving into the investment summary, the pricing proposal before I do, Eric.
Josh Brunell (33:39) So based off of your last meeting on Tuesday, once again, I’ve built this in kind of like a phase partnership approach where volumes and products scale from years one to years three. So that we’re gradually shifting the work from the team doing this today. It’s not just a hard cut off of like, hey, we’re going to implement this in three months and then not know what to essentially do with those team members or, you know, there’ll be a change management kind of pushback there. So the way that I’ve kind of structured this is focusing on in year one, those net new 700 providers that are coming on, getting them onto the new process and onto medallion first and foremost. And then in years two and three is when we’ll start adding some more of the bandwidth and work that the team’s doing with things like recredentialing revalidation, start shifting that work over to the medallion platform. So I’m going to walk you is.
Eric Kahler (34:34) That,, is that pretty standard how you work with a lot of companies or do you all typically do go all in right away? I mean, just we’ve.
Josh Brunell (34:42) done both. So the one, so if I know you had the opportunity to connect with another Charles bank portfolio company, so they’re much more so, obviously.
Eric Kahler (34:51) They’re like, they sound like they’re ready to do all in, probably, right?
Josh Brunell (34:53) Away, right? They’re going all in right away.
Eric Kahler (34:55) I got that.
Josh Brunell (34:56) Line, but they had a different, but they had a different reason of doing. So, you have a team that is much more senior and a sound process in place. But it’s just the sheer volume that is obviously, it’s starting to break your model. Whereas with them, they were using, they were fully outsourcing this to, yeah, and they were doing such a poor job. They started having to staff up very quickly. Yeah.
Eric Kahler (35:22) They sounded like, I mean, I was talking to them. They had a bigger team than we do. I think for a much smaller, yeah.
Josh Brunell (35:27) Yeah. They actually, I think he said a team of 30 I think is what he said. They actually, so they actually had only, I think six people doing it or six or seven, but they like doing it full time. They also had 30 people involved in the process similar kind of model where like they had the crho, getting involved in doing credential, like she was like doing credentialing, like hands on, and they’re like we need her to actually be doing her job. So like, yeah, it was not great. But yeah, I guess.
Eric Kahler (36:03) Yeah. So, I mean, who knows, we’ll have to figure this all out, but.
Josh Brunell (36:07) You have both options available? Yeah.
Eric Kahler (36:09) It’d be nice to see both because typically how we would want to do something is, I think we would want to slow roll it at first because we always want to make sure it works. We don’t want to go and throw this out to everyone and have it. But then I mean, if it proves successful, we probably would pivot a lot quicker to say, let’s just do this all.
Josh Brunell (36:24) In absolutely. So that is also.
Eric Kahler (36:26) It would be a good problem to have that we have people that don’t have enough work. We would figure that out.
Josh Brunell (36:32) Yeah. And the good thing about the way that our… contracts are structured is that you actually have the ability. So it’s a three year investment is what we’re about to walk through to essentially pull forward work in years two or three or products that we have planned to roll out in years two and three. You could pull that forward into say year one, if needed, say you kind of burn through those units of work in year one, you could pull them forward. And we have that we call it skew flexibility in our contracts built in. And there’s not any sort of like financial ramification or penalty that you pay for going over that usage essentially. So you could just pull that forward. And then what would typically happen is that we would just work in partner together on an earlier renewal. So like we’d be. So it’s volume based. So obviously, the more volume you commit to across their three years, the better the per unit pricing is across the different skews that we’ll walk through. I’m going to start with kind of walking through those SKUs on this next slide. And we’ll highlight the specific areas that were, that… will kind of ramp up in years two and three. If that makes sense. But think about it like this. We have like our core platform which is the medallion software. And then, and then we’re running processes across. So like we’re essentially delivering units of work for all the different actions that we’re doing. So, think about like submitting a payer enrollment that’s going to be the payer enrollment line item for new enrollments, payer revalidations that’s us handling those caqh management that’s going to be a its own line item. So you can kind of choose which products you will want to roll out. First and foremost based off of like, hey, we know this team is very over capacity. This is going to be the biggest area of value. So this is just a starting point. I just want to call out, kind of walk you through the concepts. But I imagine we’ll iterate on this and how we want it structured. So just want to call that out. Cool. Anything else Nicole you want to add before I dive in? Awesome. So as far as year one of the investment, so this is just looking at a portion of those essentially just all net new providers that we would be bringing on of those 700 doing new enrollments, delegated roster generation for caqh management, ncqa compliant monitoring and then running those cred packets on all those new resources.
Josh Brunell (39:03) And then we have a one time implementation cost which goes away after year one… and then we are going to be ramping up as far as year two and three, the quantities of providers because we’re going to then bring in your active providers, in years two and three to then handle the revalidation kind of renewal work which I’ll walk through here momentarily on the next slide. But before I do, I just want to kind of pause and kind of let you look at what the quantities are, how the unit pricing structured and then the level, of discounts as well. I’ll say this because you are a much higher volume than axis medical. This is like a significant drop off as far as per unit pricing compared to what they will see. So there isn’t going to be parity with their contract, but, you all have a much deeper discounts as far as per unit pricing goes because of how many people you have. So that’s year one… year two ramping up, the quantity of providers to 1,400. So taking on more of the active provider base, handling those, start handling those revalidations, upping the credit credentialing and recredentialing, just all under one one skew. And then from there, this would be like what all in looks like. So yes, you can go all in up front. But the way that the team’s structured, I don’t think it necessarily makes sense unless you have plans to reallocate them right away because then you’d be carrying the cost of both the full team as well as the platform. And there’d be a lot of redundancy. So like this is essentially what it would look like across all your providers. Sounds like we’re gonna put this down to. It. Doesn’t sound like there’s plans to grow their delegated contracts. So like this would come down a little bit. But outside of that, sounds like we’re pretty close on everything here. And then we just need to finalize the payer revalidation piece with.
Eric Kahler (41:00) The like… actual price paid? Would it would be back based on what actually gets worked? Is that right? Like you actually pay based on the true quantity? Not the, does… that make sense? Like it’s, we guessed it’s about 700. But if it’s 800, is it going to be more because you’re paying the per unit price or is it so?
Josh Brunell (41:25) You are?
Eric Kahler (41:29) That might be a dumb question. I just double checking that. It’s not like.
Josh Brunell (41:32) So you’re paying? Yeah. So it’s annual payments is what you’ll be paying. And in those payments, like we’re not going to be like on a monthly basis going and saying, well, you actually had this many units consumed. What we will do however is at the end of as if those units are consumed throughout the entirety of the contract, that’s when we’ll come to you and say, hey, you have kind of two options here. You could either buy more units, or we work on maybe an early renewal. And then that way you can benefit from say we renew and you want to even increase further the volumes, then you can potentially get even higher unit pricing discount. The total volumes across the contract is what’s driving the discount on the per unit pricing. So.
Eric Kahler (42:19) It sounds to me like if you don’t use, if we did less than 700, we’re still paying 675. If we do more, we would have to buy more units, yes.
Josh Brunell (42:27) Yeah. But we can’t, we do have, there is some language like around that we could maybe we, we’ve seen put into contracts around like a slight rollover too. So like that is something that we can consider to a degree like if they’re we’re going to want to try to get as close to the pin as possible. Hence why I was asking all those questions. Yeah. If you have reports that can share us, your exact revalidations, your exact growth rate in the last year, so we could get very exact. It’s it’s always better to just maybe be a little bit more conservative in that scenario so that you’re not left over with a ton of credits at the end of, the contract, yeah.
Joshua Levitan (43:09) Hey, this is josh. I apologize. Everyone, I’ve been driving back from a doctor’s appointment. Some have been quiet, but I think the way to think about is this, we get close to the pin as possible because we want the numbers to be accurate but high. So you get advantage of volume based discounting, but we don’t want to overshoot because that’s not good, for you. But then essentially like think about this as a gift card, right? So you can move the dollars, on the gift card, we get close to the pin that determines the dollar on the gift card, right? Then within that, like josh already talked about moving between years, either pulling from or pushing two years as well as from one skew to the other, right? So we don’t really care how you consume the X amount that’s on the gift card. And obviously, if we’re trending right over there’s, the early renewal conversation, if we’re trending right under, there’s a conversation about how that can be rolled over. But, but you’re, we spend so much time in these conversations trying to like get these numbers correct because we want you to get take advantage of the volume based discount. We want that gift card number to be the most accurate. But then how you consume it over the life of the three years is incredibly flexible.
Joshua Levitan (44:22) Does that add context, to the question? It, does that makes sense? Thanks. Yeah. How I?
Josh Brunell (44:30) Mean from,
Chris (44:31) from our view on that, if we’re tracking at 7,000 units per year, how are, how do you guys let us know where we’re at in that process? Like, hey, holy. It’s been two months and you guys have already done 6,000 of these. So we’ve got a problem. You know, how do we stay in touch with what the overage or under usage of the units are either monthly or yearly? Yeah.
Josh Brunell (44:55) There’s there’s two mechanisms we have reporting built into the platform to track your level of consumption and the number of enrollments that you’re completing.
Josh Brunell (45:05) And then we also have an internal team that will be dedicated to action behavior centers few resources you’ll have like a dedicated account manager essentially that will be with you on a monthly or quarterly basis, whatever you prefer or could be even bi weekly, and can review those numbers with you, and make sure that we’re on track. We’d also… anytime we kind of hit that anniversary date, that annual anniversary date, we would have, a meeting executive level meeting to share where we’re at from a burn rate and if there is the need to do or consider an early renewal or not. So there’s kind of two mechanisms working with the team directly and then we’ll have analytics that we’ll provide you with.
Chris (45:57) And if we get to the point where, you know, maybe we haven’t hit and just to confirm because I think you guys said this, does it mean as far as moving things if we have let’s say our caq a management, it turns out to be 900, but our payer enrollment is 6,000. Did those units transfer in between processes or are we, so we have that capacity too. So, okay. Yeah.
Josh Brunell (46:30) It’s it’s the dollar amount is what, is what we focus on, not necessarily where you spend it across the difference, the products or SKUs. And with.
Chris (46:42) the delegated roster generation is that for like in that first year, we would get four roster generating. So if we have to, we would generate a roster quarterly or do you support four?
Josh Brunell (46:54) Yeah, it’s not like that’s. How many times we’re gonna run the process. It’s like, hey, you have four contracts where you have, your two four payers that you’re doing delegated rosters, submissions to. And so we will own obviously, you share us that template that you’re using and we take that and then we automatically populate it and just forward it to you to submit. And so our team does the quality checks on that and we’ll make sure that those get submitted on a, whatever schedule that you have agreed upon with your payer.
Joshua Levitan (47:30) And build into that too. If the pair goes and change the template on you, right? You get that over to us. We, we rework the automation so it’s really priced on essentially per template or per payer. But then with the assumption that we’re generating them monthly, we can’t generate them more or less frequently if needed. But, the work on our side is in setting up the automation to generate them as well as maintaining that automation and adjusting that automation when the payer inevitably messes with the template and gives you very little notice about the fact that they’re doing so and that’s sort of where we see the value.
Joshua Levitan (48:03) And so the pricing is aligned with the value that you get out of the service in the way, we sell this, that scale.
Chris (48:13) Bye.
Josh Brunell (48:19) Any other, any other questions, on the proposal? Well, I’ll send this obviously this deck over so you can look at the per unit pricing, the breakdown and detail and discuss and debrief internally. If if you can. Also, I’ll send all that in an email and a recap and a follow up. If after looking at it, you feel like the inputs are off or you feel like this is under over scope, like I would love to get that feedback and then reconnect just to make sure we can make any changes.
Josh Brunell (48:53) And then from there, like the one thing I just wanted to discuss is like what does the overall kind of timeline look like from say we get to a point where contractually we agree on a, you know, set price proposal structure from there. Like it sounded like we would bring this up to sea level leadership for review like what does that process look like? And how can we best support you?
Eric Kahler (49:22) Yeah, I think a couple things. One is, yeah, we first have to circle back with our internal it team. We’ve talked a little bit about this kind of stuff, but we haven’t really, we haven’t spent a ton of time with them. So, yeah, we got to talk to them, just make sure we’re all on the same page and they see the same opportunity because they may have other thoughts on what if we did this or that because they’re very heavily involved in the Salesforce piece of it. I will say that I will.
Josh Brunell (49:46) Say with this structure, the big benefit is that the implementation up front, knowing that we’re going to be starting with net new opposed to like having to do a huge data export from Salesforce up front. It’s going to hopefully alleviate, their team’s involvement and burden of having to get involved to help with doing that kind of data migration from one system to another. It’ll allow for a more kind of gradual got.
Eric Kahler (50:13) It export? Okay. Cool. Yeah. And that’s part of what they’ll want to know. And then also just, they’re going to have an opinion in general on the direction we’re all heading. So that’s like the first piece. And then of course then there’s also, yeah, let’s say we all were like, yeah, this is the right path forward then it’s more.
Chris (50:32) Working.
Eric Kahler (50:33) through the C suite to get their buy in. I’ll say like looking at, the contract pricing at all, like I get how you all structure it. And it makes a lot of sense how you did it. And to your point, like we have a team of 20, I think we have to go back. We’d have to go back and really understand of those of the, we were really focused on the 11. But like of the rest of the team, how much is really impacted? Because I mean if you look at the year three costs, it’s essentially close to the cost of the whole team. So we would have an issue with because the biggest benefit to us is cost savings. Of course, the denials is going to be, could be really nice. And I think we all agree there’s some benefit there, but it’s hard to know what we’re really going to get there. And then the speeding up of revenue also nice. But like that’s not exactly why we would do it. So we would need to get really comfortable internally with like what do we think the true net benefit is on the team to this? Because it’s a huge investment and there will be overlap? Yeah.
Josh Brunell (51:34) 100 percent. Yeah. What we don’t want is obviously like for there to be an increase in the cost, of, yeah, owning this process. And so… I will say like, the volumes that we have estimated on years three, are fairly high to the degree of how many people you have. So that is taking into the factor like growth and increase of volume. So like, yeah, please take a look at, the units of work that we have estimated. And then also, yeah, the team and how they’re structured. And if there’s any feedback that we can take to either adjust our proposal or adjust, like how we’re thinking of like the cost savings. Like I say we reconnect on that after you have time to review this and then… kind of walk through that feedback together so we could really have like a sound business case to bring forward to the, your C level when ready, cool. Well, we’re we appreciate the time.
Josh Brunell (52:39) I’m gonna try to… maybe give you all a couple minutes back in your day. I’ll get this deck sent out to you. And then I say we plan to reconnect as soon as this team’s available. Maybe sometime next week. I know you said you or is next week you’re on site?
Eric Kahler (52:56) Why?
Josh Brunell (52:58) Don’t we plan for the week after falling Easter, well?
Nicole Campbell (53:07) While josh is pulling up some calendars would love to know like, I know Eric, we talked a bunch this week but like Liz, Chris, the rest of the team directionally, the idea of moving forward with a more like all inclusive provider to handle this.
Nicole Campbell (53:21) How are you feeling about? Just the thought of bringing on medallion as like the financial piece. Obviously, we work through but just in theory overall.
Chris (53:30) From a process standpoint, I mean, I’ve often said that credentialing was the area most… ready for AI because of the repetition, of the, you know, all the things that you guys have mentioned, the ability to just repeat applications over and over again, the submission process, all of this speed, the lack of having to… factor in the amount of human error that goes down because people type, I mean, I’m the worst typist in the world, if I was doing this job, our error rate would skyrocket. So, I mean every.
Nicole Campbell (54:09) day, yeah.
Chris (54:10) Yeah. From a conceptual standpoint, I mean, I would say, if it was up to me and cost was not an issue, which is why Eric is here to… I would start tomorrow. Yeah.
Nicole Campbell (54:27) That’s super helpful feedback. I just want to make sure we’re on the same page and there’s no.
Chris (54:30) Yeah, yeah, yeah.
Nicole Campbell (54:31) And especially with the way it would work with the team and obviously like the new structure. So that’s really helpful to understand that from that side, the team is on board and we have to like work through logistics to make sure it works long term, yeah.
Chris (54:46) I mean, with us, it’s always a matter of, we don’t bring things to and I think we’ve been pretty consistent about that. We won’t bring things to the C suite if it’s not something that we are in full support of outside of the cost factor, right? Obviously, we have to work within our Lane on the cost side based on, what we’re allowed to do. But so, so from that end, you know, we’re full steam ahead. As Eric mentioned, we always had this planned as being an augmentation to the team and finding them other things to do. So we’d have to look at that and see, okay, if it, depending on how long it takes to get there, how do we start, you know, finding things for people, we’ve got natural growth coming in all the areas. So, I mean, that’s not usually a huge concern but it is something we have to think through just from the health of the team standpoint. Yeah, as well. Appreciate that.
Nicole Campbell (55:37) Feedback. And like we can always have those continue to have those conversations too.
Chris (55:42) For sure.
Nicole Campbell (55:43) Okay, josh. Sorry, I just wanted.
Josh Brunell (55:44) To know I was just gonna, I was just gonna say, so the week of like the sixth would Tuesday the seventh work as far as us to aim to reconnect on this? That gives you all next week and then a day to catch up unless?
Chris (55:58) You want, let me see. Tuesdays are usually rough for me. I.
Josh Brunell (56:02) Could also do one actually.
Chris (56:03) I am open that particular Tuesday. I do have time in the afternoons.
Josh Brunell (56:11) Would two o’clock work on the seventh? Two two? Sorry that.
Chris (56:16) That would work for me. I, yeah, personally, I’m not sure how it looks on Eric or Eliza’s scale schedule. Could also be two central. Yeah.
Josh Brunell (56:27) We’re available from one one o’clock central through to… three o’clock central.
Chris (56:40) I can make anything work for me. I think I can make, yeah, I can make it work. Yeah, two will work for me too. Okay, cool. I’ll.
Josh Brunell (56:50) get that sent out and I appreciate the team’s time. Thank you very much for the feedback.
Josh Brunell (56:55) Have fun next week. Getting together in person in Austin. We’ll follow up. I know Nicole will to Chris asking about.
Nicole Campbell (57:02) I’m going to ask all of you now. Yeah. Where are you?
Josh Brunell (57:03) Yeah. So, I’ll.
Nicole Campbell (57:06) be sending a side email, happy.
Chris (57:09) To help all.
Josh Brunell (57:11) Right. Enjoy the travel. Thanks again, team. I’ll follow up here shortly. Thank you. Thanks everybody.