Transcript
Jeremy Walker (00:00) what’s going on? Hey, Dave, she just entered the waiting room. So I’m going to let her in.
Jeremy Walker (00:14) Hey, friends, Haley, how are you?
Hayley Seguin (00:17) I’m good. How are you guys?
Jeremy Walker (00:20) We’re doing good. I hope you’re feeling better. I.
Hayley Seguin (00:24) Know, I had a freaking air infection and, you know, what is like the irony of it is I was having really bad allergies and like just sinus. So I did a neti pot, which I don’t really do a whole lot. And then literally a week later I have an air infection. It has to be that like clearly some fluid probably got in there or something. So won’t be doing that again.
Jeremy Walker (00:50) No more neti pots for you, no.
Hayley Seguin (00:52) It was brutal. I’m like I’m just trying to feel better and then I end up making it worse. So, anyway, man.
Jeremy Walker (00:59) Well, if down in Dallas, it’s anything like here in Raleigh right now, you just have a coating of yellow everywhere, so.
Hayley Seguin (01:06) It’s horrific.
Jeremy Walker (01:07) Yeah, it’s terrible.
Hayley Seguin (01:09) It’s raining now. I guess we have a little bit of a cold front blowing through, but, yeah, I hear that like I was taking zyrtec, it stopped working. I switched to Allegra, it’s not working. I hear the nasal sprays like nasacort, flonase, like that’s. Apparently what we should be doing for seasonal allergy people this year.
Jeremy Walker (01:30) So, just goes straight to the back of the eyes. Yeah, that’s.
Hayley Seguin (01:34) that’s what.
Jeremy Walker (01:34) I use and it’s the only thing that gets me through this like three week period so that’s my recommendation for you.
Jeremy Walker (01:41) Whoever you heard that from is they’re doing it, right? So, awesome. Well, I appreciate the time… we’ve been busy on our end kind of keeping an eye on cityblock and the business case and try to do our best to review some of the scope that we went through, listen back to the call and also make some edits based on the email that you sent us. So really would like to use the time today, I guess one. And if there’s no meaningful updates that’s completely fine. But one just get an update from you on the response from the team. Based on what we showed last time we’ll review this scope, we’ll showcase how that impacts the business case that we put together. The good news is we’re still positive meaning the value of medallion is still greater than the cost. And then we’ll quickly just align on what the next steps are. I know that you mentioned Susan would like to see some kind of a demo and we can potentially record that. We can also schedule that. So anyways, that’s the full agenda if you wouldn’t mind just kicking off, giving us an update on if you did talk to the folks that were on the call, what was the reaction? How did Susan respond just generally from our last conversation?
Hayley Seguin (02:56) Yeah. One of the people that were there, they didn’t really speak or weren’t really involved but they were listening, sent me some follow up questions specific to I think like the initial implementation cost. I think I asked you about that. And so I gave her that she seemed, you know, excited about the content and kind of the possibility of shifting to something like this. And she’s someone like from a business perspective is kind of helping support me with like the decision side of things.
Jeremy Walker (03:25) Yeah. And.
Hayley Seguin (03:26) Then Susan, of course, like it’s so complicated because I’ve been trying to work on this solo as you guys know. And like one of the things that I really struggle with is like the growth side of things and like the attrition and like all of those things like I don’t really have insight to and I mean, I can guess but, and I know kind of the approach we kind of took in some ways guesstimate as good as we could, but it’s critical that those numbers be accurate and like to where she can really compare. Is this, I think she said it on the call like is this truly a savings or is it not or not a savings? But like a, you know what I’m saying?
Jeremy Walker (04:07) Yeah. So.
Hayley Seguin (04:08) I think that’s the one big takeaway from Susan and then her desire to really just see more about like how are you guys doing this? Like what makes it different than what we’re doing? And so, yeah, I think that was one of the biggest feedback from her. I will say just overall like the urgency of, it has kind of like stalled and not that it was urgent to begin with. But I feel like even like more stalled her like need in the organization kind of shifted a little bit over the last couple of weeks. And she has oversight over another team that she did not have. And so she’s going to be a little pulled away for a little bit. And so in terms of like having her available to like strategically plan for this optimization idea, like I may not have her full attention for another month or so. Unfortunately, and so that’s kind of where we’re at like a little bit of a limbo phase of like what, how aggressive are we chasing this? Like what is the timeline? I don’t know.
Jeremy Walker (05:12) But.
Hayley Seguin (05:12) overall, I think it was a good. They overall were like, okay, this is interesting because I feel like even me when I first reached out to you guys, I didn’t realize that it was like a la carte like the full services of everything. And so they were like, wow, okay. Like this is definitely different than what we’re currently doing and kind of like a setup and run kind of thing. Like we don’t have to do a lot of planning and strategic thinking about how we make it happen. So that was kind of the brawl, yeah.
Jeremy Walker (05:46) That’s super helpful and totally understand the priority shifting. I think we work with a lot of companies that things move very quickly and sometimes things can pause very quickly, right? So it’s not something we haven’t seen before, right? And then I would love to hear like your perspective, we haven’t talked in a little bit. I’ve kind of given you multiple I guess off ramps if you will, to pause things with medallion, but just want to ensure again and in the vein of we don’t want to do something that’s not in your best interest or what you believe is best for your career and kind of where you’re at right now. And so we’d love to hear from you kind of where your posture has been towards moveworks or towards medallion. Moveworks is the last company I worked for towards medallion. And yeah, we’d love to hear.
Hayley Seguin (06:32) I mean, to be honest with you, I feel like overall this industry, you guys like I don’t know if you’re plugged in to like LinkedIn or like other people and like technology is taking over this particular industry. Yeah. And they are coming for our jobs and good for them. Like we love that for you technology like and it all in all, it’s like advancing, you know, what we do and making it more accurate, making it faster, like doing all of those things, making us, you know, enabling us to do other work as opposed to this manual crap that we do in this industry. So yeah, I think I say that to say that this is where the industry is trending. So for me personally, the days of manual tracking and manual teams, and like all of that are going away. And I have to shift my like rolodex of what I can do to be able to maintain a position in this industry moving forward quite frankly. So I’m here for it. And I think I already knew that like going into this, there’s gotta be somebody that like facilitates the, you know, relationship between a vendor and a company. And in my opinion, like if I had a company, I would want somebody to facilitate that and it’s not just like let’s bring these people in and do all of it especially when you have kind of a unique arrangement like we do here. And there’s a lot of aspects to licensing, credentialing and enrollment. And I don’t know, but even if it takes away my job one day that’s fine. There’s other jobs out there, you know, quick.
Dave Wallach (08:13) Question I have. And thank you for that insight. When we met with Susan, she seemed incredibly bright and forward thinking. Yeah. Does she share that same thought process that you think you have, or what is her thought on everything you just mentioned?
Hayley Seguin (08:27) What part of, what part of what I just said, are you questioning if she shares?
Dave Wallach (08:35) The automation, right? The technology, right? That it’s the future, right? Or the future’s here basically, right? So, yeah.
Hayley Seguin (08:43) 100 percent, I don’t know if you guys follow cityblock on LinkedIn or have any visibility, but we hired a CTO probably like, I don’t know several months ago. He’s fantastic. His name is Alberto. He came from, like, I don’t know from where but him and our CEO have been working very closely together about the integration of AI and, you know, technology into what we do as a company. And we just posted a huge like thing on our website and, you know, all kinds of information out there about our ideas and how that’s trending for us. So, I would highly recommend you guys take a look at it and read through it and that is something that the company is 100 percent company wide is aligned with. So.
Dave Wallach (09:37) It sounds like Alberto is really leading the charge with transformation. And, yeah, there’s probably multiple initiatives that could tie back to his mission. Yeah.
Hayley Seguin (09:48) And when he first came on, I was like, God, I’m like what does that mean for our team? And Susan was like Haley like that’s a little bit lower down the totem pole of like things that he wants to work on. It’s definitely not out of sight and I think across the board company wide, it’s you know, we’re on the technology train, do?
Dave Wallach (10:06) You think as conversations progressed and we had another conversation or so with Susan and continued maybe inching closer to partnership. Alberta would have an interest in meeting with medallion just to understand automation or is that too far fetched from his vision? It.
Hayley Seguin (10:20) Might be too far. I don’t know. I mean like he’s really in the weeds of like from like the clinical teams and like our community health partners and like all the different little things and like how we can make things better. But Susan may be our best bet. And I mean, she’s you know, she’s C level with, luckily, we have her and I don’t have like just some director or somebody else like, we got Susan, like she’s literally her boss is the CEO. So she’s tied into all of this and she’s probably our best bet for sure. And she’s administrative focused like she, this isn’t her first rodeo. She’s definitely, you know, can know that, we can make the choice in house and know that it fits the organization’s goals and visions.
Jeremy Walker (11:07) Yeah, cool. Yeah, that’s all super helpful. I think it, you know, you talked a lot about the improved organizational efficiency initiative. It sounds like a lot of that is connected back to that. So if we can continue to attach ourself to that vision, I think the more executives that are excited about what we’re potentially going to help cityblock do the better, right? So that’s super helpful. Okay, cool. Well, I think what would be helpful? Let’s jump into. I have one slide prepared. That kind of just highlights how the volumes that we have scoped out for based on the email that you sent us. So let me pull this up really quickly here. And then we go from there. All right. Cool. So the big ones that, are different from the last time that we talked are one, we actually have a line item for state licensing renewal.
Jeremy Walker (11:57) And we have much more. I think last time we had 25 state licenses because that was just going to be for your new providers. But anyways, this is reflecting from the email that you sent when you mentioned that you’re planning on, you know, in 20 25, you had 260 initials and then 440 renewals. So I just assumed that for the next three years, you should probably see similar numbers. Is that kind of what you were alluding to when you sent those numbers as well?
Hayley Seguin (12:27) Definitely for like, you know, and then they come in and they talk about, well, what about growth? And I’m like, OK, well, give me a number. Give me a number?
Jeremy Walker (12:36) Yeah, if.
Hayley Seguin (12:37) you’re like what? So that I can calculate this, but, what? I definitely wanted us to just have that for like,
Jeremy Walker (12:44) last.
Hayley Seguin (12:45) Year and we’re already in April. We don’t have any like significant new hires right now. So I would think the next like so pretty much for this year or, you know, the first year, I would think that it would be comparable for sure. Yeah. Now they’re down two, three years. I don’t know. But what I do know is I have a sync with Jonathan. He was the finance Guy on the call. I have a sync with him on Monday unrelated to this, but I’m going to see if he has more time because I want him to help me with it and he absolutely does. So, I’m going to propose a little bit more time with him so that, he can look at this too because I can’t do this on my own and they need to, somebody needs to provide me some additional numbers that makes this valuable for them to be able to compare and contrast. Yeah.
Jeremy Walker (13:36) So, and I will say like this is where the complexity, of the medallion model, I guess does come into play. And what I mean by that is it’s impossible for us to mutually agree on exactly how many providers you’re going to hire over the next three years, right? And a lot of times you grow slower than you were anticipating. And there’s extra allocated funds. And a lot of times there’s you know, additional growth that you weren’t forecasting and that’s a good problem because if you grow too fast, the complexity and cost of any other method of doing things also increases, right? So if the business case makes sense and is essentially cheaper with medallion, that’s true for the more you grow. And actually the gap between scaling with people and new tools. And medallion actually gets wider and wider, right? So that’s not a, you know, obviously that would lead to earlier renewal and potentially things like that. But that’s a good problem to have again because it means that you’re doing the most efficient way of growing, right? So, I think at the end of the day, one of the things that we wanted to talk about today with you Haley, is someone who’s kind of our internal champion if you will, is having our back with regards to the scoping and being able to align with that vision that hey, we can do our best to get with Jonathan, get back with Susan, scope this out to the best of our abilities, right? Medallion doesn’t have 450 happy customers because we’re under scoping it and then doing a bunch of early renewals, right? Like we usually are pretty accurate with the scoping that we do and the pricing models that we put together. But at the end of the day, it’s not perfect. And it can never be perfect. And so that again, that kind of story and that vision is something we would love for you to help us out with. Because again, the essence of the story is we’re not trying to pull a fast one. We’re trying to be accurate. But to your point, it’s really hard for someone within the organization to give you an exact forecast for the next three years. So does that make sense 100?
Hayley Seguin (15:40) Percent. And I’m trying to collect my thoughts with that so that I can explain it back to some of these people. But I think the, so the idea is these numbers we’re more comfortable with because it’s a direct reflection of last year, right? And if you’re quoting this at these numbers and it ends up being greater, then that’s a good problem to have, then we, the problem is where it ends up being less and you have like an overabundance of resources out there with, you know, not a waste but just not going to use every single dollar. And so, okay. And,
Jeremy Walker (16:25) I can kind of send you a quick summary of like, yeah of what I said and even like the, if the rebuttal is okay, well, you know, this isn’t going to be perfect. We’re going to end up paying too much or too little. I can kind of give you quick little, I guess talk tracks on both of those points because they’re valid questions. But in reality, it’s you know, our effort is to do as best we can. And then we do have what’s called skewflex, which is another thing I’ll highlight in the follow up email, which allows you to kind of move the spend around between years. So again, I’ll include some of the explanation on that in my follow up for you. Yeah.
Hayley Seguin (17:04) I think one of the big because, and while we’re here actually these numbers don’t include this idea. I think we mentioned it or I did at some point like we’re starting to really get into cross licensing, cross enrolling a number of providers. Is it all of them? Is it some of them that I still don’t have clarity on? But I think in the coming weeks I will. And these numbers don’t reflect that. So it could end up like, you know, being a higher number. If the action plan is to cross license and cross enroll a subset of providers, all of the providers like these could be larger numbers. And maybe that’s where we could maybe see like, okay, let’s say year one is, I don’t know, my brain. It’s Friday and my head hurts. I’ve had a headache for two days. What is going on? But let’s say like in, you know, six months, they’re like, yeah, let’s pull the trigger on that. Let’s do cross state licensure in that situation. What if that happens? What if we, I don’t know how does the pricing work? Is it a scale? Is it like, okay, you’re in this bucket because you’re 260 to 500 or like, how does that work?
Jeremy Walker (18:28) Is that a fair?
Jeremy Walker (18:29) Yeah. It’s all based on volumes. And I actually you mentioned Jonathan earlier on the call. I did send an email, a one off email to him following our previous call because I pulled in a slide from the appendix that actually showed the cost per SKU. And then the volumes that we quoted for those volumes significantly can impact the cost of the individual SKU.
Jeremy Walker (18:54) And so, because we increased the total spend and increased a lot of these numbers that you see here that you know, kind of brought you into new tiers of discounting. And so essentially how it would work is you’d commit to these volumes and a set SKU price, right? That would obviously be discounted based on these volumes and based on further conversations. And then in the event where you do pull the trigger, like you said, six months into a partnership with medallion and you need all this additional cross state licensure and things like that. Essentially, we would add an addendum to our original partnership agreement that includes the additional volumes at that same price or even potentially a lesser price. Because again, the volumes have increased. So that’s how that would work. And again, that’s something that we can build two different pricing models for. But if it’s all speculation and it’s something that’s six months out, I just don’t know if that’s I don’t know if it’s worth the extra effort on everyone’s part. But how likely do you think of a scenario? Do you think that actually is it?
Hayley Seguin (20:02) Is very likely and we’ve been doing it for some providers already and I don’t know if their approach is going to be like just for leadership just for some of our behavioral health people like kind of all up in the air right now. And we’ve been cross licensing like some of our RNS and like it’s just been kind of sporadic. Yeah, definitely something that from the top down. They’re having conversations about doing it and having resources ready to go. And so I just don’t know like how we’ve already made some efforts, but how many additional providers is this going to apply to that’s? What I don’t have clarity on right now, but I think that’s all of that is what brought Susan to the point of like could we get pricing? However she mentioned it like if we have 10 MDS that we have to license in 10 states, if we have four NPS that we have to license in 10 states. Like what does that look like? And she wasn’t sure if that would even be… for her in her mind and like comparing numbers and thinking about like, you know, I don’t know. I don’t know what was in her mind, but that’s what she asked. And so, yeah.
Jeremy Walker (21:17) I will say like the most difficult part about that and, you know, rest of my team, David miller, keep me honest here is like scoping it out from like a business case perspective and like the actual return on investment because I think the way that I’m thinking about it is what we could do is scope it out price you and formulate the partnership based on the numbers that we see here, right? And then also have a pre negotiated pricing that includes additional licensing if needed at X price, right? But again, if Susan is really keen on, I know Dave asked the question when we talked to her last time like, hey, if it’s a one to one comparison from a cost perspective, if medallion’s 350,000 and the cost saving is 350,000, does that like close the deal on a partnership? And she said, not necessarily. So like that’s the good thing is I think she’s thinking more long term than just the cost benefit analysis right now, but it would be really hard to kind of quantify and justify that additional spend. So, I think that’s why what would probably be best? And again, Dave and Mallory, if you have a different perspective, let me know. But like focus the value and focus the initial partnership on what we have here and then have pre negotiated pricing for potential additional licensing.
Hayley Seguin (22:33) I think that could be a good solution for her brain and for how she’s thinking about this, the company overall, right? Because it’s unique, right? Like you may have people that are like, yeah, definitely we’re going to have 110 new providers tomorrow. Like ours is a little bit more, you know, we’re not a startup because we’ve been around the block for a while but we’re definitely, you know, finding our way still. So I think that it’s a little different than, you know, other people. But I think that I’m on the same track. I do want to review with Jonathan just to see if he has any additional input on these particular numbers. If you could just include, email me this so that I have all of this together and he can map it out with his brain for what he saw last time. Yeah, we can talk about. Does this get us to an accurate enough place in terms of the business case? And then if we proceed to, you know, wanting to do it, maybe having some custom, whatever you said numbers pre.
Jeremy Walker (23:39) Negotiated like pre negotiated pricing for additional licensure. Yeah. Okay. And then like really and this is like me talking because we’ve had a relationship with you for a little bit like if it really came down to it Haley like we need lots of approvals for this, but if it made everyone’s mind much more it is we could consider doing something like a two year deal as well where we try to do our best to forecast for two years.
Jeremy Walker (24:08) So that, the risk I guess of really missing the scope for the third year isn’t as, you know, isn’t as I guess obvious. So that’s something that we might consider as well as again, this is for really when we get later into discussions, but that’s a potential option as well. If, if that would use Susan’s mind. So, yeah, yeah. Okay. Cool.
Hayley Seguin (24:29) That’s good to know. I do think if you could do some sort of demo or just anything about the technology side of things, you know, go look at our posts about AI and how we’re integrating that into our care model and maybe use that as inspo for like what we’re doing and like what we may be interested to know and how medallion is doing.
Jeremy Walker (24:50) Okay, awesome. And then what’s the right way for us to? Because at some point obviously, and we want to be respectful of her new initiatives and kind of the things she’s working on. But what is the right way for us to get back on the calendar with Susan? I think what we’ll do is we’ll probably spend the time to go ahead and record that demo. Obviously, I’ll take a look at some of the cityblock initiatives that are going on with regards to AI and kind of tailor the demo to some of that. Obviously that takes time. And so our only ask would be maybe after that. And once things settle down for Susan a little bit, would you be willing to come back on both of you and maybe Jonathan as well to re, review the business case based on the scope that you confirm with Jonathan and then kind of get some alignment from there on a path forward. Does that work if we were able to do that?
Hayley Seguin (25:42) Yeah. 100 percent. This is really giving like your real estate trying to sell a house, right? It’s like, come on, you’re making me I’m spending 20 30,000 for these open houses. You’re taking up my time like come on, just buy the house. That’s what my brain was thinking about as just the mapping this whole thing together, you know, because I do recognize that it’s a it’s effort that you guys are putting in and I want you to know that, it’s not been wasted by any means of.
Jeremy Walker (26:07) Course. Yeah.
Hayley Seguin (26:07) We, we have, we were supposed to have a team sync in may where we were going to go to Chicago and that’s even being postponed. Oh, wow. Yeah. Like people have already booked flights and they’re postponing it because of everything that she has going and full time. She was like, I may not be available for this and she feels terrible. She’s like, I, she feels awful but she’s like it may be a month or two that’s fine. Like we can circle back to this. So in terms of like you guys and your urgency with it, like know, that like we’re still at the table with you. It’s just, you know, some changes, in our urgency and changes in what we’re doing over here and my boss being really high level and having other things going on. But we also got a new Cho not too long ago. And oh, cool.
Jeremy Walker (26:56) Okay.
Hayley Seguin (26:57) Yeah. So he, he’s going to be somebody that I lean on a lot. I’m actually booking something with him in the next couple of weeks to kind of like give him a demo of all things Lc. E. So he knows like what we’re doing and I have some decisions I need him to make. And so I’ll preview this to him as well. So that cool.
Jeremy Walker (27:12) Yeah, we’re.
Hayley Seguin (27:13) we’re doing this and he may be a good asset too, that can partner with us in lieu of Susan or in addition to Susan… you know, he’s more health focused, but he does have his hands in all things that, you know, are tied to his clinicians. So.
Jeremy Walker (27:30) Do you, do you see a world where potentially who you report to changes with all these new leadership influencers or is it always going to be Susan?
Hayley Seguin (27:37) Susan is my third boss here and I started in December of 20 24.
Jeremy Walker (27:42) I reported.
Hayley Seguin (27:45) to the senior director of clinical staff affairs essentially and he got laid off.
Hayley Seguin (27:53) And then I reported to our SVP of the clinical practice. Bye Mallory. Happy Friday. Bye Mallory. And then now I’m reporting to our Cao.
Jeremy Walker (28:07) Okay. So you’re saying, there’s a likely scenario where I’m.
Hayley Seguin (28:11) not going to hold my breath. I’m not going to hold my breath like that’s. Funny. It’ll be some other, you know, who knows? I hope not because I love Susan. She’s really like I’m able to finally learn from someone in like a really long time and I like really look up to her and like admire her. And so, I would like to stay under her, but I’m not going to hold my breath and I’m up for anything. So scrappy. You guys, we got to stay scrappy.
Jeremy Walker (28:39) That’s funny. I feel like we’re living in the same world a little bit over here, with medallion. Luckily, it’s all good stuff and it’s progressing the company forward, but just ever going change, yeah.
Hayley Seguin (28:51) I feel like a stepchild, I feel like I don’t really have a home.
Jeremy Walker (28:54) Yeah.
Hayley Seguin (28:56) It’s been scary but also, I like luckily, I transitioned by mine that it’s like, hey, I’m good. Like I’m good. I’ll survive whatever it is. I’ll survive.
Jeremy Walker (29:07) Yep. That’s awesome. Well, I would love to, if you’re open to it again, I don’t know what you and Jonathan have for next Friday, but I can send you this. I’ll send you. Like I said, some of those talk tracks around the scope and, you know, that we do our best, but it’s never going to be perfect. And then, if you were willing, I’d love to get time again with Jonathan to review the scope that you potentially discuss on Monday with him. And sure it’s all in a good place that way, that point after that conversation, we’re fully ready to speak with Susan again and be confident about the content that we have, right? It’s been vetted by you. It’s been vetted by Jonathan. And as long as we have you in our corner, I think whenever that conversation does come up with Susan, I feel like we’d be in a really good spot for it. So, does that, is that something that you’d be willing, to schedule for next Friday?
Hayley Seguin (29:57) Yep. I’m about to slack him and I let him know that I want a little bit more time with him on Monday to add in this conversation. And I’ll mention to him that I would love if he could on next Friday, join async with you guys just to revisit everything. So I’ll give him the preview. It looks like, he should be here next week. He doesn’t have much going on Friday, so.
Jeremy Walker (30:20) Okay. Yeah, just, yeah, either email or text me, but Dave go for it. Yeah, I.
Dave Wallach (30:25) need to drop Haley for another call. I have to kick off, but great catching up and I’ll talk to you real soon. I’ll let you guys wrap up from here.
Hayley Seguin (30:31) All right. See ya. Thanks Dave.
Jeremy Walker (30:32) Bye. Okay. Cool. Haley. Well, like I said, text or email me, once you get back to or once you hear back from Jonathan, we’ll get that scheduled for next Friday. And then in the meantime, like I said, I’ll send you a bunch of content that’s hopefully helpful for you. So, but yeah, thank you for the time today. It was great catching up.
Hayley Seguin (30:51) Yeah, it was. Have a good weekend.
Jeremy Walker (30:53) All right. You as well. Thanks, Haley. Bye.