Transcript
Hassan Zahir (00:00) good afternoon, sir?
Josh Brunell (00:01) How are you doing, Austin? I,
Hassan Zahir (00:04) can’t complain? Happy to see a couple of these things getting across the finish line last day.
Josh Brunell (00:09) Yeah, yeah. Me too. Hi, Roxy. How’s it going?
Roxanne Williams (00:16) Doing well. Thank you. Busy day.
Josh Brunell (00:22) Yeah, yeah. Hopefully we’re your last meeting so you can play some catch up.
Roxanne Williams (00:28) I think John’s joining us. I’m not sure if, Tom, yeah, Tom.
Josh Brunell (00:43) John’s joining right now from the waiting room, okay?
Josh Brunell (00:53) Hey, Nicole, just tagged.
Nicole Campbell (00:55) My water bottle very quickly team. Sorry?
Josh Brunell (00:59) All good. Got some more folks rolling in, so.
Josh Brunell (01:06) I know it’s been a couple weeks. How you been… good?
Roxanne Williams (01:12) It’s been, it’s been busy just like on payor calls all day today, which is a good thing to get payors on the phone. So, just in heavy contract negotiations right now on my side, so.
Josh Brunell (01:28) Okay.
Roxanne Williams (01:28) That’s where, and that’s where I need to be spending the bulk of my time. It’s a contract negotiation. So it’s a good thing.
Josh Brunell (01:34) Yeah, hopefully we’ll be able to free up from that here pretty quickly. John. It’s going to be right back. So, we’ll oh,
Nicole Campbell (01:43) my gosh. We’re all leaving things around today.
Josh Brunell (01:46) You know, the back to backs they pile up and, you know, you got to get water sometime well.
Nicole Campbell (01:52) I filled it up. I just left it on the counter.
Roxanne Williams (01:56) Well, that doesn’t help you, does it? No, it’s.
Nicole Campbell (01:59) just silly choices. Did you take any time for your family during spring break? Are you guys doing anything next?
Roxanne Williams (02:08) Week? No. So, my son was with his dad, his week of spring break. He went to Orlando went to universal. So he had a good time.
Nicole Campbell (02:17) Nice.
Roxanne Williams (02:20) So,
Josh Brunell (02:20) funny enough. Sam is there now, Sam, who’s been supporting all the calls from a technical standpoint? Oh, yeah. So we brought Hassan on today. We’ll do introductions once John gets back, but Sam’s on Hassan’s team. He leads our solutions consultant org here. So.
Roxanne Williams (02:39) Perfect.
Josh Brunell (02:41) Hey, John. How are you doing?
John Pearl (02:43) Well, sorry about that.
Josh Brunell (02:46) All good.
John Pearl (02:47) It’s been an afternoon.
Josh Brunell (02:48) Yeah, that’s what you’re not the first one to join this call and say the same thing. So don’t worry. Yeah, awesome. And I didn’t see Tom accept the invite. I have a feeling he won’t be joining.
John Pearl (03:02) Yeah, he is traveling. So he’s unable to join today. Yeah.
Josh Brunell (03:07) All good. I know we have an hour. I don’t think we’re going to need the whole time in case we run over the 30 minute mark though I just want to be aware. Do you all have a hard stop at the top of the hour?
Roxanne Williams (03:17) I do not.
John Pearl (03:19) Okay. I’m good.
Josh Brunell (03:21) Okay, sweet. And before we dive in quick introductions on our side, Hassan, who’s joining today? He, I was telling Roxanne before you hopped in, John, he leads our solutions consultant org here at medallion. He’s Sam’s manager. She’s out on a family vacation this week. So he’s going to be supporting, he’s been meeting with us internally as we’ve been talking about the opportunity and partnership with together women’s health. So he’s read in but Hassan, if you want to say a little bit about yourself.
Hassan Zahir (03:55) Yeah, thank you, josh for the introduction. Roxanne, John, a pleasure to meet you both. As josh said, I’m Hassan, Zahir, I lead the solutions consultant org here at medallion. I’ve been here for about two years, been in health tech, startup space for about 15. So, just excited to actually meet you both after hearing so much from the team as we’ve had kind of our internal syncs. I’m happy to support where I can. I’ll be a fly on the wall unless needed, but happy to support however necessary.
Roxanne Williams (04:25) Nice to meet you, nice.
John Pearl (04:27) To meet you.
Josh Brunell (04:29) Awesome. And then let me just go ahead and pull up the overall agenda. So I did want to just do a quick kind of like recap… following the last meeting since we met on the tenth. It’s been a few weeks. So I just wanted to talk about some of the feedback we heard coming out of that call and some of the things we talked about John via email that we’ll be covering today, making sure we’re aligned on the agenda and then also see if there’s anything else that you want to make sure we include.
Josh Brunell (04:58) But I know the big piece was like contractual guarantees in our slas, especially around payer enrollment from submission through to completion. We gathered the data from by analyzing the payer list that Roxanne sent over. So we’ll review the output of that and what we’re going to be contractually committing to within the slas. We also got your feedback on the last call regarding adjustments for the Roi analysis which we’ll review specifically around, hey, what does this look like? If we have more conservative growth? What does this also look like to update some of the internal kind of current state turnaround times around the process today? So wanted to get your feedback there. And then lastly a more conservative proposal. So an option where instead of the adding 40 providers annually, I think we talked about a more conservative estimate just to see what that models out to… outside of these three things, any other key points that you want to make sure to cover?
Roxanne Williams (06:06) I think this is good or John, go ahead.
John Pearl (06:10) Yeah. Sorry, Roxanne, maybe one item to talk through. And for… Nicole and Hassan, I am not a credentialing expert by any stretch of the imagination. So forgive me and Roxanne might need to lean on you for this, but TWH has like pho agreements where like phos are doing credentialing on their behalf. So just want to understand like how that relationship looks like with a medallion partnership. And then obviously, I don’t know how that changes the math but just something that we’ve talked about internally.
Roxanne Williams (06:54) Yeah, you actually read my mind. I was thinking about that as another talking point if we had time and.
Hassan Zahir (07:01) So what’s happening is that application is being completed and then submitted or what does that process look like for you? So.
Roxanne Williams (07:08) Currently, the pho, the hospital system is the one that has the direct agreement or a delegated agreement with the payer. So they have either their application or like a roster that we’re saying they’re all different. It looks a little different per pho, but we’re basically submitting either some form of application checking off which payers we want to participate in through that pho, and then providing like basically a roster for the provider if it’s multiple providers, or just like there’s an application, if it’s an individual provider, then the pho takes that and submits that via delegation or just a normal application process dependent on if they’re delegated or not.
Hassan Zahir (08:07) Yep. And that, and that makes sense. And so essentially, they have the delegated agreements or they have the better rates negotiated via contract. And so the providers are getting in network with the health plans under their existing contracts. And so what I guess I simplify is that asking if you’re submitting an application a lot of times, what we see is that an individual application for that provider is submitted to the health system, the health systems will run their process and then get that provider in network that way. And so that’s why, I was trying to clarify is like, is there an individual application every time for the provider? Or sometimes you’re just sending rosters over that include those providers?
Roxanne Williams (08:49) I think it depends on whether, the health system is delegated with the payer because if they’re delegated, they’re going to provide a roster to the payer versus going through the credentialing process. If they’re not, they may have, you know, an application, a payer application that they’re submitting, but everything will run through, the health system because we’re choosing which products we want to participate in. And it’s different for every practice every provider. It’s not always consistent although we’d like it to be we’re working on that, but that.
Hassan Zahir (09:31) Makes sense. I guess I was just trying to figure out like in those instances, what is your requirement like for that provider to submit?
Roxanne Williams (09:39) The… so it almost like probably be like we’re submitting an application. I don’t know like, the specifics I’d have to grab, you know, get that from our credentialing manager. But it’s all of the basic demographics, caqh, all of that information that would be on a probably a payer form plus… picking the product type. So there’s two pieces to it.
Hassan Zahir (10:10) One’s which product types you want them to be from the health system. And so that was the reason I was asking. Typically we do something very similar to that a lot of times with organizations when we’re submitting like a hospital application for a provider to get privileges at a hospital. And so it’s generally like the same type of information that’s being submitted. I was curious and wanted to make sure that you didn’t have to do like psvs on them and submit like what the results of those psvs were with that application. If it’s solely the process of your completing an application and indicating what that provider is going to participate in, then we can get you some updates on what that needs to look like… from kind of like a volume or cost perspective.
Josh Brunell (11:00) Yeah. Is there like a standard? Like I think what could be even more helpful is, I know Barbie’s been helpful in helping us understand some of like the requirements when they’re submitting standard enrollments directly. Roxanne, do you know if she has like a sop for this kind of situation that she has in place in the health systems?
Roxanne Williams (11:25) Maybe, but it’s going to be, it will be dependent on the pho. So, I mean, it’s they each have their own process. I mean, I can get a roundabout of what that would look like, but do you not, I would think this is not an uncommon situation or ask, I mean, it happens frequently. Yeah.
Josh Brunell (11:49) We can support it. It’s just when we run into these situations where each one of the health systems has their kind of own set of requirements we don’t need, we don’t need to validate it at this moment. But prior to implementation, we’d want to understand what that workflow looks like. So that our, your operations kind of expert with medallion your engagement manager would have that understanding upfront. If there’s ever like a custom workflow that needs to happen that’s outside of the standard payer enrollment, like a process that we typically see with, you know, a, we would just want to know that in advance, build that into your essential project plan during implementation. So we know what that looks like.
Hassan Zahir (12:34) Yeah, just.
Josh Brunell (12:35) To.
Hassan Zahir (12:36) be clear, Roxanne, there’s not an issue with us doing this. We just try to identify, we treat this as a hospital application or we treat this just essentially like as a standard enrollment, like what data needs to be completed and be submitted? Yeah, because there’s just different data requirements. And that’s why I was saying like hell, we don’t need to do like psvs or provide background information or anything like that. You’re committing some you’re completing and submitting the application. The pho is submitting it on your behalf. And so we work with like msos and like all sorts of other organizations where we have similar kind of workflows and we would essentially treat that as an additional application. So, I don’t think there’s a lot for us to worry about there. It was just a matter of making sure there were any gotchas before we say, yeah, one is receiving.
Roxanne Williams (13:22) Yeah. And I submitted that in the payer listing, I noted, I indicated whether it’s a pho arrangement or not. So, the one what I submitted to you guys has that notated then?
Hassan Zahir (13:35) That was already accounted for and we would treat that enrollment application. So, whatever you have today, I’m glad that you clarify that and we made sure that there weren’t, any red flags or yellow flags or anything we need to worry about. But that’s exactly how we would treat it. That’s exactly how we would treat it. Okay?
Josh Brunell (13:55) Great question. Any, anything else that’s not on, the agenda here, John, that was a priority.
John Pearl (14:03) Maybe the only other thing that I have front of mind, I have an assumption on the answer but just curious like, so today we’re on modio, we’d… obviously need like a data transfer from modio into whatever the future state platform looks like. I assume that’s pretty straightforward but just wanted to confirm yep.
Josh Brunell (14:28) Yeah. And, and that’s the line item under implementation that’s essentially included in there is that you’ll get a technical resource that’ll help support the data migration effort, technical solutions manager during implementation, amongst another, a number of other resources. So, yes, you’ll be covered there absolutely. And one thing we can do as part of this process to even expedite the implementation is kind of get you the, we call it a data import template that’s all the data requirements that we’ll essentially want to map over from modio over just to make sure that, you know, we have an understanding of where that data exists in advance. If it is, if it’s all in modio that’s great. That makes it easy for us.
John Pearl (15:13) Okay. And then maybe the flip side and this is always an interesting question to ask a vendor. But God forbid, like the, we don’t see the value long term. Can you talk about like switching costs or getting data out of medallion, if we needed to go back to modio, or like what that looks like? Is it like from an export perspective, we want to make sure that we have access to that data if we needed to?
Josh Brunell (15:41) Yeah, Haas. And you want to answer that one? Yeah, John.
Hassan Zahir (15:47) That’s honestly like the easiest thing. One, you can make a request to your account manager, engagement manager at medallion. They will get an export of all of your data out for you. We always have that bi directional API. So at any given point in time, if you wanted to get any data out of medallion, you have the ability to use the API to get that data out of medallion as well. So we support it in both ways. A request at the end of the contract terms or at any point in time during the process, you can just get it with our API.
John Pearl (16:16) Awesome. Okay. Other than that, I’ll look through my notes, but those were the things that were top of mind from my perspective, so.
Josh Brunell (16:24) Okay. Awesome. Let’s dive in. So, yeah, we talked about really… one of the biggest differentiators between medallion and modio is that we’re not just software, right? While our process is going to automate, say 90 percent of your workflow. We do have people in the loop both from a quality standpoint and to help drive, follow through to help you scale more efficiently to where you’re not having to hire and grow your cred staff team as the organization adds more providers. And one of the things we talked about is like, yes, we have our standard slas which are typically around submission of work. And there was a request coming out of our last meeting around, hey, what does this look like as far as like overall commitments from medallion to complete the work?
Josh Brunell (17:14) So we did analysis on your payers and across all your payers that we were looking at across the several states, our average was about 54 point five, seven days. After a meeting with our team internally, we got operations approval and legal approval to move forward with an SLA of 75. We typically will add a 20 day buffer to whatever our average is just to take into consideration any sort of outliers, but that was the number that we were able to get approved. And one other caveat is like, yeah, that’s a 45 day improvement from what we had heard from your team, but know that just the 54 days is our true average. So just wanted to call that out. What are your thoughts? Roxanne?
Roxanne Williams (18:02) OK. So based on our payor mix, you’re moving from your average of 54 to committing to 75. Am I understanding that correctly? Yeah, so.
Josh Brunell (18:15) Our average is 54 days, but from an SLA standpoint, like in order for us to be within our SLA, legal and operations approved, a 75 day SLA for that’s through to completion. So, not just a submission SLA, but a completion SLA?
Roxanne Williams (18:35) Meaning they’re fully enrolled and confirmed with the payor. Yep. OK.
Hassan Zahir (18:42) Roxanne. That still will happen on like that 54 point five, seven day average. And so like nothing’s going to change from that, what we’re saying here is like even if the payor is being problematic, even if there are things beyond typically what we would consider our control, we are still going to commit to that 75 day submission to completion SLA?
Roxanne Williams (19:06) Yeah. OK.
Nicole Campbell (19:15) Maybe I’m picking up on a.
Roxanne Williams (19:16) Little, yeah, I’m just curious if you’re I mean, so you’re is it, is this typical that you build in a, that large of a buffer or is it based on something around our practices payor mix? I’m just curious what is contributing to the difference?
Nicole Campbell (19:36) Yeah. There’s two things. So this is something like number one, we don’t offer to every customer like a submission to completion SLA. And it was something also that modio or any other software does not build into their contracts. And mainly the buffer is built in because we can’t control all the operations of the payers and we took the mix of the turnaround times of those payers and josh, I don’t know if we have that information in front of us but that’s where the buffer comes in with what we can control, how much we can control of it and the payers we built that off of josh, don’t know if there’s other numbers there you want to step in with? No?
Josh Brunell (20:16) No, it was based on the analysis of your specific payer list that we ran the analysis on. So we have, okay. Yeah, we have an in house data team that will cross reference and look at our turnaround time averages across all. We netted at 54. And so our go to standard is a 20 day buffer on top of that just to account for outliers as discussed. But if, was… there an assumption to get that lower? Because the issue is, and we can walk through this in more detail when we’re going through the contract. Is that’s essentially, if we miss, right? If we miss, like in our slas, if we have any sort of chronic breaches, that gives you obviously the ability to one not pay for that unit of work. But then secondarily, if there’s chronic misses, be able to walk away from the contract. So, John, to your point earlier, we have those protections, in place, God forbid that’s going to happen. We’ve never seen it happen. But if that does happen, you’re protected… yeah.
Roxanne Williams (21:25) So your average of 54 that’s across all payers, all states?
Josh Brunell (21:31) From the, from the list that you had shared, yes.
Roxanne Williams (21:34) No, no, not our average, but your average is that all states all payers or that’s for our specific markets?
Josh Brunell (21:43) That’s for that’s for in?
Hassan Zahir (21:45) Your markets?
Josh Brunell (21:46) Yeah, it is.
Roxanne Williams (21:48) That in our market yep it.
Josh Brunell (21:51) Was actually, yeah, 54 point five, seven days was the specific number, which actually was oddly enough very close to what, our average is anyways. So.
Roxanne Williams (22:03) And that’s commercial and government payers, right? Which I think I asked before, okay, because our mix isn’t really different than, you know, the average?
Josh Brunell (22:17) Yeah. And that I’ll say too that, yeah, this is for those direct enrollments. I know we’ve talked about as well like the path to delegation, our SLA to that. Once once we do go through that process is a three day average to essentially, complete a cred file. And so that will, that number will expect it to go down. And there’ll be additional obviously value added by getting a provider through that process that much quicker that’s not taken into consideration in like kind of, the business case that we’ve modeled out. But I did want to just call out as well, like, what our average is.
Roxanne Williams (22:57) So, okay. And can you go back? I do have a question around the, can you go back to that other slide yep, the one we were just on? So, the enrollments, okay, medallion is three days average to generate and submit applications to the payer. So, is that based on our team providing you with the provider’s information for onboarding? Or you guys are a part of the onboarding process and gathering those documents? Or are we, our team has to have everything ready submitted to you? And then that’s when the clock starts or you’re a part of the gathering. So.
Josh Brunell (23:41) The, the top piece when it says medallion will commit to, a 10 day SLA that’s the moment you hit request of an enrollment?
Roxanne Williams (23:50) Okay. And,
Josh Brunell (23:52) so, that is not taking into consideration like the time it takes to like get this implemented, right? So, like as we’re loading in providers, as we’re getting stood up like that. That is, that is a separate piece. Yeah.
Roxanne Williams (24:06) I’m not talking that’s not what I’m talking about. I’m talking about let’s say we have a new provider that’s onboarding, they’re ready to go there’s? Obviously gathering of their documents, right? Their medical license, and all of the pieces that have to be submitted to the payer, is that something that medallion is doing or our team is expected to have that ready for medallion? And then the clock starts to submit that to complete and submit the application? Yeah.
Hassan Zahir (24:37) So, Roxanne, what happens there is that’s a part of the onboarding process. So we’ll know who the payers are and so as a provider is being onboarded, they have those tasks or those requirements. And so in order for a provider to get in network with your health plans, when they’re onboarding, we’ll capture all of that information up front. Some of that is going to come from caqh, some of that may need to be supplemented by the provider or an admin. It’s the reason why the provider has their portal. And so, the goal is that the provider logs in that first time and we’ll sync their account with caqh. We’ll identify the additional information that’s required in order to meet all of their requirements for the health plans that they’re going to be enrolled in. And so then they have a completed profile from that point in time, you can submit these enrollments and the SLA clock starts from that point moving forward. So, the goal is that medallion automates the vast majority of capturing that information, those documents, those licensure documents, proof documents. All of those sorts of things are a part of our onboarding process. That provider’s profile is then complete. And once the provider’s profile is complete, all of the downstream workflows can be initiated.
Roxanne Williams (25:53) Okay. So there’s not an SLA around like the onboarding timing of like gathering that information from the provider.
Hassan Zahir (26:02) There is not an SLA around that we have the averages. We have an idea of how long it takes based upon the various provider types. However the SLA is based upon what medallion can own. In the instance of onboarding. There are instances where there could be non responsive providers regardless of the amount of outreach. And I’m sure that you’re familiar with that. Being a big bottleneck, it’s the reason why we automate as much as we can there. It’s the reason why we have the automated outreach and different ways of getting that information. But there is not an SLA associated with that. We’ll be extremely proactive.
Roxanne Williams (26:40) Okay. But just for clarity purposes, that is what your team owns, the onboarding piece of it with the.
Hassan Zahir (26:46) Provider, we have the onboarding portal. We perform the outreach to the provider. We would engage you if we have like non responsive providers and we have to escalate, because we could say this provider hasn’t submitted this information and, you know, after X amount of tries and we’ve tried SMS messages and email and all these sorts of things. So, yes, we do own that process that is a part of our onboarding process. And the reason why we have the really good onboarding turnaround times.
Roxanne Williams (27:15) Okay. And then, can I ask why it would be 10 days? Because if you’ve got everything and is this in my reading, is it per enrollment or is it for a provider in three days average, all applications are submitted and are completed and then submitted, is that for the provider level or in each individual enrollment level, it?
Josh Brunell (27:42) Is both, but you have the ability when you are going through the process of onboarding a new provider to do like a bulk request of all, hey, we want them enrolled with all these health plans at once and then submit that all at once. But to your question, though, the reason why we typically have the 10 day SLA for submission is because there are, there is a lot of variability between what we are able to do from an automation standpoint with the payers. There’s some payers, where it’s a very quick and easy process where they might have a portal. And then we have medallion platform mapped to that portal. And we are able to capture that data, use robotic process automation to fill out that payor portal within, you know, real time. But then there’s the other end of the spectrum where you might have like a New York medicaid or a situation where what is required is a paper application gets mailed to a provider. You need to have a notary involved and get that signed off. And so we account for both ends of that spectrum… now. Is, is there… like,
Josh Brunell (28:50) I’m trying to the word I’m looking for? Is there a, an… internal SLA that your team has in place that where you’re seeing much faster than that 10 day average… because that is that’s our, that’s not our at or sorry, 10 day SLA that’s not necessarily our average. Our average is just under three days, I believe. And so like we’re getting them out the door faster. I think it’s just more from a protection standpoint for that more manual workflow if it’s needed.
Roxanne Williams (29:23) And then… on the SLA for the 75 days, is that at a provider level that the SLA or it’s at an enrollment level. So let’s say you enroll a provider and 15 payers and three of those payers go beyond the 75 days? Is that when there’s not a fee, is it the fees based on the individual enrollment or for a provider as a whole?
Josh Brunell (29:56) No. So it’s broken out and I’ll have to, I can pull up, our SLA maybe at the end of this call and we can review it in detail like what the actual language the legal language is, but it’s essentially, it, it’s taking account for the number of misses that we have. So anytime we miss that SLA, like when it’s above that, then, yeah, you don’t pay for that unit of work. And then if there’s chronic misses over a 12 month period, then that is when you have the ability to walk away from the contract. I’ll have to look at the specifics on like to… your related to your question. So is your question saying, I guess.
Roxanne Williams (30:42) what I’m asking is the, are you considering that like one provider, 15 enrollments? So they each have that like 75 day target or are we saying one provider on average is completed before 75?
Josh Brunell (31:00) Days? It’s on a per enrollment?
Roxanne Williams (31:04) Okay. Yeah. Okay. Perfect. Okay.
Roxanne Williams (31:19) I don’t have any additional questions on this part, John, do you? Nope? Excuse me? I’m good. Okay.
Josh Brunell (31:29) All right. So this is just a just really quickly a refresh just because I know it’s been a while of like we were talking about overall business value. Like this was what we had shown and we took some of the inputs. And so some of these numbers modeled out differently, which we’re going to walk through here. The really thing that drove them was previously, we had, I think a 30 day time band in for how long it was taking to take and process provider data before application submission, and that was revised to 10 days as far as the current state goes. And then the other point being that instead of the 40 providers that we were talking about adding annually, we cut that number in half by about 50 percent to put a more conservative estimate out there as far as new providers being brought on. So we changed.
Roxanne Williams (32:19) The SLA time, I mean the turnaround time as well?
John Pearl (32:25) Since I.
Roxanne Williams (32:27) mean the 54 days? Yep.
Josh Brunell (32:30) Yep. Sorry, not highlighted. But, yeah.
Josh Brunell (32:36) Sweet. And then, so as far as the analysis goes like the biggest thing that’s being impacted or I would say, the two numbers here are the revenue acceleration piece. So previously above 5,000,000 goes to two point two, right? Because we’re only targeting 20 providers instead of the 40. And then we also were looking at the impact from like a time standpoint. So this is coming out to us a 6,000,000 dollar cumulative benefit per year. And yeah, once again, I call those out here. Any questions on how we get to this number?
Josh Brunell (33:20) And I also have the updated pricing proposal with the 20 providers and that more conservative growth to walk through after this as well?
John Pearl (33:45) Yeah, I think that this is helpful to see.
John Pearl (33:53) That… so 30,000 a day is assuming 20 providers. So that’s what’s… the daily revenue per provider you used… that’s like 1,500 or something?
Josh Brunell (34:13) Yeah, yeah. Okay.
John Pearl (34:15) Sorry, my mental.
Josh Brunell (34:17) No, no, it is 1,500. I should have called that out on here. I think on the previous one, I had that. Sorry.
John Pearl (34:24) No, no, all good. Okay. And then, yeah, sorry on that. Like more conservative approach. Definitely… appreciate that view. Yeah.
Josh Brunell (34:39) I could just dive straight into that. So this was the previous quote that we were looking at with years, this is year one, year two and year three. And like the difference being that the quantities jump by 40 as far as the different product skews here. So we were looking at like about 220 and then 200 K and 210. On the initial quote, we took that and we put together same products but with more conservative growth on the provider side. And because you’re only adding 20 new providers, that obviously reduces the number of new enrollments as well. So bringing it from 220 to 175 annually in year one. And then after year one, this one time implementation cost goes away. That’s what we were talking about earlier that for data migration, initial setup and go live following that, it actually tapers off to closer to about 151 and then 157. And so this is obviously less than the 220 to 200 K range. It’s a more conservative modeled out as far as the growth. But one thing that me and Nicole made sure to do is we went to our finance and leadership team and were able to still secure the same level of per unit discounted pricing as if you were to commit to us with higher volumes. So you still get the benefit of that if you were to move forward with this.
John Pearl (36:19) Yeah. I think seeing them both is helpful. I don’t know if I pass this on. So apologies if I didn’t the reason I asked for the conservative view was like more of like a what if like we don’t grow at the rate we anticipate. So I think having that view is so helpful. But yeah… the goal is to continue to grow. So obviously it gets worked out on the per unit basis. So, okay.
Josh Brunell (36:45) Totally. I actually also added one other thing on here. I know this is a future state goal is to get established delegated credentialing agreements with your payers.
Josh Brunell (36:58) So I added the products as well on a third kind of proposal… which I have here that I could walk through real quickly and so just so you could have that price if you’re comfortable moving forward with it now. Great. But I know that was something that was a future state initiative. Roxanne. So I have both available for you. This wanted to kind of walk through what these components are and similar like to how we have the other contract broken out. We have four kind of different skews that you would want to move forward with as you’re getting set up. Of course, we have a one… time cost that’s essentially the consulting work to help set up the policies and procedures to secure delegation, making sure that you’re all prepped for any sort of payer audits as well. And then on the, once you do move forward, you’ll want to get all your providers across the organization credentialed. I just put into four, say you secure four delegated agreements and I was looking at your payer list. I saw four kind of national level payers that I think could be good targets. So I penciled that in there. And then you’ll want to change the monitoring from our standard kind of license expiration monitoring to ncqa compliant monitoring as well. So that not only takes into account any sort of like expirations on the license side, but it also is consistently running checks against some of the psvs that we’ll be performing as part of the credentialing process. So those are the additions there. Once again just wanted to add them. So you have visibility into that what the pricing would look like. I know it might not be phase one scope, but did want to include that. Okay? Can.
Roxanne Williams (38:57) you provide, I think you mentioned you could, but like for our payer list, I’d like to know what your actual turnaround times are for those payers. Yeah, yeah, that would be helpful. And if you currently are submitting for any of those hospital systems that we participate particularly in Michigan and Illinois. So the ones that are marked as phos on that list, I’d like to know if that’s a current payer relationship that you have or, you know, have a client, that you’re submitting that type of agreement with. Yeah.
Hassan Zahir (39:42) We’re likely submitting for everyone in Michigan. Roxanne. The reason being is that we are the credentialing partner for the mpca. So the Michigan primary care association. So we have a whole host of smaller organizations who are a part of the mpca who are submitting enrollments for and we’re doing credentialing for. So the answer is likely to be just kind of a blanket yes, but I’ll try to see if we can get to like what level, but I can give you that confidence in sharing that we do support enrollment and credentialing for mpca today.
Roxanne Williams (40:15) Okay. That’s helpful. But yeah, the, if I could get the actual average turnaround times for our pay or listing, that would be really helpful.
Josh Brunell (40:24) Yep. We’ll we’ll work, on getting that over. And then… I guess like, can you help us understand from here? Once we, you know, obviously figure out, hey, structurally what proposal makes the most sense and then align on overall price like, what else would you want to partner on together before we obviously bring this to the broader org and start talking and planning maybe for next steps around like implementation and things of that nature. Is there any other things that we could help support you with or provide as far as the business case goes?
Roxanne Williams (41:00) Do you, I don’t think you’ve provided a referral listing yet, have you?
Josh Brunell (41:07) No, we did not, but happy to, yeah, happy to put in the referral request internally and get you connected. I, I’m assuming this, but let me know. You probably obviously want to talk to someone that’s similar model as yours similar size, multi state doing direct enrollments today. Do you want to also talk to someone that’s gone through the experience of… getting delegated credentialing agreements set up? Is that an important piece for you or not? I don’t.
Roxanne Williams (41:39) think at the moment. I think that part’s that’ll be, would be phase two for us. So I think that’s fine. Okay. And maybe I’m looking at this wrong, but I guess should the, and I’m not trying to stick on the 75 days versus 55 days, but shouldn’t the model be… tailored towards the SLA as far as like what the outcome or the cost savings truly would be if that’s what the guarantee is not based on the 55 day average?
Josh Brunell (42:17) I can, I could update the bva to that absolutely or.
Roxanne Williams (42:21) Just, I mean, tell me if I’m looking at John, maybe jump in and get your thoughts, but I just if that’s what the guarantee is.
Josh Brunell (42:29) Yeah, that’s I mean, go ahead, John, let me know, your thoughts before I’ll yeah.
John Pearl (42:35) I mean, if I’m understanding it correctly, you’re… saying like we would expect 55 days, but, to build that buffer in for what medallion can’t control guarantee is 75 for what TWH pays for. So like maybe it’s a range of like somewhere in that if it’s 55 days or 75 days here’s. What that acceleration looks like from an outcomes basis. But I’m guessing the reason you use the 55 is because it’s.
Josh Brunell (43:08) the most likely, yeah. Yeah. OK. Yeah. But I mean, if you want me to build the business case and like the revenue acceleration metrics based off of 75, that’s still 45 day increase. I’m happy to put that forward. Yeah, yeah.
Roxanne Williams (43:25) And I think that would be a good idea.
Josh Brunell (43:27) Yeah. I’ll go ahead and do that. I think regardless like moving… forward with the 75 day SLA, do you still think that’s like in Roxanne, a good… enough improvement to the current state today to feel good about moving forward with the partnership, I mean.
Roxanne Williams (43:48) I think it’s a good improvement. I think, the other issue too is basically, so we don’t have a firm enough system to know that our true turnaround is 120 days, right? So that’s an estimate that we’re using based on a lot of what I’ve seen recently, but there’s not like true documentation that it is 100 percent, 120 days. On average. Our system just isn’t set up that way. So I just want it to be. So, I think, yes, there’s a huge going to be a big improvement and if we could get down to that time frame, even 75 days, I think it’s a good improvement… but I just want it to be more realistic than overshooting or over like stating what the actual impact will be? Because I know our CFO is very.
Roxanne Williams (44:50) Concerned about like what the true impact is going to be versus, are we just moving revenue up a little bit? Especially because our providers mostly are new providers and a lot of this might not impact a good bulk of our providers because, and I think maybe that’s why we are modified it and reduced the number that we’re going to estimate that are coming on. But a lot of our new providers there’s a hard set start date based on their, when they graduate, right? So regardless if we, if turnaround time, you know, is 75 days or 100 days or whatever that there’s that set time that they’re going to start and we can build their start date around. So I just want to make sure we’re conservative with what we’re actually saying. The impact of this will be yeah.
Nicole Campbell (45:44) And I actually think we can write in the range but we’ll update the calculation. So we’re being most conservative. But hopefully actually the STC SLA will give your CFO like the most confidence since if he’s concerned about the outcomes, there’s now like an actual contractual guarantee built in. And then maybe that range can be like, hey here’s best case scenario. And most likely, but no matter what you’re still going to see a benefit is kind of the way we’re framing it and committing back to him.
Josh Brunell (46:16) Yeah… that, that’s helpful though. I will, I’ll go back, and make those revisions. And then after I get this over, it’d be, and I gather, the and send back, the payer per… payer kind of turnaround times. What would be a good next step would be reviewing this again kind of like a finalized version before we get it in front of your CFO. Or, I guess, you know, typically what we would want to do obviously is like make sure that we’re aligned there. And then we would recommend like, yeah, an executive intro at some point but kind of want to get your feedback there on what makes the most sense.
Roxanne Williams (47:05) John, I’ll let you. Yeah.
John Pearl (47:07) I think… so. I think we need to probably huddle as a group internally to kind of think about next steps we want to move fast, but we also want to make sure we’re doing our due diligence as you can expect. So all of that is to say, I think like Roxanne Tom and I will be regrouping this week and then we can follow up in terms of like what next steps look like. I think like one thing like we have our own like internal model of like what Roi looks like. And to Roxanne’s point, like we want to go super conservative because like we’re the ones pitching this idea for TWH and want to make sure that like if we sign up for it, that we actually hit these numbers. And like, I guess I’m curious from this group’s perspective, like you… flash a number like 10,000,000 up in front of a client like that’s obviously a pretty extraordinary number. So like for what it’s worth, we’ve built in like what’s the margin that we retain on this? What’s cost of capital that we can actually accelerate here. What does a ramp up look like of a new provider starts? They’re not at a full book of business day one. After credentialing, all of that is to say our model… is a bit lower and maybe a next step could be, we could show you what our model looks like and then bounce those ideas off of you all and see if we’re not thinking about it the right way. If there’s something we’re missing. But all of that is to say, I guess we probably need to debrief internally and then… yeah, I have.
Josh Brunell (49:00) A couple of things that I would also so to Roxanne’s point like happy to connect you with a customer to talk through and validate some of these outcomes. Secondarily we work through with a number of organizations where during the evaluation process, we’ve actually worked with other… PE firms who have actually stepped in and done a similar kind of modeling out to ensure like get involved in kind of the Roi discussions. And so honestly, I have one customer… in mind that I’d be happy to connect you with John on the PE side and then also on the customer side as well like talking about the overall experience with us that’s gone through the process of implementation, gone live, seeing the outcomes. So like kind of both of those options we can be happy to facilitate.
John Pearl (49:58) Yeah, that would be great.
Josh Brunell (50:00) Yeah. And I don’t know how… I’ll kind of get a couple of options for you guys and I’ll put those requests in internally just to get availability. And then, yeah, happy to coordinate those calls. I’ll simply just introduce you via email once I get the approval from them and then kind of leave it up to you to schedule and coordinate and have a candid discussion.
Roxanne Williams (50:24) Okay. Yeah.
John Pearl (50:26) Definitely appreciate that. That’d be helpful. And then on the, I think I saw a link to the msa on that deck. Is that something that like we could review in the meantime? Yeah.
Josh Brunell (50:37) We would actually, so I’m going to have my legal team actually put it on because that just takes you to our website kind of like boilerplate msa, you have the custom SLA put in there. So I’m having our legal team generate that, and then I’ll send you the contract via email. Okay? Sounds good. Yes. So.
John Pearl (50:58) Just from our side, like we need to reconnect internally and we are at TWH, we have like a pmo process to like submit these initiatives. So there is a little bit of like a timeline to get our ducks in a row submitted to the pmo and then have that reviewed and approved. So there is still probably a couple of weeks before like the green light, but all of that is to say like these conversations we can have in the meantime, msa review in the meantime is something that we want to continue doing because like I said, we want to move fast with the milestones… that we know we have to still account for like from the pmo side. Okay. Yeah.
Josh Brunell (51:45) And happy to move as fast or slow as you need us. But I wanted to make sure, yeah, we do this the right way and obviously get you all those, everything you need to make a sound decision. I in kind of like walking it back like as far as the timeline you had just shared would like targeting… whether it’s medallion or not. Other vendor say would like a may decision be like a good estimate end of may or do you think it would be longer than that? And I’m just kind of thinking about, yeah, obviously a lot of a big cohort of new hires that you’re bringing in towards summer, right? Roxanne. So I was just trying to think if you want to move faster than that, like we can absolutely support. I just mentally want to know how, you know, what the timeline looks like on your side. I.
Roxanne Williams (52:43) Would think may would be a good timeline. Yeah, I think that makes sense as far as like having a decision made. I know the graduates in or come on board at the end of August or like August, September, their start dates, they graduate at the end of June. So I think we can start 30 days prior to their graduation. So, yeah, if we had a decision by end of April first of may and then could on, I mean, could we start to on board in a month’s time frame?
Josh Brunell (53:20) Absolutely. Yeah. Okay. Yeah. Once we have a contract executed, it’s typically like a couple days to like get, you know, introduced to the team, a kickoff call scheduled. But if we have advanced notice of like, hey, we have a hard date that we’re looking to hit, then we could do some of that during the pre sales process. So, and I.
Roxanne Williams (53:47) think and just want to express this. So obviously the cost of this is important, but I, from my perspective, I want because this will impact teammates probably in order to move this forward, I just want to make sure like I truly understand the process that we truly understand the turnaround times and the improvement that it will make. So that, that’s why I’m digging into some of these process pieces because it’s critical that this is important especially if it’s going or critical that it’s successful if it’s going to impact teammates for.
Josh Brunell (54:27) Sure. Yeah, yeah, I completely understand that. And, and one thing… I think we already put this together but I’ll resend it just in case like clear understanding of roles and responsibilities up front.
Roxanne Williams (54:41) I’ll.
Josh Brunell (54:42) say this, like, we work with organizations that are closer to like the 1,000 providers range and are operating on an even leaner model with medallion where it’s only one one… fte, like real full time administrator. In this case, it would likely be Barbie and then in partnership with our team. And so, like if you’re thinking about like, you know, repurposing an individual on that team, like just know like that’s that, that’s a typical thing and a common benefit and use case that we see. So.
Roxanne Williams (55:17) Yeah, absolutely. Okay.
Josh Brunell (55:21) Awesome. I will get you the updated dac later today, and then I should have the contract by tomorrow morning from our legal team. I’m just waiting it’s in their queue. So I’ll send that over. I’ll get started on the process to line up a reference call. Can we shoot maybe if not next week? But, the following week potentially to regroup, it sounds like you wanted a couple of weeks, John, just to kind of discuss internally,
John Pearl (55:52) Yeah.
John Pearl (55:59) Roxanne. I’ll defer to you. I can move my calendar around probably a little more easily than you.
Roxanne Williams (56:05) Yeah, I think either thirteenth fourteenth or fifteenth is good. I’m out on the sixteenth and seventeenth. So, yeah, that, would that’d be fine.
Josh Brunell (56:21) Okay. Sorry… Nicole, what of those three days?
Josh Brunell (56:28) What would be best? Probably Monday morning or I, I’m I know, we have some travel planned that week. So, I’m just trying to think, you’re muted by the way?
Nicole Campbell (56:39) So, sorry. Let’s set something Monday. We’re probably traveling both of us. So either Monday morning before 10, josh, or we can do Tuesday like.
Roxanne Williams (56:51) Afternoon… let’s.
Josh Brunell (56:54) do Tuesday afternoon? Okay. Would let’s see 11?
Roxanne Williams (56:58) 30? I’m good. Any time after one 30 on one 30 Central Time, so.
Josh Brunell (57:06) Okay. Let’s do one 30 central? Okay. Awesome. I’ll send that over. Perfect. Thanks, josh. Yeah, thanks for the feedback today, Roxanne and John. Yeah, we’re really excited. We’ll we’ll get some of the information you requested over and I’ll have a recap, in the contract over by tomorrow, and then, yeah, we’ll reconnect on the fourteenth. I’ll reach out obviously before then regarding the reference call as well. Once we get that one. Okay?
John Pearl (57:38) Sounds great. Great. Appreciate it very much James. Thank you.
Josh Brunell (57:41) Have a good afternoon. Thanks. Take care.