Transcript
Molly Dwyer (00:00) is that Angelica?
Molly Dwyer (00:13) Hello? Can you hear me?
18136195752 (00:22) Hi.
Molly Dwyer (00:24) Yes, this.
18136195752 (00:25) Is Angelica? Good morning.
Molly Dwyer (00:28) Yeah.
18136195752 (00:28) Good morning. I got a computer like a new computer yesterday and I have to authenticate myself. I’m still waiting for the code. So I just decided to dial in so you don’t have to wait too long.
Molly Dwyer (00:43) Okay.
18136195752 (00:45) Anyway, who is this? Ray or Molly? I don’t know who’s on the phone. I can’t see anybody.
Molly Dwyer (00:52) This is Molly and we can reschedule if it makes more sense. I did want to just review.
18136195752 (01:04) Actually, I think it would be good for us to talk about a couple of things. I know you’re waiting for me to sign the amended agreement. Yep. So if you’re okay with it, I just want to talk through about a couple of things.
18136195752 (01:20) So, number one, we recently had a tpa had, I… guess they outsourced some of the work to India and the Philippines. And… so the state, they lost eligibility status with the state. And so we’re trying to work, look at all of our vendors, make sure we’re compliant. I know you guys use subcontractors and you named three like that. I’m aware of. So I want to make sure that we have that addressed, you know, because ultimately, we are responsible to make sure our information is not going to be leaked or shared with anybody. We are not supposed to. So that’s the first question. The second question is I do need to talk about the workflow. I’m not sure if you are the right person and we have our parent company and we’re thinking, you know, because all the issues we have, we can possibly move this back to them. They can own this process, but I needed to understand from you guys from your point of view, like is it, I know there are struggles on both sides from yours and from ours and I just started diving into the process. I see some of the challenges. So I want to talk to you about that as well, high level, not to the details like who’s supposed to do what, you know?
Molly Dwyer (03:06) Okay. And when you say moving it back to your parent company, are you talking about secure?
18136195752 (03:15) Our parent company is chapters health system. I believe they… so well, I mean, the people can work on that, but I know they probably use a different vendor. I’m not sure. So I just want to see if, let me see if I can get on a zoom… call. I’m sorry, I didn’t mean to interrupt. You. Go ahead.
Molly Dwyer (03:47) Oh, no, you’re okay. I guess I’m just a little bit confused. So, because of the workflow, like, I guess areas that you’ve been working through, there is desire and correct me if I’m wrong, but I’m just trying to make sure I’m capturing this, right? There is desire to move the partnership under the chapters team.
18136195752 (04:14) Right, correct. Yeah.
Molly Dwyer (04:23) Okay. Well.
18136195752 (04:24) First of all, I think we need to confirm, make sure like your subcontractors are needed, like, you guys need to confirm for me that you guys don’t outsource it to anybody that CMS… would not approve.
Molly Dwyer (04:48) I can bring this up with merit, but I think, if that is like, is that the only piece of feedback for the delegated agreement to confirm the vendors or confirm?
18136195752 (04:58) The, yes, who did you say you were going to bring this, to merit?
Molly Dwyer (05:04) Merit, merit miller, who’s our director of credentialing?
18136195752 (05:08) Oh, okay. Yeah. Okay. I think I met the person. Yeah. Okay.
Molly Dwyer (05:16) Yeah, I’m sure you may meet her at an upcoming call. So, she has been pretty involved with the carenu partnership. Is there any other areas that you have feedback regarding the delegated agreement?
18136195752 (05:36) Yeah, I think there’s a lot of confusion of what’s truly delegated,
Molly Dwyer (05:45) And can you share more on what the confusion is?
18136195752 (05:50) The confusion is, I think, like, even when Ray did the training, we, really focused on, okay, when we get to this point, I think, for example, our team will credential some, providers get the information and we’ll send it to you guys and then, you guys will wait for something it’s not, received, then you close it. So our team thought it was, still in queue and it’s actually, closed at your end and there are little things I don’t think, we needed to, talk… about that, specifics. I just want to see if, there’s a chance, like, if we, because for me right now, I just look at the options we have and, I know, it’s been a very rocky relationship between us and you guys and, do you guys feel like we can improve the process, improve the outcome or do we need to both seek other solutions?
Molly Dwyer (07:04) Yeah. I mean, I think in full, like in being completely candid like we have, it has been an ongoing struggle I think to really align with the carenu team and our team is fully dedicated to providing additional clarification on workflows. But the conversation has just been taking place like consistently since we kicked off. And I think where we are really striving to be at a place where, the carenu team can trust our process and, you know, trust our workflows but it sounds like there’s still gaps there, which we definitely want to address. You know, we are committed to making sure that your team is confident and comfortable in terms of the workflows. But I guess I’m just a little bit surprised to hear that especially after like we’ve worked through the facility components that we know, are we’re going to be supporting moving forward? I guess I’m a little bit surprised to hear the feedback. Is that like you’re thinking about moving this to a different team within chapters? Like we have done a lot of work to get to this place. And I think we… do, you know, want, to see this succeed. So, yeah, I guess that’s kind of.
18136195752 (08:30) Where.
Molly Dwyer (08:31) we are, yeah.
18136195752 (08:34) I think the concern is really for me, I, this is just me and you talking, not, we’re not going to modify or the contract or anything at this point right now. I just want to tell you because the base, I just, I started to be involved with the operations two weeks ago. So there are going to be perception gaps. So I just want to be very straightforward about that. I think that my struggle… is like when I, a few meetings I attended, I get the impression like medallion is more acting like a repository for us. You know, I know you guys do some work but it seems like our team is doing a lot of the outreach and confirming information. Maybe they should, I don’t know like I just think of the, for me, it’s really, I would that’s why I think it’s beneficial for us to talk. I expect to see something, you know, I’m sure you have other clients then if you can give me, okay here’s, the workflow. Normally, if this is the information, like if there are 10 items need to be checked for a provider to be credentialed, you guys own four. This is the four that you own. This is the six. And here’s the sequence. Something like that will help me understand the workflow a lot better. Because right now, I think there’s a lot of confusion, you know, on both sides. Maybe it’s just me because I haven’t been with the process that long. And I do feel like you guys are working with our team a lot just to look at the meeting frequency that’s a lot. But I also don’t believe in meeting and then you just don’t solve root cause issues. We keep meeting about symptoms, you know… yeah, so.
Molly Dwyer (10:40) I… can work with Ray. I think we need to take a step back because there is, we have two different services for the providers and the facilities. There are going to be two different experiences for the providers. Like I think Ray, I just asked her, like if she had shared with you like kind of like your responsibilities versus our responsibilities. And it sounds like that was reviewed like, I don’t know if it makes sense to revisit and do a deeper dive into that. But ultimately… like… we, I think you coming in new to the partnership like having full visibility, there is still going to be work that your team and your providers are responsible for providing us so that we can run their credentialing files. And that is always going to be the case. Like we need the data and information to be able to do that for the facilities. You know, I think we’ve definitely are open to continuing to improve that workflow. And we can, you know, have more of a discussion there… but I think a next step is we can do another conversation around what those roles and responsibilities are for those two workflows. Would it just be you? I think I’d be curious like who else from your team needs to better understand that. I.
18136195752 (12:07) Think for me and, Carla is our senior director for contracting and she will be overseeing the credentialing because normally contracting network adequacy, and the credentialing, they all should be under the same umbrella. So Pauline is going to focus on claims alone. I think that will probably create some clarity. And I think for now I prefer just Carla and I meet with your team. Like I said, you know, it’s a, whatever the information I receive, it may be partial and it may not be 100 percent accurate. So, I really want to hear from you guys actually like clearly outlined, you know, on two pages or three this year. Here’s what we do for providers and this is what we do for facilities. This is what you guys own. This is what we own, not into like deep in the weeds. I mean, we worked with you guys this long. I feel like we owe you and we owe ourselves from me personally. I feel like we need to do a little bit more due diligence to better understand the process. And maybe we don’t need to meet twice a week. You know, we just needed to, you… know, understand your capability. I mean no company is perfect. I’m not expecting that. But I also feel like our team like our it team can automate a lot of the, you know, information that you guys need. And then whatever we can do to speed up the process to make it more efficient for both of us, it will be very beneficial. You know, if you guys are open to that approach, I think, you know, we’ll partner and we’ll get it better for both of us. But if we like always try to come up with temporary solutions. It’s probably not going to work long term. Does that make sense?
Molly Dwyer (14:11) No, it definitely does. I think like this, I, you knew, you’re new coming in and like I think where like let’s take the time and just do a deep dive into like what you’re responsible. Your team’s responsible for what the medallion services are responsible for. I think just, I want to provide some clarification in terms of like how our team like team structure is modeled to support you. Ray is currently having weekly operational meetings with your team. And the intention there is to like work through day to day questions, things that come up making sure that like there are any items that are blocked are resolved, so that your team can continue working productively, these meetings that we have that I’m having at like the executive level are once a month. By no means are we trying to have two meetings a week with your team? We definitely want to be mindful of everyone’s bandwidth. So that’s really the intention there. I think for the purposes of getting you and Carla up to speed, like we will probably have to have more frequent meetings where, you know, we’re having a deeper dive with you. We can schedule time for next week and review the workflows and processes ultimately. Like I think I really just want to make sure that we are aligned like our ideal state is that… whether it’s the data integrations with your technical team or it’s the overall trust in terms of our processes. Like we want to get your team to a point where they are able to not be so in the weeds and really use medallion to our full capacity because right now, like I think to this point like they have been really just… I don’t know, I don’t want to say the word distrust but really questioning all of the work that we’ve been doing. And so, I think what we’re trying to do ideally with your partnership is to get to a point where everyone understands the workflows we have, you know, recommendations to help drive efficiencies, whether it’s the data integration or whatnot, but long term get to a point where it’s more sustainable for your team and you’re able to fully maximize the medallion partnership by trusting our processes et cetera.
18136195752 (16:29) I can’t agree with you more because I feel like if there’s no trust then we shouldn’t continue, you know, this partnership because what I heard is like once you guys the credential, we still verify the 100 percent credential of the providers. I never understand why we’re doing that and my background, I was a PM for a long time. So I’m always like a more process driven and want to make sure we don’t do anything that’s not necessary, you know. So waste of time, energy resources and doesn’t add any value. So I think for me to see the bigger picture that will help. I think of the training like Ray provided it’s really for hands on like hand holding process like for people understand, okay, once you get to hear what you need to do, what I’m looking for, it’s really like a high level. So Carla and I both understand okay, what we needed to manage our team with. I think I appreciate the fact that you guys are meeting with them weekly, but I also concerned like if they needed to meet with you guys weekly, either they’re not doing what they need to do or you guys are not doing what they need to do because of, you know, they shouldn’t be able to meet less frequently and focus on the process. That means there’s still no clarity for them. At least based on my conversation, I feel like they do the things that they do. They don’t make sense to me. I’m familiar with the overall process and we use the, I mean when I was with another company, we use a Symplr, I know like what it’s not a hard job. So I don’t know why we’re struggling this much with this process. I’m like a very transparent and straightforward with you. So that’s my special I guess with you. Yeah.
Molly Dwyer (18:34) I think we’re fully aligned there like, we want your team to be in a sustainable place like this. And if it’s meeting bi weekly, this.
18136195752 (18:42) Is not a sustainable. Yeah.
Molly Dwyer (18:44) And so for like for the short term, what I recommend is for Ray to continue meeting with your team weekly. And then you and I and Carla, we can set up some individual time. I’ll ask Ray and do a higher level overview of like what the bigger picture to your point looks like. And then also kind.
18136195752 (19:07) Of.
Molly Dwyer (19:07) layer in where we’re stuck with your team and where we’re stuck just in general with the partnership. From there, we can then, you know, make an action plan and think about, you know, some midterm and long term, you know, milestones. But I think having that first conversation and getting aligned from a big picture standpoint, will be a good first step. Yeah. And.
18136195752 (19:36) The other thing I probably need to get a deeper understanding, this is like a conversation between you and me. Not with my team, my staff. I wanted to know like if you guys have the capability to fully create potential, what’s the, why did we set up this way? I guess like I’m sure, there’s a lot of information we needed to feed to you guys for me. I think it’s really just want to see if we can streamline the process and make it work more efficiently collectively. Not just you or our process collectively. We need a more efficient process even though I don’t know all the details from where I sit. I look at what we have right now. I feel like, you know, there’s a lot of time and energy is wasted and I don’t see the value, so.
Molly Dwyer (20:35) Yeah. Do you mean are… you referring to like the credentialing work that your team is doing internally to make it work, maintain your ncqa?
18136195752 (20:49) Yeah. So, because I don’t understand that your process yet. And so, of course, like I, my team is, they’ll say, okay, this is well, you guys medallion didn’t do this medallion didn’t do that, but I see some of the things, we own them, right? So, and I think it’s a workflow issue. It’s for. So, first of all, I want to understand what your like from your perspective, what you can share with me and Carla. And we are also working with them very closely to see where we can improve if we can cut the lead time of the, so you guys don’t have to wait for information from us, then we can move, we can move the providers in queue to be credentialed quickly. Yeah, let me,
Molly Dwyer (21:43) go back. I need to meet with Ray who’s closer, to the more like operational.
18136195752 (21:50) And.
Molly Dwyer (21:53) whatnot? So let me regroup with her.
18136195752 (21:59) Okay. Yeah. I think, you know, obviously, we haven’t worked that long at all, but all I hear is negative things about you guys. I don’t judge you based on what I hear. I judge you from what I hear from you guys, right? So, I think it’s helpful for us to go over the process and understand where… your perspective, what your struggle is. I mean, if there’s a problem, it’s never a one sided problem, you know? Yeah. And sometimes it’s just a miscommunication. Maybe we needed to find a better way to communicate with both teams. Yeah. So, I think that the goal is because we already invested this much time and energy, it… will be a shame to give it up. And, I, you know, at least for me, I wanted to make sure we do a deep dive on both sides and understand why we get stuck or why we’re slow, why things are stalling. And then we go from there. Yeah. No, I, we’re.
Molly Dwyer (23:11) completely aligned. We want this to work like we are committed to making it work. And so, I’m excited to partner with you, and kind of take a step back and figure out where both teams, can, you know, help each other to get to that point. Yeah, I hope.
18136195752 (23:32) You guys don’t see it as a negative thing. Sometimes when we reset, initially, it will take more time, but the long term, it will save both of our time, you know, like, definitely.
Molly Dwyer (23:45) No, it’s, worth the investment. And, I’m excited, to work with you on this. I think we’ll definitely loop in Ray, if you want, we can set up some time for next week if you have your calendar open.
18136195752 (24:00) Yeah, sure. Let me, me have, Carlos… calendar open as well. So I can give you the time minutes. Yeah. Do you… know what time you have available and I can check you?
Molly Dwyer (24:29) Could do.
Molly Dwyer (24:35) Ray is out next week? What about the following week? Is that too late? Or the?
18136195752 (24:41) Following week, I think it’ll be too late. I mean, if you need her to explain the high level that’s fine. If you don’t need her, I think we can always come back. I mean, we’re not going to be, in the module and see which field we need to fill, it’s, just really high level to understand the process. And also the week after next week, I’ll be out of office for three days. Okay?
Molly Dwyer (25:10) Why don’t, we do Tuesday? Are you available at three eastern?
18136195752 (25:16) Okay. Tuesday doesn’t work, but it looks like Wednesday, we have both of us are available from… one 30 to four.
18136195752 (25:32) Have.
Molly Dwyer (25:33) any availability there could do Wednesday morning at nine, okay?
18136195752 (25:39) That works nine to nine 30. Yeah, perfect. Okay. All right. Let me, I’ll send.
Molly Dwyer (25:47) you over an invite now? Okay, you.
18136195752 (25:51) Have a Carlos information or do you want me to send it to you?
Molly Dwyer (25:55) If you could send it to me, that would be great. All.
18136195752 (26:01) Right, perfect. Why don’t I schedule the meeting then? Like I can, I’m in the calendar right now. I’ll just put you in the invite. And then if you need somebody else to join, then you can forward to the meeting. Will that work? Yeah, that’s fine. Okay?
Molly Dwyer (26:20) Okay.
18136195752 (26:20) I appreciate your time. I think, you know, we’ll get it, right? And… we’ll make it better. We,
Molly Dwyer (26:28) will, we, will, I appreciate your time and I appreciate, the candid discussion. I’ll look for your invite. In the meantime, I will paying merit on the subcontractor question for the delegation agreement, because.
18136195752 (26:44) our legal really wanted us to make sure we have that in place because, you guys do have named subcontractors, we want to make sure we’re you know, a compliance is required. It’s a hard requirement. Yeah, understood. Thank you.
Molly Dwyer (27:02) So much. All right?
18136195752 (27:05) Bye bye.