Transcript
Jason Zednick (00:00) hi, Amy. Good morning.
Amy Frana (00:03) I’m on mute. Good morning.
Jason Zednick (00:06) How are you?
Amy Frana (00:08) Ready for this week to be over? How are you?
Jason Zednick (00:11) Yeah, ready for this week to be over… but I, it’s… like that’s like if I can get what I need back today done like then, otherwise, Monday’s just gonna be terrible. I know, I think I can like, I think I’m in a good spot. I just gotta like get it done.
Amy Frana (00:31) I’m with you. I always block my Friday afternoons to actually get stuff done. And it never fails. It always gets eaten up. And this week, it’s like not if they’re back to back. So, I still like if my time gets eaten up, but I still have an hour block to work is great, but like third time. So, I get half hour chunks of work and it just like cuts down time.
Jason Zednick (01:01) Right. Yeah, it’s hard to get movement in the in between spaces. I struggle with that a lot. Yeah.
Amy Frana (01:08) Was Nick joining this one?
Jason Zednick (01:11) I don’t know. I did not speak with him. He’s usually like 50 50 on it. Okay. Yeah. So we’ll see, he’s good. Hey, crystal. How are you? I’m.
Crystal Eligon (01:25) good. How about yourself?
Jason Zednick (01:27) Doing okay. I’m doing okay, Amy and I were just extolling the virtues of a Friday. Oh, yeah. So.
Amy Frana (01:42) Kristen and crystal, I don’t believe I’ve had a chance to meet you. So it’s nice, to meet you. I’m Amy, frana, so, head of engagement management here at medallion and excited to work closer with Jason more recently to learn your account a bit more and see how I can help.
Crystal Eligon (02:00) Okay, perfect. Nice to meet you too.
Jason Zednick (02:06) Did you say Kristen?
Crystal Eligon (02:08) Yeah, she’s on pto today and I believe Gina’s on another call and I’m not sure if Diego’s joining today. I haven’t seen him for the morning, so.
Jason Zednick (02:21) Okay.
Jason Zednick (02:28) So, what I wanted to do today was I do have like a brief review of because, you know, I told you, we were looking at the submissions sort of auditing them.
Jason Zednick (02:41) And I do have a brief review of sort of the findings. And so, if Diego is available, it might be nice for him to come by no means necessary. I can always just send, I have a little presentation. I can send it and we can review it ad hoc, but if he is available, it might be nice for him, to… join.
Crystal Eligon (03:04) Okay. I’m gonna see if I can teams him real quick. Yeah, see if he’s available.
Jason Zednick (03:12) Hey, Alicia. Welcome. Hey, are.
Alewis (03:13) you guys looking for Diego?
Jason Zednick (03:15) Yes, yeah.
Alewis (03:16) Hold on. Let me pop in his office. Okay?
Jason Zednick (03:18) Thank you. All right. Yeah, thank you.
Crystal Eligon (03:24) Are you all on.
Amy Frana (03:26) site then? Crystal?
Crystal Eligon (03:27) Yes, we’re just in different areas… where.
Amy Frana (03:33) Are you based out of?
Crystal Eligon (03:34) In Houston, Texas? Oh.
Amy Frana (03:36) Nice. I saw the sunshine in the background and no white stuff or rain. So, it looks very nice.
Crystal Eligon (03:43) Yeah, we’re supposed to have a nice weekend too. I just hope it stays that way because we’ve been dealing with a lot of cold. And then here comes the heat.
Jason Zednick (03:56) Yeah.
Alewis (04:00) They’re logging on. He said, give them like two or three minutes, no.
Jason Zednick (04:04) Worries, no worries. Thank you Alicia.
Amy Frana (04:06) No problem.
Jason Zednick (04:08) So after this crystal… I have sort… of like a worksheet that I’ll need you and Kristen’s help in reviewing. Nothing… complicated, but I’ll walk you through it,
Jason Zednick (04:39) And then trying to think if I have any other major topics for us other than that?
Crystal Eligon (04:50) Is the worksheet going to be sort of based to assist in the audit?
Jason Zednick (04:56) No, no. It’s separate. It’s a whole medicare thing. Oh, I’ll pull it up and show you,
Jason Zednick (05:06) It sounds more alarming than it is essentially on one of, the demographic update requests that was submitted early where… and I’ll pull it up and show you where a bunch of lines were requested to be removed or locations were requested to be removed. We did not remove them, you know, like, as we knew we did not weren’t supposed to, but when the line was completed, the medallion record of it got erased, they’re all still in medicare that’s fine. It’s just in medallion. So, what I did is I went and pulled the medicare report and sort of mapped the medicare enrollment to what I believe the correct location in medallion is, and I just want y’all, to go through and confirm that what I think is correct. And then I’ll have my team just put them back in okay?
Crystal Eligon (06:03) It sounds good.
Jason Zednick (06:04) Yeah… and I’ll walk you through that all just… after this.
Jason Zednick (06:27) Alicia, where you’re… team members with the updated role. Are they good? Are they able to see them?
Alewis (06:39) So, Jennifer is both Jennifer and Yancey are actually out on vacation. So, I’m not sure.
Jason Zednick (06:44) Oh, okay. Yeah.
Alewis (06:45) Yeah, Yancey should be back mid next week and I think Jennifer will be back on Monday, so I can have them check. Okay? Yeah.
Jason Zednick (06:51) I was able to like log in and ask them and it’s there. Okay? I’ll make.
Alewis (06:57) sure. I think I only had it added to Jennifer and Yancey. Correct?
Jason Zednick (07:02) Just the two. Yeah, that’s.
Alewis (07:03) correct. Yeah. Okay. Yeah. So both of them, I just got back to work today. I was out sick, so both of them should have it, but neither one of them are here today. So I will confirm Monday.
Jason Zednick (07:13) All right, should be good. Just, you know, let me know if it happens.
Alewis (07:18) Yes, sir. Thank.
Jason Zednick (07:19) You, hopefully, you’re are you feeling better or how?
Alewis (07:23) I probably should have stayed out till Monday, but I’m here. I’m getting it done. All right. Wow, I respect that. They still not on yet. What are they doing?
Crystal Eligon (07:53) I mean, Gina are probably on a call, yeah.
Jason Zednick (08:01) Well, you know what? Maybe I’ll just show you this other thing first, Chris. Okay?
Alewis (08:16) I just sent a little prodding message.
Jason Zednick (08:21) Yeah, and we won’t need much of his time. It’s a very, just short couple slides. I just want to walk through real quick with him. Okay? So, crystal… so this is not… what we’re going to be looking at. I just need to find.
Jason Zednick (09:10) I just need to find the right one to show you. I should have it completed.
Jason Zednick (09:23) Thank you for having me.
Jason Zednick (09:31) This is the one. Okay. So on this record, this is the one where all of these locations were accidentally listed, as to be removed. And so, you know, we told the team don’t remove them. There’s. One in here that’s an ad, just add the one and that was fine, that is how that happened. They are still all still enrolled in medicare. But what happened was… when we completed the line because the system like looks at the request and just sort of does what it was, what the request said even though that’s not what we actually did now for the enrollment for services of Houston and medallion, those… locations.
Jason Zednick (10:25) Are, are no longer on the enrollment in medallion. Again, this is just a medallion. Medicare is fine. So what I have done is, and this is the one… what a 1,111 beaver road was the only ad. And there were like 38 removes. This is the only ad. So that’s just why it looks that way.
Crystal Eligon (10:50) Oh, I see. So.
Jason Zednick (10:52) What I did was, pulled the medicare report for psych Houston and compared… what was in there to all of your psych Houston locations and just mapped them, to what the correct enrollment is for that location. And that’s just what this is. So, there’s 53 there’s actually a few that were in medicare that were not in medallion previously. But I was able to sort of match them. And so I believe this is correct, one to one everything that every location that is in medallion… that has a match in medicare because not all of them do, it should be listed here. So if you and Kristin can just sort of compare the medicare record here with the location info that’s listed here. And just make sure that like, yep, that is the correct one. And it’s all based on address. I did it all based on address. So, you know, 700 north Herndon… and then some of them also say, you know, Avalon place, kirbyville, Avalon place, kirbyville. And so that’s it that’s all this is, it’s just making sure that my reading of it is correct, that they do match. If you can just check a box to be like, yep, that looks good. What I will then do is I’ll take this to my team and we’re going to go record those enrollments in medallion so that, they are there again. So I’ll share this sheet with you. Any… questions about that?
Crystal Eligon (12:49) No, I think it looks pretty easy to understand what to do. Yeah, should be fine. Good.
Jason Zednick (12:56) Great. And then if any of these, if you’re like, ooh, actually that’s not right. Just leave it unchecked and we can… we’ll have a separate conversation of like, okay, is there something else, that should be that is in medicare? Or maybe it’s not medicare at all. And then we just know we need to get it in there. Okay. But… yeah, but that’s it. Okay, is.
Crystal Eligon (13:21) It only for the Houston psych group.
Jason Zednick (13:23) It is only for the Houston psych group. Okay? I am going to have to do this again because there… are three other groups, that we submitted extra locations for that are not on the request. So those… will be enrolled in medicare, but the medallion record is not going to be right. So I’m going to have to come in behind it and just make sure we add those extra ones in that will be less involved than this because, you… know, it’s not they were taken away. It’s just, we got to add a few back, gotcha. But, yeah, but that’s it, this is the real one with this exigio.
Crystal Eligon (14:08) Okay, perfect.
Jason Zednick (14:10) Okay, great. Yeah, thanks. I will. I’ll email this sheet to you and I’ll sort of write out what I just summarized here as well. So, so you’ll have it. Thank.
Crystal Eligon (14:21) You. And is there a certain date you would like this completed?
Jason Zednick (14:28) I hadn’t thought about that. If we can do it by next Friday, that would be good. Yeah, let’s just say next Friday and then, we can talk, if you need more time, okay, cool. And it will be fairly simple once I have it to get in front of my team, to push it to the platform again. So, so that’s not a big lift on us, okay?
Jason Zednick (15:15) Was there any new… questions or concerns for anything that you’ve seen in the last week?
Amy Frana (15:29) Well, usually.
Crystal Eligon (15:31) We like to just email you. And that way we can kind of keep everything in line. Yeah. So it’s been more easier that way. Yeah, by any chance, did you hear anything from the unitedhealthcare issue? Remember how we were trying to sort that out. Can you remind me? I think it was the Cheryl Lucas incident where we weren’t sure how to enroll her?
Jason Zednick (16:00) Oh, yeah, we are.
Jason Zednick (16:08) We’re we’re still trying to research that this is something that Amy, this is the optum thing that I have a deal into. We’re we’re we have some contacts at optum, we’re trying to like… reach out to them and ask for their recommendations. But we, we’ve not heard back yet. So that’s sort of where we’re at.
Amy Frana (16:31) Yeah, crystal, I can chime in. So, I actually came from optum prior to here but not the group that not optum, behavioral health. And so I have reached out to somebody I used to work with that’s in that department. Leads, leads a group within obh, just to ask specifically like what is recommended, how, what is the best way? We just haven’t heard anything back as Jason mentioned. So, as soon as I hear back from her, and, if I don’t by kind of early next week, then I have some other contacts that I will try and get that try… and reach out to as well to get an answer for you all. Okay. Thank you. Yeah, you’re welcome. They don’t make it easy over there. Having come from there. Like I just want to say, they do not make it easy.
Crystal Eligon (17:27) Hey.
Jason Zednick (17:28) Diego. Hey, Gina, welcome. Hey.
Amy Frana (17:30) So, what was that last conversation about?
Jason Zednick (17:34) Optum and, the medical specialties on the behavioral health contract.
Amy Frana (17:41) Oh, okay.
Jason Zednick (17:44) Yeah. So, so Amy was just saying, you know, she came from optum. And so she had some contacts and we’re waiting to hear back to hopefully get like a more clear path. But we haven’t heard back yet. So, it’s still a little unclear to us. And on that note, Diego, Gina, I don’t believe you’ve met Amy frana. Amy is our head of engagement management. And so, I asked her to come today just to, you know, sort of say hi, introduce y’all, to each other. I know especially with Janine being gone, you know, I just wanted to make it really clear that there’s still a lot of visibility into senior psych care is still very much a priority for us and I definitely still have the support I need to sort of, you know, keep things moving, and work on the improvements that we need to see. And so, I’ll let Amy say hi. Yeah.
Amy Frana (18:51) I mean, Jason said most of it, but Amy frana, nice to meet you all. As I mentioned. I, prior to being at medallion, I was with optum and the broader, uhg, for about six years. I’ve been here. I think it’s eight months now. So, I had Janine on the team who I work closely with Jason and Janine getting more familiar with your account.
Amy Frana (19:16) Now with Janine gone and working directly with Jason so excited to be able to partner, with you all and Jason to help make sure any blockers or any improvements that are needed can continue and keep moving forward.
Jason Zednick (19:31) Great. I’m.
Diego Basagoitia (19:33) glad to meet you. I’m sure you heard a lot from us.
Amy Frana (19:38) So,
Diego Basagoitia (19:42) I do have just a question on all that, and roughly how long have you been looking over? I guess our account now, has it been the entire time or just a couple months now, so.
Amy Frana (19:55) The eight months that I’ve been here, Jason’s, been in my group. Janine was his direct leader. She reported in to me. And so, in terms of like familiarity, have known about it, have stayed connected through the challenges since I’ve been here. But even more closely in these last couple of weeks now that Janine is no longer here.
Diego Basagoitia (20:18) Okay. And from your perspective of everything that’s been going on, how do you, how do you feel the progress is going in towards process… improvements, and going towards just making sure that the workflows here are honestly not only accurate and detailed to accuracy but rather just kind of the, what I would call the stoppages that I keep seeing here and there. How do you, how do you see that going forward?
Amy Frana (20:56) Yeah, great question. And actually we, I know we don’t have a ton more time, but I worked with Jason on putting this together so that we could lay out based off of everything that especially now that we’ve been hearing and then also some broader updates. So if it’s okay, I’ll have Jason run through this. And then the last slide, I will better address, your question on where I feel and think that we are. But just in the interest of time Jason, do you want to run, is that okay, Diego, if we go that route?
Diego Basagoitia (21:32) Yeah. Okay.
Amy Frana (21:33) Awesome. Jason. If you want to run through your first couple and I can take the.
Jason Zednick (21:37) Last one, yeah, for sure. And, this will be quick. So, so time isn’t a major concern for me here. So, you know, Diego like I told you, we asked our team to sort of like look at, do an audit, look at the lines and what they’ve done is sorry… we’re going to talk about that effort. The issues surfaced like the themes, the major themes and the things that I think are in place or being put in place that are going to like help that. Then I want to talk about the track your eye really quick. And then the broader sort of strategic effort that Amy spoke of. So when, they looked at the work and they sort of identified the issues. There were four major things. And then I sort of wanted to specifically call out the medicare, Texas medicaid piece separately. So the four major themes that they found are, you know, follow up delays and status management issues, not making updates in medallia and timely to communicate, you know, status effectively incorrect applications. And then sort of a subset of that is failure to follow… like client specific instructions like sbcs specifics. And so there’s a couple of things that have been in place and all of these things are like… post implementation… like all of the things I’m gonna talk about. And some of this you’ve heard before are things that have been in place more recently that I do think are gonna sort of drive improvements and a lot of it’s like really fundamental stuff like for delays and status management, we have entirely new bi tools, entirely new reporting that is driving the work for the people actually managing it. The systems they were working out before were just I’ll just say not sufficient. And now with our new reporting tools, the queuing is gonna be better to sort of make sure follow ups are timely. Things are actioned appropriately. And as part of that, those reporting tools, I’ll speak a little bit more about this in a second. The leads over your team or the team working your account have better visibility to check and make sure that follow ups are timely submissions are timely and those sorts of things. And that’s the second thing is that restructuring of who is working on your account. I can’t actually I couldn’t actually describe what it was sort of prior to that because that’s sort of how I came on board. But when I started on your account was when those changes started to take effect. And so now the structure is such that there is a specific set of team members working on senior psychcare requests and you have operational leads over that specific team. And furthermore, I have direct contact. And communication with those operational leads. And that is not something that I had when I sort of first started with y’all and took over. I meet with those operational leads twice a week. And so that is more recent in the last couple of months. And that has given me a much better ability to have very specific conversations about what’s not going well, what the errors are, and to work through them and to have them then communicate that directly to the team responsible for that work. And also to reinforce those ideas. You know, it’s not just like a one time thing. And then the last thing I’ll say about that is our entire incident… logging error apparatus has… been entirely overhauled. What we were doing before, didn’t give us like the analytics that we needed to do like really good trend analysis to find failure points in that system, like individuals that are particularly issues, that kind of thing. And now we do now we have that so we can sort of correct or eliminate those failure points as necessary. And then the last thing on the medicare medicaid side is having that direct line of communication with the leads. Has given me like the ability to have very, like thorough conversations of literally opening up the portal with them going in showing them where the errors are happening and that translating directly to the team that’s doing it as well as sort of correcting an internal issue where they maybe didn’t have the group ptan reports that they needed. And we fixed that they now have that they have access to that and, you know, when there are issues there, they can come to me and we can work that out together.
Diego Basagoitia (27:08) Gotcha. And I know that as you’ve heard us say before, the most important payers by far will be medicare and medicaid. And that I would like done immediately as quickly as possible because that’s the one that affects us the most not only in providing care to the residents at the nursing facilities, but also the ability to credential them decently fast enough in the mcos group since we can’t really get credentialing going until we have both those numbers. But that just medicare and medicaid alone is 60 to 70 percent of the business. So, that is by far the most important aspect. And the goal will always be to try to get that done within 30 days. Both both of those were possible.
Jason Zednick (28:00) Yeah, absolutely. And, I think we’re at a place where medicare that’s within reach Texas medicaid there. There’s just delay like I checked earlier, and, it’s just a backlog that, that’s still a problem point.
Diego Basagoitia (28:18) Yeah, they got.
Gina Myers (28:19) A couple through we notice, but still there’s a lot still, yeah.
Jason Zednick (28:24) They’re still.
Gina Myers (28:24) Hanging out.
Jason Zednick (28:26) Yeah… we are at 11 30. I still have a couple more things to get through, talked a little longer than I intended there. Are we good for?
Diego Basagoitia (28:36) Yeah, for me. Yeah, I don’t have a hard stop.
Jason Zednick (28:41) Is that good for you? Amy?
Gina Myers (28:43) Yeah, I’m just checking so I can let my next one know, but yeah, we can go ahead and keep going.
Jason Zednick (28:48) Okay, great. On the tricare side, just a quick sort of recap, you know, on October fourteenth, Gina and I identified, you know, the configuration issue. We corrected it. February, we sort of identified the providers that were being surveyed by tricare. And on the ninth poll, the emails that we had, and then on the thirteenth shared, you know, materials to sort of get notification out to those that didn’t that’s all stuff, you know, already, we reached out to our compliance consultant and asked them to look at this to sort of just assess and see if there was any route that we could, you know, take to help and not there’s not a lot of new information there. So in scale service and delegation, they don’t actually require review of the emails. It’s the policy that it’s in place and we reviewed the CMS management care manual and the tricare credit requirements and they don’t explicitly call it out. But as, you know, tricare can still request evidence of verification.
Gina Myers (30:01) So,
Jason Zednick (30:02) that’s sort of where we ended the last email.
Diego Basagoitia (30:08) I sent on that was pushing for an appeal.
Jason Zednick (30:12) So that was.
Diego Basagoitia (30:14) Probably last week, I probably need to circle back. I have, I moved it up the ladder. So I do have the contact on that. Okay? But right now, I’m working it as two ways one because right now, this is causing a major issue from a lot of ways, but one… appeal to try to get that either re audited, just start the audit all over again or… are you?
Gina Myers (30:48) Talking about the tricare audit? Yeah.
Diego Basagoitia (30:50) The delegation of tricare. So.
Gina Myers (30:52) Well, my question on that is how would that even matter? Since our documentation now shows that we sent the thing over the 30 days?
Diego Basagoitia (31:04) My comment would be it’s similar to what I did with Kirana and the pro Carolina app. The only reason we passed that was I sent in a little formal document that says we identified it. It was corrected, won’t happen again. And they accepted that as the reasoning behind it, right? Meaning it was a system error, not that our policies are wrong, that’s kind of what I fell under. So, they were okay with that. They accepted it because they’re able to point to it. And I’m able to prove that it hasn’t happened since, right? So.
Gina Myers (31:41) My question there is going forward, say we do this with optum because that’s your next plan, right? Is to get a delegation with them.
Gina Myers (31:51) So if they do the same thing and just pull random files to audit, and because we know what we say, there’s 40 percent of them that are.
Diego Basagoitia (32:02) Like that 30 to 40 percent, right?
Gina Myers (32:04) What’ll happen? I mean, are you going to have to say this whole song and dance to everybody? Hey? We had this issue, but we corrected it.
Diego Basagoitia (32:12) Most likely, and.
Gina Myers (32:13) We just hope and pray that they accept that as.
Diego Basagoitia (32:16) A, I think the answer is yes on the hoping and the praying, but I think what we’re dealing with is tricare is probably the most difficult one for the sole reason that they’re managed by three federal entities while the mcos are only really managed by CMS, which is a nothing burger in comparison to the three federal entities that tricare has to report to. So, I think it has more to do with that than anything else. But again, we won’t know until we start crossing that bridge time and time again. And I’m hopeful that the mcos will be lenient or really we get lucky and they don’t pick those. I mean, I only have to have that discussion if they pick those, right? So, and that’s if they pick a significant amount, if they only pick one of them, whatever, it doesn’t matter, we’ll lose a point or so. We just got to pass a 95 percent, right? But if they do pick half of it, then I’m going to have the discussion because then we will drop below 95 percent. So it just depends on it. I mean, yeah, it’s a lot of hoping and the rate should drop over time. Meaning, well, right now, it’s between 30 to 40 percent as we get more new clinicians, and as some of the older clinicians leave senior psych care, that rate should over time drop. So, I don’t expect it a year from now to remain as high it is today, right?
Jason Zednick (33:49) It depends on the look back which could be very payer to payer.
Diego Basagoitia (33:54) Right? The big thing that they’re going to be looking at us for re auditing, is going to be the re credentialing process. That was the one thing Kirana did say is they said that they expect us to be perfect on the re credentialing. So, luckily, we don’t have to pass that until I think the third year of the initial credentialing?
Jason Zednick (34:16) Yeah.
Diego Basagoitia (34:17) Yeah. So I’m not that will cross that bridge when we get there. And now that I know that we’re on the radar for that, you know, we probably need to do a practice run beforehand or something to make sure we’re all set for it. But again, the two items of tricare is I’m trying to do the appeal, see if I can write a letter, if we can re, audit if they can give us some kind of leeway.
Diego Basagoitia (34:43) But because it’s military and all that I will find out, I’ve tried already. This is the third time I’m trying, I’m not very hopeful. The only difference is I’ve gone higher on the ladder. The other part is I’ve gone already into the pay or enrollment or whatever side of tricare. And I’m talking to their manager VP of processing, whatever they call them. And I’m trying to see if there’s a way where we can shortcut and streamline this because I need 150 plus providers in their respective companies. Like yesterday. I don’t want to do this filling out their specific enrollment request application because not only will we have to, I don’t know if, first off, I don’t know if you all have that already, Jason if you have the tricare enrollment request or whatever, but that would be one thing. And then the second thing is you were talking about pumping out over 150 providers to get into their respective practice under the tricare agreement and that could take that could take months. I feel like. So I get a little concerned about that as well. So I’m trying to find a way if we could just download the materials because we met pretty much all the ncqa requirements of all that get around it, provide them the documentation and they just put them in as an initial onboarding. And then going forward, we just do the one offs as new providers come in and make that simple. My problem is that initial, you know, big push of 150 plus people. Once we got new hires, it’s not a big deal because you’re only dealing with a handful at a time, but right now it’s that big pump. I can’t wait. I can’t wait three, six months for them to process everything.
Jason Zednick (36:46) Yeah. I don’t know about tricare specifically, but I’ve definitely worked with clients who when they’re bringing on new payers, they’ll say like, hey, we’ll roster, the existing bunch, do them all at once and then you’ll only submit the individual that would be. Yeah, I’ve seen it happen. I don’t know if.
Amy Frana (37:08) tricare?
Jason Zednick (37:09) Does, but we.
Gina Myers (37:10) did it with somebody years ago. I can’t remember who it was, maybe magellan or something like that. We had them all on a roster.
Jason Zednick (37:21) Yeah, it definitely makes that initial piece much Symplr. And.
Diego Basagoitia (37:26) That’s what I’m pushing for right now is I just need this agreement properly just set up with people in their entities right now. I have the agreement but no people in their entities. So I’m not even getting paid for any of the services right now that we’re providing. Rather we’re using some ancient contract that we have where it’s a terrible contract for us. It’s a 75 percent discount and it’s only on two of our 10 businesses. So it’s terrible. And I need to move us away from that immediately.
Jason Zednick (38:05) Let’s jump here real quick. Amy. If you want to talk through the last slide, this is just sort of really broad, very high level but highly impactful changes across our sort of structural organization. Okay? Yeah.
Amy Frana (38:23) So Diego to your earlier comments about confidence and the improvements and everything that we’re working towards, I am confident. So a couple of things just called out here that have been added really this quarter or like right at the tail end of 20 25. We’ve expanded our operational leadership. So I came in August but we did have a new coo just join us on Monday. So that is very exciting as he is diving in right away. Although he officially started Monday weeks before. He was already meeting with us and talking through some things. So I think he’ll be caught up to speed very quickly. We also added Lawrence bauder, who is our VP of business operations. So Lawrence is going to be growing his team. We currently have a business operations lead under him that has really been helping drive metrics, drive daily reviews of where things are, where things are operationally both on the enrollment side and the credentialing side. And then we also added Nicole walker as our director of payer enrollment in December. But Sarah tamweber is a manager of payer enrollment within that group as well. So we’ve really beefed up our operational team to better support process improvements, training quality, et cetera. Also on here. So leading right into the quality piece, we’ve formed a dedicated quality assurance and quality control team. What they’re doing is our quality assurance team and our quality control team. We have standard cadences for all customers. When submissions need to go through, when follow ups need to go through our queue to be audited. We also have them available for ad hoc audit. So when there are issues that are presented to us, if we need to, we’ve got a dedicated group now to go in and do a full thorough review of all of the requests. In addition to that, we did add in a trainer and created a dedicated operations training team. So that individual has come in has really been working to enhance our sops, taking the process improvements, helping to get them rolled out and trained across our entire operational organization. And then one thing that’s not on here that I just want to be able to let you all know too is we are increasing our staff to have even more dedicated reps agents that are working the lines. So we’ve added a large chunk of staff to our team that have been ramping up over the last couple of months in partnership with our operations team leader or sorry, our operations training leader, really making sure that we’re getting these processes robust and having a workflow long term that if there are issues or process changes needed, we have the infrastructure in place to help better. Support?
Jason Zednick (41:59) Yeah. And then the last thing I would sort of say to that as, you know, some of this stuff does have sort of a long tail to feel the effects of. But I would just say that as has been happening when there are issues, please raise them to me again. I have like a direct line to the operations people working it. I log those things we keep records and I have conversations and I walk through it and I show them and we do what we can to, you know, prevent it from happening again. So that’s all just like please continue to let me know I am making… I’m being as loud as I can, making people aware, we.
Diego Basagoitia (42:48) appreciate that. I mean, we have felt changes as we’ve been voicing our concerns. So I do see that the enhancements you all are making and the process changes and the quality control changes are meaningful.
Jason Zednick (43:08) Good. Yeah, I’m very glad to hear that you’re experiencing that. Even if, we’re not all the way there. We want to get better and we want to be having a very different conversation in the next couple of months. Yeah.
Diego Basagoitia (43:25) I do appreciate the presentation. I don’t know if you would be able to send that to me so I can share it with Randy. Yeah, that way he can stay current with us… and I know that the big slide he’s going to want to look at is going to be that last slide, Amy. So I’ll talk to him. We’re very big on operational efficiencies and qapi… quality assurance, process improvement. We have our own business intelligence team and everything. So we do look at trying to find ways as well to always make things streamlined efficient and accurate. Right right now. The reason medallion or credentially is so top of mind for us is that credentialing is the very first component of providing care in this world. And also, it’s the very first and easiest way for us to collect our payment for service before it even hits revenue cycle. So if we’re able to get a claim clean.
Jason Zednick (44:38) Right.
Diego Basagoitia (44:39) That means that it puts a lot of less stress, significantly less stress on Alicia and her team in trying to get the dollar in essence for our services. And if we can keep our cash flow positive and strong, it works out for everybody that’s really where this comes down to and trying to retain our providers every time we lose a provider due to frustrations from credentialing process.
Diego Basagoitia (45:07) I mean, it’s not a small hit. We’re talking about that’s a hit of 150,000 per year if not more every time they come on board and leave. So it’s not a, you know, whatever it cost us to enroll them in the six payers and the training. It’s the opportunity cost and the potential customer losses that we may have. Because if we can’t service that facility, they’ll terminate us and that facility could be a 30,060 1,000 dollar facility per year, not including how many homes that… the clinician may service, they may be serving five for all.
Diego Basagoitia (45:50) I know. All right. So those numbers start adding up very quickly. And I do want this process to be very streamlined and clean because it does affect us downstream, not by a little bit but significantly in both our customer and both our provider areas. I appreciate the work. Yeah.
Jason Zednick (46:11) Thank you. I, thank you for saying that and we’re of course going to, we’re going to continue to… push and improve and get better. So this is definitely not the end of that conversation by any means. Yeah.
Diego Basagoitia (46:24) All right. I don’t have anything else right now again? I thank you for the presentation and I’m working on all this. I don’t know if my team here has anything else… good.
Jason Zednick (46:40) Crystal, I’ll send you, that thing we talked about earlier. And then if you have any questions, reach out and we can always chat on the side. Perfect. All right. Well, thank you all. Appreciate your time. If you need anything, please shoot me an email, reach out. And otherwise, I will talk to you more next week.
Diego Basagoitia (47:00) Okay. It was a pleasure meeting you, Amy. And for future items, just for our knowledge, should we be sending emails not only to you, Jason, but to you, Amy, are you kind of replacing fully Janine’s I guess I think.
Jason Zednick (47:16) You can send directly to me. I meet with Amy weekly and sort of surface things through that? Okay. Yeah, yeah.
Amy Frana (47:27) And anything, and Jason, when we connect if anything urgent items or things that he’s hitting bottlenecks with that’s where I will make sure to get involved so that he has the support to keep things moving for you.
Diego Basagoitia (47:42) Okay. Appreciate it.
Amy Frana (47:45) Thank you. Nice to meet you all. Take.
Jason Zednick (47:48) Care. Bye.
Diego Basagoitia (47:49) Bye.