Transcript
Laura Chandhok (00:00) hi, Mira. Hey.
Mira Guha (00:01) Laura. How are you? I’m good.
Laura Chandhok (00:03) How are you doing?
Mira Guha (00:05) All right. It’s just that crazy time of year.
Laura Chandhok (00:07) It’s a really crazy time of year. Oh, man. Glad to hear. It’s. Not just us, it.
Mira Guha (00:14) Absolutely is not… but hopefully calms down soon for your sake. For my sake, for everyone’s sake. Yes.
Laura Chandhok (00:22) Yes. Oh man. I also, it might have got a little crazier because Allie let us know that she’s leaving strive in a couple of weeks. I know such a bummer. We only got like four or five months of overlap and there’s so much that she just, you know, really understands the way things have been set up here. So it’s going to be a hard one, to come back from, but we’ll figure it out. Yeah, sorry.
Mira Guha (00:50) To hear she’s leaving, but hopefully we can ease that transition as much as possible. Yeah, hopefully Kyle’s been helping with that, but if there’s anything else, let us know, yeah, that sounds.
Laura Chandhok (00:59) Good. Awesome. Yeah, I’m excited to talk today. I think it’d be good to kind of review where we are in the year… we’re overall at strive.
Laura Chandhok (01:09) I think the medallion partnership has been better. I think like Kyle’s been a good resource for us. We’re you know, definitely able to like identify priority tasks there. And he’s been helpful in like helping us understand some of the feature functionality better. For example, like he’s been showing me the teams feature and I’m going to start setting that up for some of our nurse practitioner leaders to start with which is one of their big challenges like that. They couldn’t see what was going on and didn’t know how to make sure people were following up on their tasks. So that’s been good. I think I’m sort of generally still hearing, you know, I think the themes are like still taking a long time for, you know, for new licenses for autonomous practice and like not always being sure why and what’s our providers not being responsive versus like, you know, are there things that it’s taking medallion a while to start? So I think that’s the time, you know, timeliness is probably still our biggest like… pain point around credentialing. And just like, you know, feedback that we get from the clinical leaders. And I think just like general confusion too and like us making, you know, how can we make things more like easy to follow clear, simplified, less confusing for, you know, providers who like don’t spend as much time, you know, in the weeds of all of these various like state and pay requirements. So, and those are kind of the themes. And then as we’re starting to look ahead for the year, we’re anticipating quite a bit of growth especially focused on our nurse practitioner… role and likely hiring somewhere in the range. I’m still waiting for like updated data to start to look at where this maps out by state. But in the range of 50 additional nurse practitioners this year, likely with additional, you know, multiple licenses per MP. So that’s going to be a pretty big jump for us in a short amount of time. And so we’re starting to map out now, like how do we make sure that we can start, you know, start work early to try to get people patient ready faster as soon as possible? And I think that is what prompted some of my questions too around like medallion’s capacity and, you know, costs for taking on more than we have than you have been doing for strive so far. And like supporting the initial strive credentialing, more, potentially supporting some payer enrollments. Or like, you know, trying to get our groups enrolled with payers and, or individual providers. So I think that’s kind of like the direction we want to go in to be more ready for that growth with like probably flat headcount for our credentialing team or, you know, only a small increase if anything, and to be able to kind of handle those like, you know, surges in volume… and I think, you know, we’re still like, you know, transparently we’ve been looking to see also like, you know, one of the other like vendor options software options around this and getting a sense of the market too. I think like, you know, we’re still excited about the medallion partnership and like really just want to see if like with, you know, our partner, we can just go all in and really be using the full functionality of whatever tool it is which I don’t think we’ve you know, fully done in the past. Yeah, awesome.
Mira Guha (04:48) That is super helpful. Yeah, a lot of really exciting big things and we would love to see how we can partner with you through those. And just like take it as it comes, get ahead of it all. Yeah, amazing. Well, I think a lot of helpful information for me. We can kind of get into definitely want to take some of that feedback. Yeah, especially on like the clarity piece. I totally understand like we’re trying to make this as least burdensome as possible for providers. So I want to take that back to Kyle as like something y’all can continue to focus on. And how frequently are you meeting? I think you have a recurring call with him, right? I think he’s got a.
Laura Chandhok (05:22) Month. I don’t know. I don’t join all of them. I know he has time with Nikki, some Thursdays. Let’s see, maybe it’s.
Mira Guha (05:31) maybe.
Laura Chandhok (05:34) it’s every other week. No, maybe it’s every month. Yeah. I think it’s… okay. Maybe it’s the second Thursday of the month. I’m trying to look for what’s the pattern. Yeah, second Thursday of the month. So every other month, awesome.
Mira Guha (05:49) Yeah. I think those calls will continue to help as long as folks are able to partner with him and bring those examples. So I might in our follow up ask about that. We can copy Nikki to get clarity on where like where can we be better about this and make sure providers know exactly what’s happening get ahead of delays? So I first wanted to acknowledge that I’m glad things are improving but things can always be better. So I’ll make a note of that today part of today is like taking that feedback. So I’ll take notes on that what’s coming ahead obviously growth for NPS needing a licensing there and potentially looking into enrollment. We can definitely chat a little bit about that today and then maybe even like set up a demo or if we have time today. I don’t have a call after this. I don’t want to take your entire day but we can like look at what a demo of our enrollment solution looks like. But we can kind of, I want to make sure we’re making the most of our time today. So if someone’s just like, yeah, we get it. We can skip past this. Let me know that’s fine. Get to the meat and potatoes. Yeah. So support refresh and remind you who we are. Yes, that’s great operations, current state, just kind of a high level overview of where things are, might kind of point to some of the stuff you were talking to. I put this together like the last two days. So hopefully everything is still pretty up to date focusing on those priorities, things that are coming up pain points, feedback. I did really want to talk about that consumption review. I think it would be good to get ahead of things given like as we discussed, we’re trending really high and it sounds like we’re going to continue to do so more. And then I didn’t put that in here but I definitely want to chat about the enrollment stuff. So I have some stuff pulled up that we can go into how that works. If you have us managing it. I know you’re doing the self serve piece. So you’re already really familiar with that dashboard. So then if we were to handle any of that for you, I can explain how that differs where we would step in versus if, you know, I’m sure you still want to keep some in house. You can continue to use the dashboard for that. Just wanted to remind, you have Kyle, obviously he is happy to meet with you. He exists and works in tandem with our operations team. And then our support team is also there. We often recommend still going to support for like very general stuff but obviously meeting live just gets ahead of a lot of things. And then I’m here anything commercial, anything contract related, high level strategy. We’re both able to help escalate as things occur to engagement manager, leadership, if needed for operations, things, help management if there’s contract things. So just a reminder who we are and then just wanted to give a quick peek as to how things are going. Overall. We’re seeing pretty good turnaround times on your licensing. I know we’re of course trying to get ahead of delays and speed this process up, tighten it up more. But compared to industry standard, seeing from requested to completed, not even counting like stops in the way where we’re having to task stuff out to providers and that slows things down or vice versa. Still seeing pretty quick turnaround compared to that industry standard of… looks like we are requesting at a pretty healthy pace. I was noticing today of the ones we have requested, I think at least like 25 of them were made within the last maybe two weeks. So good number of renewals stop me if needed. I talk very quickly. No, you’re good. Is this all time? Yeah. So this is all time, all 11 32 in our lifetime together and this is all medallion owned. So anything you took in house, this is not included. So obviously most of those having been completed, but a lot of stuff kind of in the process. So many requests made last week, a lot of things we just can’t work on yet because of timing for renewals. The renewal window isn’t open things like that, good number of things processing with our team, certain things in intake being worked on application wise. I’ll send this whole deck to you afterwards. And if we need to do any follow up, just let me know. And then yeah a good bit of stuff in client attention. I’m guessing this is where we’re going to be focusing a lot of our time especially like with Kyle with Nikki, anybody who needs to be kind of digging in here.
Mira Guha (09:35) Nothing really concerning as far as expiration for what I’m seeing there are like two licenses that are expiring obviously pretty quickly but just need some help actioning those. And I think I flagged that to Kyle so he knows to keep following up with your team on them. Otherwise most of these are new state licenses that are in intake. So we just need something from your team to be able to move them forward. So definitely, you know, good chunk here, but turning through those and then quite a few sitting with the board. Most of them are we’re expecting kind of an issue date based on our data between March and June. So mostly renewals, but a couple sorry, mostly new licenses, a couple renewals and some reinstatements. So just wanted to give you that snapshot of kind of the various buckets where things sit. We always try to get ahead of those license renewals as much as possible. So again, we’ll check with Kyle on anything that’s like really high priority based on turnaround time here, expiration date. And then there’s just a few things again, can’t work on them like an NP license until the RN is issued, things like that. So pretty healthy breakdown here. But any questions, observations, anything we want to take back? Yeah, no, I.
Laura Chandhok (10:45) Think that that’s a good overview… honestly. I’m not using the analytics section a lot yet. I probably would like to be doing that more. So I think like for me, it might be helpful if we can continue doing some of these reviews like to look at, you know, trends too, that’s helpful for me to share with our leaders too like just knowing the turnaround time is helpful and it would be probably even more helpful to say like, you know, our turnaround time in 20 25 or in Q4 25. Was this like in Q1? So far? It’s been this, and to see if those things that we’re working on to, you know, try to work closely with Kyle all around the, you know, open requests and work and like have better visibility with our clinical leaders are making an impact. So if that’s something you can, you know, kind of I know we have the analytics tab which is great. But if that’s something you can like support on, you know, kind of helping tell that story. That would be really helpful definitely.
Mira Guha (11:45) And if you are willing to make this a monthly thing, it would be really helpful. I can say like here’s what this like here’s our slide from last month. Here’s how it is this month that’d be great. Maybe it’s slower. Like why do we think that is? And I try to dig in with Kyle and be like, do we have an idea of what’s going on? He’s more in the weeds than I am, but that’s kind of how I like to treat things is like I will show exactly what we were doing last month compared to this month and be like here’s quite a difference or here’s how we’re improving, not like where we’re seeing slowdowns. So I’m happy to do that. And if we can make this monthly, I think all the better perfect. And that wasn’t that particular slide wasn’t analytics. That was literally just a screen grab of like the overview from your license tab. But there is a lot of information in analytics such as this. So I just wanted to flag kind of just overall progress and how we’re kind of trending as far as what’s actually being done last 12 months, seeing 200 new state licenses being issued, 148 renewals, and then just kind of to get ahead of some things, we have almost 800 licenses up for expiration in the next 12 months. Some of these have auto renew on. So we’ll just be automatically generating those renewal requests. I think the 90 day mark from expiration. And then as far as the next 12 months and this can kind of help us with that consumption tracking. We expect 75 to be renewed with auto renew. So just wanted to flag that right now as far as kind of what we can expect for usage and stuff to get viewed up. And this is also stuff you can, it’s a little trickier to find in platform if you don’t know where to look for it. But under our existing licenses section, you can kind of track what’s expiring and what has auto renew on or off. Okay. Yeah, that’s helpful.
Laura Chandhok (13:22) Yeah. I mean, I think we’re also, I’m also like we’re generally… kind of focusing more on the… MP role and not as much on the RN role. So I’m all it’s a good call out. I think like we may want to really prioritize using the auto renewal for the MPS and not as much for the RNS. So if auto renewal is on, that means like medallion will by default support the renewal of the license? Yeah. And.
Mira Guha (13:57) you can, we have it currently opted in per license? So a lot of folks are opted, they’re like they’re maybe their RN in Minnesota currently is opted off, but their RN in Massachusetts is as an example. So if that’s worth revisiting that’s something your folks can look at any time. But if it’s helpful to kind of in one of your next calls, sync with Kyle and say like, hey, like what does it look like? Mostly, you know, 177 currently on auto renew. What are those? Which ones are off? I can even send you a report of the differences between those after this call, yeah.
Laura Chandhok (14:29) Yeah, that would be great. And especially maybe like for ones, you know, in Q2, yeah, for us to review. I think I want to make sure we’re yeah, like using our budget for the highest priority things. I was literally just talking to the nurse or RN leadership about this too and they’re like, well, you know, it’s like pretty standard that the RNS should be able to be renewing their own licenses too. And we’re talking about more of, I mean, it’s basically what we have right now. I think of it more of an opt in model to getting additional support on it, but making sure that that’s actually like happening operationally and they know which ones that are listed for having additional support and can confirm whether that’s appropriate or not. Definitely.
Mira Guha (15:11) The nice thing about the opt in option is if you’re trying to be most efficient with your funds, you know, you don’t need that license.
Mira Guha (15:17) It’s their responsibility. Great. You want to make sure that definitely isn’t lapsing no matter what that’s what we’re for. So I’m happy to share some data there just for like super clarity. And then I’ll make sure Kyle knows is kind of an ongoing thing. This might be something we track as a priority that’s great, perfect. And then I did want to go over tasks a lot going on. So a lot of tasks out there, most of them currently are sitting with the providers. I’m guessing that might be kind of where we’re seeing some of the confusions. And this is something we can again chat with you is like this shouldn’t this type of task should not go to providers. It should go to admins, or vice versa really depends on your preferences and what makes the most sense? We can kind of customize that through your project plan. But a lot of those right now are sitting with providers and it is profile specific. So something we need from their profile that’s not currently there. And a lot are maybe going to be more, you know, at least seven of these are specific to a license request we’re working on to be able to move it forward way few admin tasks. But the ones that, are all licensing related. There are a lot of these over 30 days and that could be due to some back and forth that could be due to just like not being able to action it right now. I’ll admit I didn’t dig into it because there’s a lot of them that’s something we can kind of look at in the trends as well. But it does mean like all those things in combination means the average task age is pretty old. We have some pretty old ones sitting in there and might be worth kind of doing a little bit of a cleanup with Kyle. Yeah.
Laura Chandhok (16:40) Yeah, that would be. Yeah. I think that would be good. I think Nikki’s been trying to do a decent amount of cleanup too. I would, yeah, I would guess it’s a mix of ones that are still needed and ones that are not like these ones that are super old. Some of them are real like are there, you know, there are licenses we’ve been working on for months, but yeah, there may be ones that aren’t as needed anymore. So that kind of cleanup would be good. Is that something that you would recommend? Like doing in our regular check ins or setting up separate time for? And you can see how it works for him, but I know it’d be good to review together. Yeah.
Mira Guha (17:15) I think what might be helpful is I can check in with Kyle after this and like we can maybe he and I both take a look and say like a lot of these older tasks seems particular to be around X y and Z. If they’re all over the place, it might be something where we kind of start by saying let’s schedule time whether it’s our weekly or it’s a separate call before that call. Like Nikki, can you take a look at anything over 30 days just generally? And if we know for sure, like we don’t need this license, we do even just like a list and then anything else we can kind of tackle together? I can also see if Kyle has better recommendations since he’s usually the ones actually leading this call as to what works the best for him. But having any kind of insight like from your team as far as like we definitely don’t need for this provider anymore. Something like that, any provider who’s deactivated, we shouldn’t at this point, like if they weren’t before, we shouldn’t ask for them anymore. But if it’s like we’re slowing down on this provider or we don’t need anything in this state that helps us like start the cleanup and means we have less to work with on those calls. Okay?
Laura Chandhok (18:15) Okay. That’s great. Yeah. So I.
Mira Guha (18:17) can touch base with him and see if there’s anything kind of really alarming he sees on his end or if he has practice recommendations and I’ll copy and paste on that response and see if we have thoughts on how to proceed. Okay?
Laura Chandhok (18:28) Yeah, that sounds good. It would be helpful to just in general, I think have this cleaner and know that the tasks that are open are real. And the ones that are, yeah, there’s not as much noise in there. That would be great.
Mira Guha (18:39) Yeah, it means it’s easier for both your team and ours to focus on like what matters. Absolutely perfect. Okay, great. So this is probably not as helpful but I did want to just kind of track like as of right now again, with this increased growth, seeing a lot of tasks being queued up and a lot of them being actioned. It doesn’t mean as we’re seeing more tasks like that might mean we’re seeing slower time to address them, but nothing super worrisome especially given that we know what’s kind of going on with some of those aging tasks and this all sits in your analytics tab if you ever want to review.
Laura Chandhok (19:11) That’s completed in. Sorry, what were the, what’s the access? Oh sorry.
Mira Guha (19:16) Completion time? So it takes about 60 days on average to complete a task. And I think that’s getting skewed by some of those really old tasks. So, okay. Okay. Yeah. Sorry, that one gets cut off from the fun joys of the dashboard.
Laura Chandhok (19:29) Yeah, it was interesting too. I don’t fully understand like but hearing some sometimes like the providers done something but they didn’t mark the task complete. So like that’s what needs to get completed. So, I’m hearing that from the team some too that like that’s you know, confusing and I don’t you, know, if you have more like if that’s a common thing that people run into and if it’s certain kinds of tasks. But something I’ve been hearing that like… I can imagine is a little confusing for providers too. Like, well, if I did then, you know, like I sent in whatever it was and not realizing that they have to go in and mark tasks complete too.
Mira Guha (20:06) Oh, yeah, that is definitely a big part of it. We do require that like task complete that triggers a workflow for our team to address it. Yeah, I don’t know that I’ve heard, I’ve not recently had that issue where like that’s what’s holding things up is like someone forgot to click that button if that is like helpful for us to do any kind of like retraining or like provide a refresher resources or something like recommendations and requests when you’re doing tasks just to help speed things up on our end.
Laura Chandhok (20:39) Yeah. It’s a good idea. I mean, maybe you can put a question too just around like a refresher on basically basic medallion functionality. I would guess that is not something that most of our providers like understand, well, you know, even if it’s not like a live training but just like sharing a job aid or like common questions. And did you, or did you know, kind of thing that they could read that could be pretty helpful? Yeah, we.
Mira Guha (21:06) Have we call it a provider welcome packet? It can also be like a provider best practices that has like videos of like here’s, how to go through and like see what your tasks are here’s. How to complete your profile. Nice. I could go ahead and share like a web doc version of that, and then you guys can work around with it to make sure it makes sense. Perfect.
Laura Chandhok (21:26) That’d be great. Okay.
Mira Guha (21:27) Awesome. I’ll make a note of that. Yeah, anything we can do to help enable them, make sure they’re not having to ask a 1,000,000,000 questions. Yeah, yeah.
Mira Guha (21:36) Amazing. Okay. So, I think we have a good sense of like a couple of priorities. I’ve definitely, I’ve been taking notes this time, but as far as kind of big priorities, some of them like can keep them general, can keep them specific. It sounds like a lot of it right now. Just kind of is NP, licensing in general. So I want to just start with a bullet for that, task clarity and cleanup, being another one. And then I can put in some details after the call just to save time. And if anything I write down doesn’t make sense to you or doesn’t seem accurate? Just let me know. Just taking a look at some of my other notes. I’ll put in a note about like provider training resources. Yeah. And I’ll say like maybe auto renew as well, auto renew, review and cleanup. Okay. Anything else? I can have stuff that’s not necessarily in here or make a separate slide. But anything else we really want to focus on as just kind of a big priority or I guess I realize this says pain points but, anything just kind of to note, for big feedback, or things to be looking forward to things to expect in the next, couple months here. I’m not sure where.
Laura Chandhok (22:47) This fits, but I think like successful rollout of that team’s the leadership, leader access functionality will be important. So, I’m planning on setting that up for three trial users in the next few days.
Mira Guha (22:58) See if.
Laura Chandhok (23:00) Kyle can do kind of an overview for them of how to use that functionality, what they’ll be able to see. But I think that could be pretty helpful and we could give it to other kinds of clinical leaders too, not just the MPS leaders, but for the other roles too. So, I mean, that will help with, you know, probably all of our priorities around like speed of, completion and transparency.
Mira Guha (23:23) Let’s… put maybe.
Laura Chandhok (23:25) Like, yeah, not as a pain point but as a thing to explore like the payor enrollment support, the initial credentialing too. So, I’m new with the credentialing. So I, we could definitely spend some time with Nikki too, like looking at, you know, what, like, what is our full process today? What could, where could medallion be doing more? I know we still use caqh for like, the primary source verification that may be part of it too. Like, is that, what could shift over to medallion? And do you guys have, you know, is it faster typically if you guys, like take that on that’s sort of like what I’ve heard some is like it might be faster, it may be more expensive, but like that might be worth it to us to have it all be kind of more integrated. Yeah.
Mira Guha (24:09) Absolutely. And, I think it, the truth is, it can vary, I don’t it doesn’t or is this something you’re kind of, I know you’re handling it now by using our platform. Yeah. I might have Kyle speak more to the caqh piece of it, but I can kind of explain how we do things. Oops, sorry, I’m just pulling up medallion. Yeah, go ahead. And I can add some slides to our deck for today from another deck because we love decks here. That just kind of it’s very clear on like here’s what we do here’s where we need your help. It’s kind of like licensing very much and like we get data from you, right? So, I’ll go ahead, I’ll actually just show your, Da, your platform. Since you have an enrollment tab, we’re just not doing the enrollments and I’ll show you like how it works for you, how it works for us. So, you’d still be working out of this tab. Instead of requesting something as client owned, you would be requesting it as medallion owned, it’s as simple as make sure that is checked instead of strive. So if something comes in, it will look very similar to this once it’s first requested, except that it will say medallion instead of client here, you’ll still see information on profile completion, which group PC, whatever you call it, we’re affiliated with for the provider or if it’s a group request. So depending on what the request is, we’ll ask for that information upfront. I think your groups are pretty complete. So, like I don’t see it being a huge lift for you to transition, to more managed than self serve. From there, what happens is our team does what’s called intake. And I’m gonna switch slides real quick for this part, much like licensing, ignore this part. We get all that data from you, provider profile, group profile, whatever’s relevant for us to be able to initiate the enrollment request. We usually need more information for enrollment work, than we do for licensing. So, I’d say maybe even 85 90 percent at least the more we have, the better. And most enrollment, does we do ask for caqh info? We probably already have it because of licensing their, their login credentials. So we can go ahead, and use that in our process as well as with the profile completion. So that’s why this says X, it really depends on the payer, from there, we make sure the linkage is correct. Probably, the case for you since you have the group information already in medallion and across the, enrollment, our team then goes in and does what’s called intake. It’s basically an audit of that information and the request. So we make sure we have everything we know, we’re just generally gonna need for that payer if it’s medicare medicaid, that’s gonna include like surrogacy funds, stuff like that versus just kind of general stuff, caqh, group information, all that fun stuff. We verify that, you can request those lines of business with us. That is a big thing. We want to make sure that’s accurate because we’re going to submit it however it’s requested. If there are any dependencies, we will identify those. Sometimes it’s things like Aetna requires that three providers be submitted with the group contract request, and then they need like that first or the group first, I’m, making this up, this might not be accurate, but you get the idea, from there, we do intake, complete that’s when it gets consumed similar to licensing. So it’ll, hit your contract consumption. Once we’ve completed that audit process and we start working on the application. Essentially, if we are meeting anything maybe something, a document is expired or, we need clarification, there’s a work history gap, something like that. We task that out, same as licensing. We ask that your team mark that request or that task complete. We review for the accuracy, and then we go ahead and we submit that enrollment request. We have this big old list of here’s generally what pay we’re going to need depending on the type of enrollment request. So like if it is medicare, we need the pico, surrogacy stuff. We need to make sure your team can kind of give us access to work on those things. For group profiles, we need all that jazz irs W9 bank information provider profile, caqh being a part of that, and then all the usual stuff we need for licenses. So, this is a starting point depending on the payer, we might need more, all that good stuff. So, we, basically, and then that takes us into credentialing. It’s a lot like what you’re doing right now except that the idea is you put the request in, you give us the information, and then we do the legwork of submitting the application to the payer, we conduct follow ups every, usually 10 business days, depending on who that payer is, we might, we do it through a phone call, we’ll check their portal. We will include a copy of the application in the notes section. Once we submit the application, so much like licensing, a lot of the meat and potatoes will sit in the notes section. There’ll be a reference number. If we do a call, there’ll be a track of the emails.
Mira Guha (28:51) If we’re emailing someone at the payer, if you have, contacts at, united, whatever, who we can leverage, if you can share those with us, that can help us sometimes speed things up, generally from being able to actually submit the application. So, making sure we have everything it’s up to date, intake’s completed, from submission to actually being par in a network, usually see 90 to 120 days. I think that’s calendar days. I’ll double check for you. Sometimes medicare medicaid is a little faster, more like 60, it really depends. Sometimes it’s faster. Sometimes it’s slower. We try to get ahead of delays as much as possible, but that’s kind of generally, what we tell folks is 90 to 120 days. This is super.
Laura Chandhok (29:36) Helpful. Okay. Yeah, you have, couple… questions. So, so one thing strive has been working on is, we have like we have a, you know, we’re kind of a unique model where we’re not like as primarily a fee for service provider. We’re like a, you know, value based care risk contracting, focused provider group. And so a lot of our patients right now are risk, we have a risk attribution model with oak street health big, you know, multi specialty physician, group across multiple states. And the challenge there is like we are not contracted with the payers that oak street is contracted with to submit claims. So we can, you know, we can see their patients. We, we have the, like the agreement with them, but we can’t we are not enrolled, with some of the payers in some of the states. So we can’t bill. We can’t, you know, also get like risk adjustment, risk coding through submitting claims. So, we’ve one initiative I think would be a good place to start on. This is like we have started trying to direct, you know, to apply for contracting and credentialing in some of the states where they have more patients, where we just don’t like basically for them, we had some overlapping states where we already had agreements with Aetna with humana, with other big payers because we had risk contracts with them. So, we were already in network and contracted and credentialed, but there are states where we are contracted with them. So we’re trying to go directly into those states. And we’re not, we don’t have a risk contract with unitedhealthcare that’s a big one we’ve been trying to get is like a lot of unitedhealthcare is one of the bigger payers under, in oak street’s population, and we don’t have a direct contract there.
Laura Chandhok (31:23) So we’re trying to kind of go to those states and get them. So, I guess, I think that could be a great place to start where it’s like it’s pretty new for us. We don’t really have a, you know, existing relationship there. It’s been kind of taking a lot of time to try to get those in and without a lot of success. Initial question, like do you guys have stats on like how’s how the success rate for getting contracted when it’s like a, you know, a new, practice or group request with a payer and how that varies by state. I don’t know if.
Mira Guha (31:55) we do, I don’t know if that’s something that we track, if you have a couple like it sounds like, unitedhealthcare is a big.
Laura Chandhok (32:02) One. Yes.
Mira Guha (32:04) Are there any particular states where you’re really focused right now?
Laura Chandhok (32:08) Yeah. Let me grab my… it.
Mira Guha (32:13) Might be helpful for us to kind of, I would recommend even if we were to kind of do some sort of pilot with you, we still have you kind of scope out what you’re looking for with enrollment like an enrollment expert. We can’t provide like consulting, but we can say like, as of right now, like I’m like they might say like we’re working with uhc, I have another client working with uhc in this state and like, things are going pretty slowly, things are going pretty quickly. Sometimes unfortunately, the reality is we submit an enrollment and they say our panel is closed, the market is saturated. At that point, we regroup with you. And the reality is, if we do the work and submit the enrollment, we do charge for that, we don’t charge kind of like license and completion. We, we charge for the work we do. Yeah, but we could regroup with you and say like, hey, do we want to try again in six months? I don’t I haven’t been on an enrollment operations call in a minute, but sometimes they’ll say like maybe we can put together kind of a document of like what makes your organization special? Like like kind of the services you’re rendering or like, your stats? Yeah, yeah, we’ve done stuff like that, but if you, and that’s maybe something we can reconvene on is like overall goal, sounds like some of the bigger pairs in certain states, for the services you’re rendering, I’m guessing you’re doing mostly in person versus like telehealth, or is it kind of, any hybrid?
Laura Chandhok (33:28) We’re most, mostly virtual actually. Okay, mostly. Yeah, mostly telehealth, we’re very, pretty limited in person, the in person are like home visits. We don’t have a physical practice location. Yeah. So it, so that makes sense. I mean, I think if you could see what you know, what you like can or can’t share around like contracting success rates. I think we’re looking at like, uhc, a few of the states that we have been working on are Illinois, North Carolina, Ohio. I don’t know, you know, but it.
Mira Guha (34:03) Yeah.
Laura Chandhok (34:04) It’d really be for anywhere that strive kind of has a footprint today, because I think part of it is like, it’s just a, it’s just a lot of work to follow up on all these requests. And so, even if, you know, if, like if your success rate was the same as ours, like it still might be worth transitioning it. But I think, if you had data on success rate, that could be like it helped me build a case for, you know, we should shift this to, to having medallion supported absolutely that.
Mira Guha (34:31) Totally makes sense to me. I don’t get a sense. We’re in a huge rush but would love to see if it does make sense. I’m glad I asked about, the telehealth thing. I know that can be a sticking point with like they require some sort of physical address even if it’s like an authorized agent or whatever. And we have a.
Laura Chandhok (34:47) physical that’s the thing we have physical addresses. But yeah, I think it’s like hard to know how to position, I solve sometimes because it is kind of unique. I mean, we do have physical addresses in each state, where we operate.
Mira Guha (35:00) There is not state.
Laura Chandhok (35:01) There’s just not addresses where we see patients. They’re like… business addresses more. And anyway, we could get into all that. But, yeah.
Mira Guha (35:10) Yeah, I, it’s easy to, but yeah, yeah, yeah, I’m the kind of person who’s like if this can become an issue later. I like, yeah, no. But that’s.
Laura Chandhok (35:19) good. We can take one. I mean, I was just looking, I think we actually do probably have quite a bit of information that’s not in there for, the, groups yet that you would need to submit those. But it all makes sense because I’ve been going through and submitting some of these myself. So now, I know exactly why you need, you know, W nines and big statements and stuff. Yeah. So there’s so we can probably like pick one, you know, get it more fully fleshed out. And then, so, so do we have pricing yet for what that would, cost for medallion? Is that I can’t remember as a part of our existing agreement, we need to add it as a service.
Mira Guha (35:47) Yeah. So that transparently, there aren’t a ton of clients who are using us alone for self service enrollment anymore. So you are kind of a unique case in that sense. I usually, the way we do pricing is we get an estimate from you on how many you think you would need and then we can write some sort of quote in an addendum. I will say at the risk of getting my head chopped off, like very frequently we’re seeing like somewhere in the range of like 250 dollars per enrollment. And thankfully, there’s no like pass through fees that could fluctuate up or down depending on how many we’re adding to the contract stuff like that. But I could go ahead, and as we’re, I already put spoiler alert for the rest of the call. I put together an addendum proposal given just how quickly we’re growing.
Mira Guha (36:30) I didn’t include enrollments because I wasn’t sure that we were ready for that. If we were interested in like even just putting in 10 for the remainder of the year. Yeah. And knowing you have skewflex if you don’t use it for that, you can use it for something else. We could just factor that in and I can see what pricing we can offer you. Yeah, I.
Laura Chandhok (36:46) think that’d be great. And, yeah, and, is, would 10 be like 10 per under a group? Like does the group count as one and the providers count as one?
Mira Guha (36:56) Any single request counts as an enrollment. So, if you had any, like if you wanted to obtain a new contract with Aetna and you wanted to enroll five providers under it, it’s what we call a group enrollment for Aetna plus the five providers would be separate. Yeah, that’s great. Okay, perfect.
Laura Chandhok (37:13) Yeah. Why don’t, we put in 10 and then I’ll just see like, I think we kind of just picked the biggest states, but maybe we just do whatever was next on the list that we hadn’t gotten to yet and let you guys try that one and see if you can make more headway than we’ve made so far.
Mira Guha (37:25) Yeah, I mean, starting with 10, I feel like that’s not the worst thing. I’d probably still have someone meet with you and chat through it. Like Kyle is amazing. He’s he’s most of his background’s in licensing. So sometimes we bring in someone else to at least initiate that conversation. I think I got some helpful information today but like, yeah, having like the group profiles completed stuff like that. And I’d say if we add 10, that’s really low risk if you even decide to do two and you’re like, no, thanks. We’ll put the rest of those towards licensing. Okay, great. I know we’re coming up on our schedule time. So did want to just flag, we’re yeah, we’re jumping right through that consumption. So have 20 K left quick stats. We’re about quarter through the contract, 80 percent consumed. A lot of that I’d say is from the new state licensing being high. There’s a couple things where I’d say just ignore it. Our sanction monitoring, you bought the sanction monitoring. It’s just that the way the SKUs are reflecting, we just changed, the name, it looks funny but the funds were there. It’s just that’s the way it’s consuming. A couple other licenses that weren’t technically contracted that we’re using. I guess there was one enrollment. I can take a look and see what happened there. But just so you can see where the consumption’s happening. We have a lot queued up. So we are absolutely gonna cut through that contract very quickly. Once these go through that and get completed, we will be quickly over the contract. We try to get well ahead of that to avoid any kind of service disruption, anything like that. So, did some quick math here. We do not have to get into the, you know, the nitty gritty of it. But, based on what is in that upcoming, it’s queued up, it hasn’t been used yet based on what hasn’t been requested and will be requested via auto renewal. We did some math there, upcoming queued up but not used yet. Some of these have a new state licenses. Again, there’s a couple things that weren’t contracted, but we’re using skuflex for right now. And then the really big piece there is we went ahead and put together based on all this information and how we’re trending an addendum proposal, based on like monthly averages, growth we’re seeing with providers, I can factor in that we’re expecting about a 50 NP growth. But if you happen to know more about like we actually think we’re going to need this many new state licenses versus what you predicted, that stuff like that or more renewals, as we add more NPS that’s a really helpful starting point. This is what we put together as of right now. This should be all the same unit pricing you currently have in your contract. But all that data in the previous page, all that stuff was factored into this. I will say, I know it’s a, it would be an extremely quick turnaround time. Our team would likely be willing to do some sort of incentivized pricing on the unit price, which would save you money going forward if we were to get this signed by the end of the month. I know that’s in like less than a week. If that is possible. I can see what we can negotiate down, understanding there might be some fluctuation in these numbers as well. But anything we could do to make this a quick turnaround time, anything we can do to book it this quarter? I know our team would be thrilled about, and we’d be willing to probably cut you some special discounting.
Laura Chandhok (40:22) That makes sense. Yeah, that, yeah, why don’t I think if you can see what you can do, that would be great. I’m thinking like… especially like with Allie leaving in a couple of weeks, it could help like, that timeline could be possible for us and we, and there’s a lot of discussion right now around these additional providers coming on, in that preparation. So, it would be ambitious, but I don’t think impossible especially since we went through, you know, since we went through all like the fun, last minute contract stuff at the end of the year. So, hopefully James is okay with, our agreement now. Yeah, if you could, if you could like see if there’s any, you know, opportunity I think probably especially around the licensure?
Mira Guha (41:02) Or like the new license, I hope it’s here we’ll.
Laura Chandhok (41:04) need those. Yeah.
Mira Guha (41:05) Definitely. This all goes through the people who make way more money than I do. But I definitely am hoping that we can do something here especially if you think it’s possible. Yeah. If it helps, I’m happy to just like hop on any quick calls leading up to that 30 first date just to help make sure we’re aligned on everything. I tried to make sure payment terms matched up. I think like, I’m trying to remember what you have, but like we can do quarterly if that’s easier to make this a little bit more palatable. But I’ll go ahead and if these numbers at least initially look okay, I’m just gonna send this version over to you right now. I honestly think with some of the growth you outlined, this might be a little on the conservative side, but as of right now, I think if we’re not certain, I’d say we go with this versus something massive. This is a pretty big bit of growth.
Laura Chandhok (41:48) Yeah, I mean, I think if you could, if you could also add in like what the unit cost would be for payor enrollments and maybe just, put in 10.
Laura Chandhok (41:56) Is that in there yet? But, and then also, if we wanted to start, having, you know, strive credentials or PSV, I don’t know what that like initial new provider, credentialing, recredentialing, support, unit cost for that too. And just, you know, small number just so that we know what the cost would be, and we can scope out like, okay, if we have, you know, 50 new providers who are more, you know, who are starting like if we want a medallion support unit that’s what this would look like. Same for payor enrollments.
Mira Guha (42:32) Okay, perfect. Yeah, I can put in, I think re, enrollment, we call that revalidation. I think that’s actually cheaper than enrollments. I’ll put that in. We also do demographic updates, which is if you make changes to the payor. So I’ll go ahead, I will send this over. I would love to find if this works.
Mira Guha (42:47) I’ll set this as monthly, but as of right now, it would be amazing to close this, the 30 first. I think it would absolutely work. Let’s try.
Laura Chandhok (42:54) Let’s try for it and then, like, so I’m working tomorrow. I’m working Monday. I’m actually off, some next week for the kids’ spring break, but let’s see, okay, yeah, like I can get this, you know, back to Allie and Erica tomorrow to take a look at and like see what, you know, what amount they, are comfortable approving at this point. And let’s see if we can get it done. That sounds great.
Mira Guha (43:13) Yeah, if we have to reduce, we can see what that would do to incentivize pricing. But I think anything we can do, we would love to see it. So, I’ll get that out to you ASAP. Okay. If it’s helpful, I can send you my cell too if you just want to text me things. I’m totally fine with that. And we can go from there, but this was incredibly helpful. Yeah, so helpful.
Laura Chandhok (43:33) I, one other thing I just like, I keep thinking, I’m going to ask her this and then I forgot. So, I don’t remember, Kyle, I think you might have copied you on this email. We’re trying to verify all of our active, RN licenses because we’re shifting to a new, scheduling software and like would like to use medallion as a source of truth for, where our provider is actively licensed. So, we don’t schedule someone, you know, inappropriately. And as, I was like great. I’ll pull that from medallion. I’m pretty sure that’s accurate. Then realized like, I think it’s probably medallion. I’m guessing it’s accurate for nurse practitioners because we do so much. There’s so much medallion support around that and we’re monitoring it so closely, but for RNS, somehow, there are people in there who don’t have any licenses listed in medallion? Okay. I was saying, yeah, some of them don’t have a medallion profile complete, so we can’t work their license request. And I, I’m more like, how is it possible that we just don’t that we have incomplete information in there, and,
Mira Guha (44:31) so, I’m going to do some more digging.
Laura Chandhok (44:32) On my side too. Like, is this something that has somehow soared somewhere else like before from, before medallion? But one question, just like I was talking to someone else’s work about yesterday, and she was like, well, if they have our caqh information, how do they not have licenses? I just wanted to check that too. Like, you know, is this like truly something that you guys don’t have a way of accessing and that we have to do? Or is there anything that you can do to sort of help like identify licenses that exist?
Mira Guha (45:01) Yeah, absolutely. I understand what you mean there. So yeah, that is the kind of thing is like some people use this as a source of truth, some don’t, if caqh is up to date and recently tested and we did a recent, integration like we pulled the data from them, which does have to be done manually for liability reasons. We would be pulling any license data through caqh. I was just like looking up like one RN in your platform where like looked at the caqh poll and there’s no existing licenses that we’re seeing in caqh. I’d say, so like that, I’m trying to see, make sure I’m not missing anything here. So, unless we.
Laura Chandhok (45:38) worked it, caqh may not be updated either.
Mira Guha (45:41) That’s my guess. So unless we actually did the work and did the license, someone added it manually or we pulled it from caqh, we just don’t have it. Can you?
Laura Chandhok (45:50) Tell me more about the caqh poll thing? Like we can’t you can’t what’s required to be able to pull it?
Mira Guha (45:56) Let me just share my screen real quick. So, like I was looking at this provider, they have a complete profile and we did the caqh because I can see it profile linked. You can relink it. If you go to the data section, this will show us what’s in caqh that we can pull over. Currently, I don’t see any existing license data in here, but it’s possible this hasn’t been attested in a minute. We have. I don’t know it might tell you last time it was. But for caqh, I think we need either their username and password or we can do their caqh id, which is like a string of numbers and then their social security number. I think we need one combination or the other. So what, something that like, yeah. If you’d like extra help on that, keep me copied on that email with Kyle and maybe we can see what we can do. But that, yeah, the reality is we need the data from one of those like three sources and if we don’t have it, we don’t have it. So we’d love to see if we can get creative with that. We can look at maybe trying to like relink some caqh profiles and making sure your folks are attesting them so that we can. But I’m guessing that’s where the gap is. Okay?
Laura Chandhok (47:03) Her caqh profile is linked. We have her username and password, it was recently checked, but it’s not finding any state licenses that’s.
Mira Guha (47:12) what I’m seeing and.
Laura Chandhok (47:13) That could either be because somehow she doesn’t have them in there or she hasn’t attested recently.
Mira Guha (47:19) That’s yeah, that’s my guess. We have the caqh number. I can.
Laura Chandhok (47:23) I think it is in there because it was down in like external accounts. I see, I looked up her too, got it. Yep, yep, yep, herself. Yep.
Mira Guha (47:31) Okay. That’s my guess. So if we have a couple examples, maybe we can dig into, we can start there. Okay? And if we need to do it in bulk like a caqh bulk import, I doubt we would sometimes we charge for that. So I just have to look into that. So if we can do it manually, it can save you some money.
Laura Chandhok (47:49) Okay. That sounds good. Yeah, I’ll talk to our internal teams too and see like if there’s anywhere else that we have this information or if doing so, if they had tested in caqh and their licenses were in caqh, that we could have some kind of process for medallion to pull that information, there might be an extra cost for it, but we could do it. Yeah, I could do it definitely.
Mira Guha (48:16) Take a look assuming it’s in caqh. So, I’m happy to spot check a couple of these after we hop off, but, okay, that’d be great. Yeah, RNS and P’S and also RNS if there are any.
Laura Chandhok (48:26) Yeah, I mean, they both matter, but I’m guessing it’s more of an issue for RNS let me see. I had a list too. Where’s my.
Mira Guha (48:36) list. Yeah, I can check in with Kyle to see if he had any updates there too.
Laura Chandhok (48:40) Let’s see. Yeah.
Laura Chandhok (48:57) The one I sent you guys, I think it was Anita… nice and safe guys.
Laura Chandhok (49:30) But that’s I mean, that’s exactly the same kind of situation. I’ll send you a few more names too after our call.
Mira Guha (49:34) Perfect. Yeah. Happy to see what we can do there. And if we do want to look at the bulk thing, I can get a quote for you depending on like how many it would be, but I’m hoping. Okay.
Laura Chandhok (49:44) Okay. That sounds great. Awesome. All right. Well, thank you. It was a great conversation.
Mira Guha (49:49) Yeah, Laura, I’ll get that stuff back to you as soon as possible. I just alerted to our team to like what we’re thinking for the addendum. I’ll go ahead and shoot over that info in my cell and we can regroup next few days.
Laura Chandhok (50:00) Sounds good. Okay.
Mira Guha (50:01) Thanks, Mira. Thank you so much. Have a good one.
Laura Chandhok (50:03) You too. Bye.