Transcript
Josh Brunell (00:00) bye.
Nicole Campbell (00:12) Is this your last call before vacation?
Samantha Bouchard (00:15) It is wow. We’re in pretty good shape. So I feel good about it. I’m taking my kids to disney world tomorrow. Our flight is at six a. M. So I’m gonna have to move so early seems.
Leticia Stewart (00:33) Like you don’t even feel well enough to go. It seems like you’re still a little under the weather, I.
Samantha Bouchard (00:37) Know, I did get antibiotics and steroids yesterday though for a bad sinus infection. So hopefully it’s only up from here, Leticia, but yeah, this was one heck of like just at the end of winter cold. I don’t know.
Josh Brunell (00:52) He’s had it for like two, three weeks now, it seems.
Samantha Bouchard (00:56) It feels like I know.
Leticia Stewart (00:58) I thought I had it for, I thought it, I could swear it had been six weeks, eight months and it was like three weeks, but it felt so long, it felt like forever. Yeah. But you should stop by and visit Marie while you’re there. She’s in or she’s in Florida.
Josh Brunell (01:14) I’m in Florida and relocating to that area very soon. Oh.
Samantha Bouchard (01:18) My gosh. It’s going to be 85. I, it’s like 30 here in Massachusetts, so I can’t even wait to just like even get like into the tunnel like off the plane. Like I’m just feel that air… hopefully, Logan.
Josh Brunell (01:39) Logan’s.
Nicole Campbell (01:40) a little bit better with security. I haven’t seen them. I’m.
Samantha Bouchard (01:43) flying out of providence, so I could go to either one. So it should be better but yeah, we’ll see, not like.
Nicole Campbell (01:48) A three a M start time for you and little kids. I.
Samantha Bouchard (01:52) know, we have to plan it. We’re so bad. Yeah, but we’re excited.
Leticia Stewart (01:57) Okay. Have fun.
Samantha Bouchard (01:58) Thank you.
Josh Brunell (02:00) Well, let’s dive in so you can get to packing and prepping for tomorrow.
Samantha Bouchard (02:05) Yes, let’s.
Josh Brunell (02:06) do it. And I’m sure Leticia, you and Marie would like some time back in your day too. I think we could get through this pretty quickly. So… obviously Leticia, we met earlier this week for Marie.
Josh Brunell (02:19) I know you’re just kind of jumping in but we gathered some data points, from your team. Purpose of the day is called to walk through a few things. One coming out of the last call, we kind of there’s some questions around like you do versus we do essentially. And so like I have a couple slides to talk through like the roles and responsibilities and how things are going to shift as far as like who’s going to own certain pieces of this process? Because medallion, as I’ve shared with Leticia, we’re much different than a modio or credstream in that we’re not just a tracking tool where you’re or like a system to use to track this information, but an actual partner in helping you do and deliver the work both through our automation and through our team. So it’s going to be a shift in responsibilities as far as like submitting payrollment applications, doing the follow up, handling things like caqh, handling a bulk of, the work that’s done manually today. And so just want to walk through what that looks like with us in comparison to maybe modio or some of the other vendors you’re considering as well as your current state. And then from there, we’re going to dive into, hey, okay. Well, what’s the benefit from a cost standpoint? Like Roi standpoint? And then what’s the price? So that’s the plan. Sounds good. Leticia. Was there anything else I missed coming out of the last call that you wanted to cover?
Leticia Stewart (03:44) Just the slas, if you have that yep?
Josh Brunell (03:48) Yep. Happy to share that. After this call, I can, I will send you a link to our master services agreement. And then in there has all of our SLA language laid out for you.
Leticia Stewart (04:01) Okay.
Josh Brunell (04:04) But essentially, it’s, very standard like we have slas around depend on kind of what you’re using, what you are using us for. In your case, it’s going to be primarily for payer enrollment. So, there’s an SLA around the time that we will submit the work. And on average, it’s just under three days. Our SLA, is 10, so that’s 10 days from the moment, you know, providers uploaded a medallion and our, you know, request is made through to that application being filled out and sent. And that takes into consideration more manual processes where you may have a, you know, paper application that’s needed to be signed in person by a provider before we get that out the door all the way through to the more automated versions of that process. So I’ll send that so you can review that following the call. Okay. Cool. Anything else?
Leticia Stewart (05:04) That’s it?
Josh Brunell (05:05) Awesome, money. Yes, we’ll go into the money. We talked about this last time, Leticia, I won’t dig in too much but I think just like the big part being like what’s going to change being that with medallion, we’re responsible for the execution end to end. Whereas now your team goes into more of a oversight role where you have visibility and everything that’s going on. But all the manual work goes away. We’re executing on that. And so hopefully it gives you and the team obviously more time back Marie you much more time back to do what you are, you know, your main role and responsibility, I know isn’t credentialing at the organization, correct? Yep. So helping you reclaim bandwidth and then also helping to having to ever have to avoid hiring or staffing that team up or backfilling that I know there’s the role who recently left like that all goes away with this partnership. So you do versus we do… there’s a lot going on in the slide, but I think just very quickly like summary like this is essentially the bulk of what your team will be doing once we move forward in the partnership as far as like work wise, it’s your team will essentially invite the providers to the platform. You have the option to link caqh that’s what will likely happen and what the recommendation is as far as helping to automate the data getting into medallion. Your team will review it. And then, yeah, medallion takes a lot of the automation from there by linking caqh and then alerting your team on, hey, where are there any gaps? And then we could either pass that to you or directly to the provider to fill in like, hey, we’re missing, you know, we need a new state license for this specific provider because it’s expired things like that. So that is the extent of like what your team will be doing just for like that new provider onboarding experience. But from there, like it’s very simple, your team will essentially make their enrollment requests in the platform, select who the provider is, what the group location payers. And then medallion populates the rest, does the application population submission, conducts all the payer follow up, collects the response from the payer, and then boom, we’re enrolled. Or if we know that, you know, we need any more information, we will of course, go through that same kind of workflow, tasking it out to you, your team being the admins, and then making those updates and then responding back to the payer. Though this is very rare that this happens because we typically will do that up front in the process before submission, if there is anything missing, we have our payer process guides to help us understand what information we need to have a clean app being submitted. That all makes sense. It does, I think to think about it this a little differently with modio, your team would still be this box, what the medallion platform does. Just this goes away and your team will just be responsible for all this. So that’s the way I think about it is like, yes, you have the platform that you can track this in, but you’re still having to do the manual work of going to the payer portal, submit the applications, go through that process, the follow up, the calls, the emails. They may have some automation built in place, but your team’s still responsible for the execution… versus with medallion, we own that outcome. So cool. Any other questions on kind of the you do versus we do before we dive into like the Roi and then pricing?
Leticia Stewart (08:47) So, I do have a question about enrollment. When you use the word enrollment, you’re not talking about enrollment, like with the payer, like when you have to enroll with a payer in our clearinghouse that’s not the enrollment you’re referring to?
Josh Brunell (09:04) That is what I, yeah. Are you saying? I’m saying like, so provider of radiology practice that you’re supporting, say they hire a provider, your team right now, today, I think there’s about five payers that you would then enroll that provider with on behalf of your client, correct?
Leticia Stewart (09:27) There’s more than five but my main ones, yes. Yeah. Okay. I.
Josh Brunell (09:34) Think the average that was sent on the sheet was five. It’s just what I was working on. But yeah, I know that can vary obviously by client. Oh.
Leticia Stewart (09:41) You know what? On that sheet where I was trying to put five to 10, but that field… is formatted. So if I put anything other than just one number, it changes to a date. And even if I try to change, it doesn’t let me, it’ll revert back even if I try to change the format of the sale, it.
Josh Brunell (10:03) Doesn’t let me strange. Okay. All good. Well, yeah, that’s helpful. Yeah, I mean, I would imagine the different clients you work with their payer list is going to be different no matter who you’re onboarding. So it could vary, right? Which is fine. I mean, we don’t really, it doesn’t really matter what payer you’re working with. We support. I think we have over 900 in our system. And if there’s any new or unique payer that you would want to do an enrollment with, we have a dedicated research team that would go out and map that payer process upfront during the onboarding and then have that built into our platform moving.
Leticia Stewart (10:42) To use.
Josh Brunell (10:43) Not only for your use case but for future customers. So cool. But yeah, when you, were you thinking when you said requesting enrollment, you thought it was for maybe another use. So.
Leticia Stewart (10:59) And this is the part where that word. So a lot of times we have to go to our clearinghouse and request an enrollment, but that’s so that the claims can come through the clearinghouse. And I’m saying that’s different from this enrollment. Yeah.
Samantha Bouchard (11:21) Latisha, I can lean in here. Yeah. So you’re probably thinking of like the Edi, and era… like enrollment so you all can like get the funds for the billing, not.
Leticia Stewart (11:32) The eft, not the eft, era enrollment. There’s a different kind of enrollment like a notification to the payer to let them know. And I’m wondering if it is the same thing, but the other ones are done up front. And then the ones that we don’t handle, they end up coming through our clearinghouse, saying they’re not enrolled. I wonder if it could be that kind of situation?
Samantha Bouchard (11:58) Ours are going to be direct to the payer, linking the providers to the group contracts that exist. But I do know there are other like one page forms that sometimes you have to do with your clearinghouse to like read things that would be separate.
Leticia Stewart (12:14) Okay. All right.
Josh Brunell (12:22) Any other questions on the enrollment piece here?
Leticia Stewart (12:25) No, I thought so. But the word it’s like wait. Okay. So that’s why I had Caleb on the other day because he does the enrollment in waystar, got it. Got it. And I think that was a totally different thing. Okay? Got it.
Samantha Bouchard (12:40) Healthcare likes to make everything more complicated and have seven definitions for credentialing paying enrollment. I know we’re always asking, we’re like define that for us so we can make sure we’re talking about the same thing.
Leticia Stewart (12:55) Cool.
Josh Brunell (12:57) So, yeah, business value analysis we talked about this Leticia is like, hey, well, if we’re comparing modia, like for our evaluation, we’re either thinking about going modio which would require you obviously retaining the same kind of in house structure, potentially maybe even having to hire to backfill that credentialing fte or going with medallion where we would only essentially need just one fte and that one fte can leverage our platform to support an unlimited scale of providers. That is like one of the main reasons why organizations partner with us is to reduce both operational cost and burden for their team so that they can scale effectively as well as to accelerate revenue. It sounds like this probably is less important in your world than this, but this may or these two may be more important like removing the burden that your team has to deal with the administrative burden and then the cost associated. So that’s what we’ve modeled out here. And I wanted to walk you through some assumptions… based off of the data that you shared. Yeah, what changes as far as like this process and how we built out the pricing? I know that you said that we were a little aggressive on our provider growth assumption.
Josh Brunell (14:19) So I’m just assuming a 50 a year increase. If that’s okay with you based off of your feedback yesterday, once again, you’re only going to be needing one fte moving forward. This is our average to submit enrollments. This is our average to complete them, we typically see a 40 percent increase or not decrease reduction in… claims denials tied to credentialing and payrollment that’s actually, I would say closer to 70 percent on average. And so this is like a conservative estimate. But what that’s tied to is like, hey, if you have delays in this process or you miss a revalidation date or a renewal on your enrollment with a provider. You know, that delays that can lead to claims denials and write offs which obviously has an impact on things like revcycle. I know we didn’t really get a number from you here and it’s probably really hard to report on today, but that is something that we would help give visibility to in the future. And then, yeah, this goes from a very highly labor intensive process to something that is much more automated with a single partner solution cool.
Leticia Stewart (15:33) For 58 days to average, I remember speaking… to someone. I don’t know if it was you talking about delegation and it happening a lot faster than that. Was that in that area?
Josh Brunell (15:49) Yeah. So this is just talking and this is me doing what Sam has shared earlier. So, yeah, we call that like delegated credentialing is when we can have that delegated agreement with a payer, where instead of doing direct payer enrollments to the payer, where we submit the application, the payer then holds it for a set period of time and then approves it after running their kind of own primary source verification on that provider. We can help organizations establish delegation agreements with payers to where all you do is essentially submit a roster to the payer and you run the primary source verification for them on their behalf. And then that helps you get the payer or the provider through the process. Much faster. In our case, we have a three day SLA with a one day SLA average of when we can then credential that provider. And then when you submit that roster, you could actually, the payer would then allow you to backdate… that claim to that date of them getting that credential correct? Sam.
Samantha Bouchard (17:05) Yeah. And Leticia, typically, what the payer requirement is to even just get that process started is you have to have around 100 providers in each group contract. So it sounds like you all are still billing under like the contracts of your partners. Is that correct?
Leticia Stewart (17:27) I don’t know what you mean by still billing. What do you mean or?
Samantha Bouchard (17:31) Sorry, not. Yeah. So it sounded like you all capture their contract information. So their tin, their like the contracts that they exist, and then you do the enrollments on their behalf. Is that accurate?
Leticia Stewart (17:46) Correct? Unless we do their contracting? Yeah.
Samantha Bouchard (17:51) So, if you, for any of the contracts that you specifically own, you could reach out to the payers and see if delegation is an option for you. But otherwise, that would be on your partners to own the delegated agreements.
Josh Brunell (18:07) Yeah. So it’s.
Leticia Stewart (18:09) not something that medagant helps with or is that something we would have to do that’s what I’m trying to understand, where does that fit in? And when is that an opportunity?
Josh Brunell (18:19) So we can support it. It’s just the payer has their own set of requirements that in order to achieve delegation, you typically have to have one the amount of the size that Sam had mentioned typically 100 providers under that single contract. I know in your case, you said some of our contracts are around 50 providers, some are north of 100. So it really just depends how many providers they have in that given state related to that contract. If there’s well over 100, and they would like to achieve delegation. Like we could absolutely help that with like the preparation to do so, and then also help with passing the audits that’s needed that’s typically performed by the payer in order to achieve delegation. So we are essentially… a ncqa accredited subdelegate. And what that means is we already have the accreditation to help secure delegation if your customers are to want that. I don’t know it’s something that’s really dependent on the size of those contracts that we could absolutely support. I do not have that in scope here both from the business case standpoint or pricing, but like just know like once you move to that model, you go from the 58 day average just down to three. So there’s a huge benefit that you can pass down for your customers and it’s just less of a burden on your team as well as far as handling the sheer number of direct enrollments. Because instead you’re just doing that one credential file for that provider. So.
Leticia Stewart (20:05) Right. And that’s what I was asking basically is that a part of this discussion or not, is that separate pricing for that?
Josh Brunell (20:15) I could get you pricing for what that looks like. But that’s yeah, it’s not included in here. Okay? And the reason why is because the way that I mean, we talked about that early on, but the way that your organization’s structured, I’m not sure… if it would be easily easy to do up front. And so I didn’t want to incorporate it into like the initial kind of business value your team would see? Okay, that would be something you want to explore on a customer by customer basis, right?
Leticia Stewart (20:45) Sam, right? I understand that. Yeah. Okay.
Josh Brunell (20:48) Do you have like a good subset of customers that have over 100 providers?
Leticia Stewart (20:53) We do. Okay.
Josh Brunell (20:54) Yeah. So I mean if you want to just like share like, hey, we have three, these three or four customers in mind. We could do some research on our end to make sure like one, do they meet the kind of criteria? Which is, do they have the, a good amount of volume and providers? And then if so, what are their payers that they, are, they’re enrolling their providers with? We would just then explore if, hey, do they accept delegation? If so, what are their requirements? And then if you want, if they do want to proceed with that, then we can include it in scope. We just don’t want to charge for you something up front and then you go to the payer and they say we have this unique requirement that you don’t meet match. Sorry. And then,
Leticia Stewart (21:33) no, that’s exactly what I’m asking. Yeah, I get that. We have, we have five, okay? Maybe six, okay? And,
Nicole Campbell (21:42) Leticia, if this is something that we want to spend more time on from the delegated side, but we need to get this piece up and running quickly because I know we have that modio, no.
Leticia Stewart (21:51) No, I know. I just wanted to know if it was included. It’s just a, okay.
Nicole Campbell (21:54) Because I was like we can always do those two things in parallel too in terms of getting you set up, but also continuing the conversation around delegation. Okay?
Josh Brunell (22:07) So, yeah, I just put together a rough estimate as far as like the cost of the current process. And then if you were to move forward with modio in comparison to what medallion is going to cost. So, this is essentially keeping the same process, adding modio’s software, and then essentially kind of keeping that same model of, hey, we’re using a software to track the process. Obviously, there’s going to be some pieces of automation that we’ll see, but there you’ll likely still need to hire that and backfill that fte who recently departed. And what that’s going to lead to is obviously a high kind of admin cost. And then I made an assumption here based on what you said before we’re coming in three times as much as modio. So when I thrown out, the number I did so 100 K could be give or take. You can obviously, you obviously know how much that contract is going to cost. But I just want to put this as a placeholder in comparison to what medani is going to come in at which I’m going to review here now. So yeah, just all in for us to manage this from the software through which is this first line item here for your 1,800 providers. And then the overall services we’re going to be delivering. There is also a one time implementation cost. This goes away after the onboarding process. So, in out years, you don’t have to worry about this. So we about 210 K in up front, in year one and then it would be just below 200 K in out years. So.
Marie (23:47) Can you add I’m sorry… for that too. Sorry.
Josh Brunell (23:54) Sorry. Go ahead.
Marie (23:55) I’m sorry. Can you add that as well? Like have a different table where you’re showing that separately? Yeah.
Josh Brunell (24:02) Of course. Yeah. I could just, I could just put this in remove this and then show you what the cost looks like in years two and three. It’s essentially, it’s essentially going to be what… we’re looking at here minus 25 K. So… what are your thoughts that they are in comparison to? And, that is essentially helping shore up. I think there’s three ftes doing this today plus another who just left you would only need one so, that headcount costs, which obviously, that’s you, you’re gonna know what the average salary and benefits are for those team members that. And plus the modio contract, I would imagine that we’re either coming in net neutral, or better but I just want to get your feedback on like just around 200,000 dollars in comparison. I’m.
Leticia Stewart (25:01) still stuck on April 30 first. So you kind of threw me off.
Marie (25:04) Can you go back one slide for me please? And then Leticia you can go ahead with your, sorry?
Nicole Campbell (25:11) What’s that? What was that? Forgive?
Josh Brunell (25:14) Me, this proposal is actually, yeah, this should have been for may, the, this is just the quote. So, this is the, this is how like how long the quote, like essentially, we have these discounts approved by our finance team. We’re we’re able to get those on a quarterly basis. And so, yeah, essentially. Okay.
Leticia Stewart (25:37) This.
Josh Brunell (25:37) means like, hey, we will commit to these discounts as long as you move forward with the partnership by may 30 first. So.
Leticia Stewart (25:47) Wait, but how’d the total change? What did you just do? I?
Josh Brunell (25:50) Just updated it to may. Sorry, that should have said, may no, the.
Leticia Stewart (25:54) Total was 210. Now, it’s 340.
Josh Brunell (25:57) Five. Sorry, like.
Leticia Stewart (26:00) Sorry, that was playing with my emotions right now.
Josh Brunell (26:03) No, I, yeah, I showed a separate slide. Sorry.
Leticia Stewart (26:12) So, what was that slide for? Because this one still says April 30 first, yeah.
Josh Brunell (26:17) That was my bad. I updated.
Marie (26:20) The wrong one? Yeah.
Josh Brunell (26:23) I showed a slide that was like kind of with pre discounts included. So, let me just there.
Leticia Stewart (26:31) You know, there’s no, April 30 first, right?
Josh Brunell (26:34) I did not know that I was.
Nicole Campbell (26:37) Wondering what I was, my question was like, what did we do wrong? And then I was realizing you.
Josh Brunell (26:42) Know, yeah, no end of and I’m working off end of months. I’m sorry, I’m not though. No.
Nicole Campbell (26:47) It’s.
Leticia Stewart (26:49) just so funny. Like it caught my eye and I couldn’t unsee it and I just, I couldn’t know what that was for. I was trying to think it was a three year deal and I was trying to put the dates together and I just it.
Josh Brunell (27:02) Was supposed to be for may and I got four instead of five. So that’s my bad.
Leticia Stewart (27:07) No, it didn’t the number, the total changed. And then I got really freaked out and I’m like what happened? And so, okay, let’s go back to this. So it includes… so I thought we were doing some kind of ranges. So if something fell like between this or this because what if it’s not a 1,000? Is it going to be based on actual and not a unit price? Like help me understand?
Josh Brunell (27:31) Yeah. So if so, there’s a couple of things that we’ll have in the contract which when I send over the slas, I’ll call out one on the order form. It’s going to be, we have a concept called SKU flexibility. So like this is going to be a multi year contract. So a three year contract, if you burn through kind of the quantities faster you can pull in from out years and there’s no like financial penalty of like, hey, you are over in this month or in this year. And therefore we’re going to charge you extra at that time. It’s essentially like think of it almost like a credit card where it’s like you have the total to burn through across the three years. And if you consume through those faster than that, then we would just partner together on an early renewal. Like, hey, we’re seeing a lot of success with medallion. We’re using, you know, we’ve actually grown and we’ve grown with your platform. And if you’re satisfied with that, we can renew at that point. So it’s always best to kind of like, you know, be conservative, I would say, but at the same time, the discounts are really driven based off of volume, so that we try to get as close to the pin as possible. Do you think the 1,000 payer, revalidations is too much. Is that where you’re.
Leticia Stewart (28:41) going, I have no idea. I’m just, it was just a question. I just want to know if it’s if I’m paying for something I don’t need? Or if I’m underpaying and it’s something I do need. I have no frame of reference.
Josh Brunell (28:52) Okay. We can obviously before moving forward with the partnership, like if you feel like we should do a deeper analysis on like what you’ve done historically with payer revalidations, like, how many did you see in this last calendar year? I know it’s that you said it’s probably hard to figure that out, but maybe collectively like asking some of the team like could get a more finalized number there.
Nicole Campbell (29:19) And we did try to be like more conservative on this Leticia like knowing that. And I think we had talked about the likelihood is we will end up like you would need more than what we’re scoping and we’re kind of purposely setting it up that way because I know we have this kind of like a knowledge gap of how many revalidations are there. So we want to make sure that we aren’t over almost overselling this contract. We’d rather give you the ability to grow into it. Is what we’re really trying to do.
Leticia Stewart (29:49) Okay. So say… we end up having 1,200 validations, we can pull 200 of those from next year. And if we don’t have that many next year, we’ll even out.
Josh Brunell (30:04) If we,
Leticia Stewart (30:04) have less, what happens? What if we have only 800, will they carry over to the next year? Yep. And then what if we end up never needing them, then do we get our money back?
Josh Brunell (30:19) No.
Leticia Stewart (30:20) No, no refunds. No.
Josh Brunell (30:22) We can work through a renewal process where we would try to right size you on the following contract, but it’s not like an issuing credit back at the end of the contract. It would just be a you.
Leticia Stewart (30:34) Wouldn’t do the right sizing after the first year, you would have to wait till after the three years.
Josh Brunell (30:43) Let me ask, but yes, I’m fairly certain, yeah, you’re essentially, we’re charging on an annual basis, right? So we’re not charging you for the three years up front. We charge you on an annual basis. And in the scenario you just mentioned where you under consume, you may very well over consume in years two and three. So that’s not why we would do that. We do have like we can put in some like slight rollover language if you were to renew with us, but we don’t issue back money on unused units of work. So that’s also what Nicole’s point like, we try to be as accurate as possible in our estimate but it’s always better to be more conservative and I think with the 1,800 providers you have like on the revalidation side, you probably will see would see more than a 1,000 in an annual basis. So.
Leticia Stewart (31:32) And the caqh, all that’s included in here. Yeah.
Josh Brunell (31:36) So you’re going to have the ability to import directly from caqh link that with the medallion profile… the one thing I did want to just double click on and that is on the attestation piece, right? That, that is something that your team is doing manually today or do the provider like contacts that you have, do it to some degree? Is it your team fully running and managing caqh for all those providers?
Marie (32:04) We’re doing it.
Josh Brunell (32:07) Got it. And that’s all those attestations as well?
Josh Brunell (32:15) Yeah. So… we can support the linkage and the, and importing it over. And if you do want us to handle those attestations, what I would need to do is just understand of the 1,800, are you doing it for? It sounds like all of them?
Marie (32:34) I, we’ll have to check with Melissa and Leah for their clients. But for the ones I handle thus far, yes. Okay. All of them, we have all of their caqh logins and we gotta go in there and make sure they’re updated… okay?
Josh Brunell (32:51) That was one thing I don’t think I asked in this process was quantity of providers that you’re doing that for, if it’s the 18,000 and you want me to move forward with that, I can update the quote with the caqh product, which is to handle those attestations. The management of it. What’s included in this is that you can do that like import from caqh automatically during the initial onboarding of that provider, and then link those profiles. It’s just being able to then write back into caqh and handle those attestations that is a separate SKU.
Josh Brunell (33:25) So I’ll make sure to include that, but it will be an added cost. And so I’ll include this quote and then what that quote looks like. And then you could compare the two and see if it’s worth it or not for you.
Marie (33:37) Or we continue to do it in house or you?
Josh Brunell (33:40) Could just continue to do it in house. Yeah. Okay. I know that doesn’t sound like fun, but yes.
Leticia Stewart (33:46) No, because I thought that was the whole, I thought that was one.
Marie (33:49) Of the key features I thought that was included, right? It.
Leticia Stewart (33:52) Was a key feature, right? Exactly. Isn’t that one of the biggest selling points that’s why I’m confused.
Josh Brunell (33:57) Yeah. Well, and forgive me. I originally thought I had it here. So, let me, and,
Nicole Campbell (34:05) I think like one thing too. I think Leticia, we are taking a little bit of your feedback from yesterday on the pricing with that being another skew and we weren’t and we were a little unsure of the scoping of the caqh and apologies, I think we are also moving a little bit faster than our normal motion here for you. So if we’ve missed something, I really apologize but what that will add is cost to the contract. So we were trying to find the best starting point for the team that would give you the most functionality upfront. But also knowing that modio is costing the team around 100 K today. We do understand that this is a bigger lift in terms of financials. So we wanna make it as palatable as possible with giving you the most value as possible. So while josh is bringing that up, I wanted to kind of like talk you through where our mindset was trying to put this together for the team. Yeah.
Leticia Stewart (34:59) But we talked about the caqh the entire time and so, and I’m just talking it’s not anything. I know we asked for this quickly and all of that, but that was one of the main selling points and one of the big things that we discussed. So to leave it out and not acknowledge that it was left out is a big deal for me that.
Marie (35:22) Was mentioned since himss, and that was one of the things that I pulled. I’m like Leticia, we’ve got to listen to these guys because I know how time consuming and labor intensive it is for us to sit there and do that for all of our providers.
Josh Brunell (35:36) Yeah. So just doing the math real quick. So on the caqh piece, we can get that at a discounted unit price, of 75 per provider. So that multiplied by eight, we’re going off of the 1,800 because it sounds like it’s all the providers in your organization. It’s going to be about 135,000 dollars just for that alone. So it would be 135,000 dollars to add the caqh management across 1,818 100 providers where we would be doing attestations… quarterly for those providers and updates in caqh on your behalf. Now, I don’t know based off of the team and staff that’s doing that today. If 135 that’s going to align with the number of staff kind?
Leticia Stewart (36:32) Of reduction. Wait. Do we do that quarterly now?
Marie (36:37) We should be… oh… okay. Again, not sure about Melissa and Leah. Okay?
Josh Brunell (36:47) Yeah. So that takes it from a 210 that we just walked through to like 340 or three four.
Marie (36:54) Otherwise, minus attestations, it stays as is correct with you linking us to caqh but not managing attestations, correct? Yep?
Josh Brunell (37:05) Yeah. So we’ll do the import over from caqh, we’ll link it to your medallion profile. We just won’t do right back into caqh on your behalf for updates or do those attestations for you. If you don’t move forward with the caqh management piece. So there’s still, I mean we have customers that have it some that don’t it’s really just more of a scale thing like do you have the bandwidth to handle those or not? And if you want us to do it, we can, it’s I’ll send you the updated slide that includes that in the pricing. So you have both options to review. Okay?
Leticia Stewart (37:43) Can we go back to the slide yep?
Leticia Stewart (37:57) And the revalidations is the one that’s every five years, right?
Josh Brunell (38:03) Those are typically every three or four, but it depends on the payer.
Leticia Stewart (38:11) So, then we wouldn’t have that 1,000 built in every year, right? If it’s only every three years.
Josh Brunell (38:18) Well… you’re doing the revalidations not just for it’s not like a one to one with your providers, like you would be doing a couple revalidations, a couple payer revalidations annually?
Marie (38:35) No, I get.
Leticia Stewart (38:36) That part, but do you think we would do a 1,000 in one year and do a 1,000 the next year and then a 1,000 the next year? I don’t that doesn’t make sense?
Marie (38:43) To me especially since you’ll have some providers as three years there or some are five years, it will never reach a 1,000, right?
Josh Brunell (38:53) You think it’s going to be much less because I’m if you want me to adjust the number, I’m happy to, I thought I was being conservative because 1,800 times five payers, and then doing and then dividing that by three.
Leticia Stewart (39:08) Three validations are per payer. Yeah, yes.
Leticia Stewart (39:23) Marie, are you doing that? I thought it was medicare.
Marie (39:27) Or Mike, fines.
Leticia Stewart (39:31) Oh boy.
Samantha Bouchard (39:33) Yeah, because what happens Leticia, if you don’t do the revalidation on time, they get kicked out and so then they become a non par status and you actually have to start the process all over while there’s likely like a huge gap of denials because the practice would like continue to staff that provider, like assuming that they were par with that payer. So like revalidations are really important because you just as.
Marie (40:00) important as the.
Samantha Bouchard (40:03) Initial. Yeah.
Leticia Stewart (40:04) At.
Samantha Bouchard (40:05) least, I mean, with the initial, you know, you’re kind of waiting for the par status. So everybody’s in the loop to like hold off on claims, but the revalidations really sneak in there.
Marie (40:14) But I’m looking at let’s say, I’m looking at our biggest client right now, we just revalidated a lot of their like if not most of their locations. So at least that one’s already done and won’t be due for let’s say three to four to five years, right? That’s why we’re looking at that total.
Josh Brunell (40:34) Yeah, you may not have to.
Marie (40:35) Do all of the clients?
Josh Brunell (40:37) Would you feel more comfortable with… lower estimate? Let’s say half of this 500. And then we put that together with the updated pricing. I mean, it’s whatever kind of estimate you feel comfortable in. And I think the easiest math, the easiest way to do it is like, hey, how long have we had these customers? Like did we just bring them on or not if they’ve and then if it’s anyone that’s been along the ride for, you know, longer than three years, then there’s probably going to be a revalidation that’s coming up. So, I know we’re looking at 1,800 total if you would prefer to like say like, okay, well, only a subset of those are the ones that we’re likely going to have those revalidations up for like happy to adjust the number to whatever?
Marie (41:26) And that’s where I think we should leave that open to adjustment, right? Yep, yeah, we could start small, we.
Josh Brunell (41:35) Could start small. And then if you guys need to come to us and say, hey, we have more revalidations in years, you know, two or three than we initially scope for. Then you could always just add them. It’s not, it’s not like a challenge for our team to do that, right? But.
Marie (41:53) We don’t want to be penalized in case we don’t need them. That’s why I’m saying we should leave that open because once you review and we have an idea exactly what we’re working with, we have all the other answers?
Josh Brunell (42:02) Yeah, then.
Marie (42:03) We would lock that in. Yeah.
Josh Brunell (42:05) Yeah. So do you want, is there like a very conservative number that you all feel much better about adding in there, we do want to at least have something in there so you can lock in the per unit pricing discount. But like if you want to take this down by that number, and.
Nicole Campbell (42:26) what we can do too, Maria, if you give us that like more conservative number, I can work with our finance team to say, hey, we think this might scale, can we lock in the lower discounted rate that we originally presented for the per unit cost… even if we want to say like, okay, it’s only going to be 500 for now, but we know we might do some adjustments in the future?
Leticia Stewart (42:50) That’s why I was looking more for like a per use kind of number. And then we would have like that baseline. And then we would know, you know, we kind of talked about this yesterday too is getting that baseline and then adjusting this up or down based on actual usage… after a year. Yeah.
Nicole Campbell (43:12) I think that’s something we can always do in terms of going up. What we won’t have the flexibility to do. Is that like downward shift? So that’s why we want to.
Leticia Stewart (43:19) Be, if we.
Nicole Campbell (43:20) Want to start at the most conservative and give us room and lock in a higher discount per unit cost, that is what I would be comfortable going back to my finance team and advocating for. And then I think you will have a good user experience too. Like that. We don’t want to oversell you. And that’s definitely never our standpoint. Like I said yesterday, I don’t want you walking into a bigger contract than you can absorb, not my goal. So, I think that’s what we could set.
Marie (43:48) up especially since our goal would be to move quickly on this because, yeah.
Leticia Stewart (43:54) Just like you’re presenting it to us, we’re going to need to present it and we need to be, you know, yeah.
Josh Brunell (44:04) I know I was.
Nicole Campbell (44:06) Going to ask around that piece. I know we’ve said like your team is wanting to move quickly, what is, just so we can set the next meeting appropriately, Marie and Leticia, what does that look like when you need to present this to your finance? Well?
Leticia Stewart (44:17) What’s the soonest you can update your go live kind of information? How long does that, how… long does it do to do an implementation? Yeah, josh.
Nicole Campbell (44:30) And Sam, do you want to take that one? I don’t know if we have that built in here.
Josh Brunell (44:34) Yeah. I mean typical implementation is I would say anywhere between eight to 12 weeks that’s just going to be dependent on a couple of things. We’ll we’ll likely want to figure out. I mean, in your case, I know there’s multiple tools being used today and data could be messy if we, there’s some things that we can do to ensure we’re on the lower side of that. And that’s essentially helping to start gathering that data up front even as we’re working through contracts. So we can cut that timeline down by a couple weeks. So Sam was on our implementation team previously. I mean she would be able to, you know, we could set up a more structured call around it. But essentially, we have what we call a data import template where it’s like, hey, we need all these pieces of data that probably live in either spreadsheets or Healthstream or wherever today. And this is like essentially the format we’ll need it in and we’ll partner with you on gathering that data. And then we have a team that would then do a quality check on the data and bring it into medallion on your behalf. So like that is usually the big bulk of the implementation.
Josh Brunell (45:42) And then from there, it’s like, you know, we can usually start kicking off like new net, new enrollments pretty quickly. But just getting that historical data in is what takes up the most time.
Leticia Stewart (45:56) Is it always a three year agreement?
Josh Brunell (46:00) We, can, we typically will have the multi year agreement for, the skew flex factor. But I mean if you are, if you have a CFO who will refuse to sign a three year and you can only sign a one like that. Is that’s okay with us? We’ll we’ll figure it out. I.
Nicole Campbell (46:17) Mean also to just be very transparent, Leticia and Marie, like you guys wanting to move quickly gives us a lot more push with our finance team. So if you want a one or two year, let us know and we can restructure the contract for you. And.
Leticia Stewart (46:31) Then when you restructure it, the discount will be lower because you’re not committed as long or what I.
Nicole Campbell (46:37) Think we would be because of the speed if we’re moving with the team, we’d be happy to push for committing to the same discounts. So you also have that flexibility of growth at the same rate that we’ve presented right now.
Leticia Stewart (46:52) Can you go back to the slides yep?
Leticia Stewart (47:05) And the demographic updates is just if we need to make a change at any point to any information that we’ve previously submitted, yep. Hey.
Josh Brunell (47:16) You know, if a radiologist might be at their vacation house and then in New York for half the year and then somewhere else in another. And then they need to kind of switch where they’re practicing at like those are all handled. And this.
Leticia Stewart (47:34) Doesn’t include any of the facility information we talked about that Lisa handles, right? This is not.
Josh Brunell (47:40) This is not include privileging, no, like the hospital apps that is out of scope. And honestly, if we were to, based on the volume that you shared, like, yes, we can do it, the volume of 25 hospital apps per person that it would like more than triple this contract, which I didn’t feel like was gonna be doable. So, I, yeah, it is and the not, and that’s not really like an indication of us having like a very high price on that. It’s just, you have 1,800 providers times 25 each. It’s like a lot of units of work for the.
Leticia Stewart (48:19) hospital. No, no, that’s separate that. I mean, that won’t be the, we don’t do that for 1,800 providers. We only do it for that subset that Lisa handles.
Josh Brunell (48:29) Oh, so she, so when she said 25, she meant like 25 total. I don’t.
Leticia Stewart (48:34) know what her, I don’t remember her saying 25. I don’t know what she was talking about, but it’s not included. It’s not included in these 1,800 is what I’m it’s not related to.
Josh Brunell (48:43) That, no, yeah. Yeah. Lisa’s portion of this is not included. No. Okay. Yeah, because I was under the assumption that was 1,800 times 25. It was, no, no, no, that’s like a huge amount of volume that we wouldn’t no.
Leticia Stewart (48:56) She only works on one particular client and she only does the facility for that one client. So, yeah.
Josh Brunell (49:04) I can part, I mean, I’m happy to have a call with her and then we can like get to the specifics of like the level of work she’s doing her.
Leticia Stewart (49:10) Client has 100, her client has 126 doctors.
Josh Brunell (49:14) Okay. And she’s doing the facilities, yeah.
Leticia Stewart (49:19) She’s doing a facility for 126 doctors. So that it’s yeah. So it’s.
Josh Brunell (49:25) a lot more manageable.
Leticia Stewart (49:28) Yeah. Her, and like I said, each one of these is a separate client. And so, and yeah, I have to go through this and determine which ones, some of them, we don’t even do their credentialing, they do their own credentialing. So out of that 1,800, I have to figure out how many doctors of the 1,800 that I have, do their own credentialing. We have no parts in it. No parts in the, any part of it. They send us the information. And then we take it, you know, we just use that for our billing but we don’t do any part of it. It’s not a large number. It’s probably a couple 100, but I don’t know, I have to figure out which ones those are, okay.
Josh Brunell (50:08) And, and yeah, that’s totally fair. And if that happens and we ended up taking the quantities down, on this work like and you want to, yeah, have us work with Lisa on getting that privileging like the privileging kind of facilities enrollment scoped out, like happy to add that in here. This would be my recommendation. So I’m going to take some of the feedback from today. I’m going to obviously put together the updated quote and then I’ll send you the link to our slas as well to review Leticia. And then after… you meet internally if you feel like the quantities need to be adjusted any further, after I get you, the updated proposal, just let me know and we’re happy to do that, and we can put together a structure of what a single one… two or three year contract would look like. Okay?
Leticia Stewart (51:05) And then you do mention privileging on one of your slides earlier. That’s why I thought about it. So one of your slides includes privileges. And I don’t know what privileges you were referring to… but yeah, that sounds good. Okay. And after.
Nicole Campbell (51:26) laying out the implementation timeline too, just want to understand for the, for you, for the team. So as we schedule the next call, when would you need to make a decision so that we could implement within like the timeline you were thinking?
Leticia Stewart (51:42) I have to get, I have to get this information. I have to look at the master services agreement and then I can schedule some time with our CFO to kind of talk about that. And like I said, we, well at this point, this wouldn’t make any changes to our Healthstream contract. We would still have to have that because that’s where all of Lisa’s stuff lives right now. And since this quote doesn’t include that, we would just be moving forward without that piece at this time.
Leticia Stewart (52:15) So there’s no, I would, my next step was to get with him and ask him how much are we paying for modio… specifically? Because all I have is a quote for adding… this service to an agreement they already have. I don’t know. And then I don’t know how much we pay for Healthstream at all, but it sounds like that won’t change. So I don’t need to do that research. And then I could just see, you know, if there’s a budget for this, he told me to do it. He’s the one. He came to your stand. Our CEO came to your stand at himss, before we did. And he was like, you got to go over there and talk to them. So I told him we already have a contract with modio that we’re working on. He was like, no, go talk to them. I don’t care. So, I know he’s open to, you know, the agreement because, and I told him no, I don’t want to talk to him. We already have this thing and he was like no let’s go talk to them and figure out what’s going on. So, I know he’s open to some costs. I just didn’t know what the cost would be. And so, and then I was going to present it as the end to end solution, but I don’t know if this is an end to end solution. I feel like it’s not.
Nicole Campbell (53:37) I would say it, is it just every time we scope different pieces, I think we were moving on our end and that’s our bad, like we’re moving too quick without having all that information for you. So I can see how it like feels more disjointed. I think a good, if you’re asking questions internally, if you wouldn’t mind getting the information around the budget for credstream, I think that makes sense. Cause then we also know then, okay, if we scope that in, are we going to be cost neutral as you roll off that as well? And then once again, you get more efficient. It might make sense in this conversation, right? Right? I’ll.
Leticia Stewart (54:14) find out too. I just, and I knew it would be more and he knew it would be more from the way the conversation went. I just, I didn’t have an expectation of what that more would look like. So now that I have that information, I can go back and present that and see kind of… like, are you crazy or? Okay, what is it going to cost? What is it going to save us? What is it going to, you know? So we’ll have that conversation. Yeah, that makes sense. Cool. Awesome.
Josh Brunell (54:48) I’ll get this over to you here. Later this later today. I do have another meeting. I do have to jump on momentarily, but then after that, I’ll get the SLA over at the updated proposal for review. And then should we set aside time?
Leticia Stewart (55:06) Early?
Josh Brunell (55:07) Next week? What works for a touchpoint? I.
Leticia Stewart (55:12) think early next week would be good. I’m actually off on Monday, so I would think Tuesday or Wednesday, okay?
Josh Brunell (55:23) I’m available on Tuesday, anytime… honestly, anytime between nine and one P. M. I don’t.
Leticia Stewart (55:36) have anything on my calendar? Well, I have some, I have a modio meeting other than that, I don’t have. What day is that the second? No way? No, the 30 first, the.
Josh Brunell (55:47) 30 first? Oh,
Leticia Stewart (55:49) April 30 first? Is it April 30 first? Yeah. March? Sorry, jess, the 30 first? Yeah, I only have that one meeting on my calendar. So, yeah, I’m free anytime?
Josh Brunell (56:06) Okay, cool. And just making sure it’s not at this time is 11 o’clock okay. 11 Easter? No, pacific. You’re pacific? Are you not? I’m.
Leticia Stewart (56:18) pacific? Yeah.
Josh Brunell (56:19) Yeah, yeah, yeah. 11 pacific.
Leticia Stewart (56:21) That’s fine. That’s too early for her.
Josh Brunell (56:25) 11 am two PM.
Leticia Stewart (56:26) Would be great. I,
Josh Brunell (56:30) hope, not. Okay. Cool. I’ll get this sent over and I’ll get the recap of our call and my notes sent over this afternoon with the proposal and the contract details. Okay? Sounds good. Awesome. Thank you both for your time, the extra time. I know we went over, appreciate it.
Leticia Stewart (56:46) All right. Thank you everybody.
Josh Brunell (56:49) Bye.
Leticia Stewart (56:49) Bye.