Transcript
Vanessa Persha (00:00) hello?
Molly Dwyer (00:01) Hey,
Vanessa Persha (00:05) how are you?
Molly Dwyer (00:06) I’m good. How are you? Good?
Kbiscor (00:11) Here we go. Oh, my goodness.
Vanessa Persha (00:14) I’m going to open it up just seeing if they have any items they need to discuss. I don’t believe I have anything open for them, and then we’ll leave the rest of the time to talk about the payr stuff, unless you want me to do that first.
Molly Dwyer (00:30) No, I think that’s your, it’s your meeting and a,
Kbiscor (00:33) lot of the approach, okay?
Vanessa Persha (00:34) All right, perfect. I think I have Leslie in the waiting room. Did Carrie ever respond to you confirming if they had that meeting nope?
Kbiscor (00:49) I guess I’ll kind of, yeah, should.
Vanessa Persha (00:52) I should, I ask if they had the meeting to even decide if we should review the deck. I,
Molly Dwyer (00:59) think, I think we should ask that, but I think we should still review the deck. Like, we need to push this as much as possible. Like we can’t wait anymore. Okay?
Vanessa Persha (01:10) All right. I’m going to go ahead and let Leslie in. So far. She’s the only one in the waiting room. Sounds good?
Vanessa Persha (01:23) Hi, Leslie. Good afternoon.
Leslie Canale (01:27) Hello. I was so eager to meet with y’all, I was going to say, I.
Kbiscor (01:31) was.
Vanessa Persha (01:34) like, gosh, I hope she doesn’t have a whole bunch of stuff. She’s eager to get this call started.
Leslie Canale (01:38) No, no, actually, I have nothing, so, I’m eager, to maybe drop if possible. So, I’ll wait for, I see Carrie’s on. Yeah, I don’t have anything. Everything seems to be running smoothly. I asked the team as well. I appreciate, the urgency in getting Yancy and Catalina back into moving people to committee, cause that was an issue, but it seems to be resolved. We have a meeting today, and they’re currently moving files over as we speak, so, that is perfect. So yeah, I’m good. Okay?
Vanessa Persha (02:16) Great. Well, you should be expecting an email from me in the next couple of days with your latest monthly monitoring report. But other than that, you know, where to find me if you need me?
Leslie Canale (02:26) Thank you, Vanessa. Yeah.
Vanessa Persha (02:28) No problem. Thanks, Leslie. Hi, Carrie. Good afternoon.
Kbiscor (02:32) Hey, there. Good afternoon. How are you all?
Vanessa Persha (02:35) I’m doing great. How are you,
Kbiscor (02:38) I’m okay. I don’t see Stacey. I know Mandy is out. So Mandy has had a couple of emergencies come up. So, yeah, I don’t have a ton of info on the open enrollment work, but I did want to share that as far as, the new enrollment work, our contracting partners are still working on that, which is unfortunate for me because I really need that information.
Kbiscor (03:14) But I do have some information as far as where we won’t be headed at least for like our mco and government payers, right? Meaning in like in the next, at least three months because there is some PC ownership changes that are taking place. So at least that helps me to know where I’m kind of locked out of enrollment work from a government side, which means they’re going to want to push enrollment in other places because.
Leslie Canale (03:56) if.
Kbiscor (03:57) we can’t do it there, we need to do it somewhere, right? So, I at least know, you know, that does give me some idea that we either have to focus in, on expansion, where we are and have the stability in terms of the ownership or… those existing contracts and moving our virtual providers into those. I suspect that… if I don’t have it this week, we have another call with executive leadership on Monday. They’re going to be looking for this. And at that point, if I have to say, I don’t have it yet, the heat will be on… the contracting partners to produce that. So, it will end up coming next week, one way or another. And really, that’s what, I, you know, I just need the list, which payers, the names of the payers, and I know what providers I have in what states and where they’re licensed. So once I have that, I, you know, I can start to move, but I at least wanted to let you know.
Vanessa Persha (05:20) Okay. No, I appreciate that. And I think that’s a good segue into, you know, the initial talking points that we have for your payer strategy review. I think, this will probably change some of my recommendations that I was originally thinking where we can start with your payer strategy, but we’ll go through those, just want to make sure. Can you all see my screen with the slide deck?
Kbiscor (05:45) Yes. Okay.
Vanessa Persha (05:46) Perfect.
Kbiscor (05:48) So,
Vanessa Persha (05:50) we’re gonna take a look at the top 10 payer request volume and then where I had kind of started figuring like where we could recommend payers to start with and align on which payers to assign to medallion, which again, like you just said may end up coming later. But I did exclude all of your par analysis lines which are, you know, they’re now in medallion and being worked. So your top 10 payers that you’ve requested so far looks like, you know, we have, and there’s not a lot of volume here. So, you know, it skews the data a little bit. But I do see a handful of medicare’s on here, medicaid’s, and so that was kind of where my initial thoughts were like where we have automation fully supported is medicare in all states. So that was basically my initial recommendation which it sounds like Carrie, maybe we hold off on for now. But then I was looking at some of our other major payers that are supported by automation that you don’t have requests for, but typically, they’re like the standard payers especially being in the behavioral health space where I think we could support your payer strategy, railroad medicare, unitedhealthcare, if you have any medical providers, you know, in the behavioral health space, and then tricare, east, we can do automation for MDS, dos, NPS, lcsws, and then evernorth, behavioral health.
Kbiscor (07:29) So, yeah.
Vanessa Persha (07:31) I don’t know if this is helpful to see or if you guys, do you have contracts with any of these payers today?
Kbiscor (07:40) We do so. So medicare, we are in, we’re… in almost every state, there’s a handful that we’re not in and… there’s no immediate path to get in those states. But, we are in almost every state. When when I see railroad, that might be a good one because there are more and more states where at least on the clinic side of the business, we have added… railroad. And once we get the medicare that’s… one that we… can more easily push over as long as we’ve set up the group, and done all of that stuff. It sounds like, we can move that uhc is delegated for us and we just moved to roster submission. So that one we’ve got tricare, we do have. And this one we don’t have a ton of MDS or NPS. And where we actually have the most challenge is with the lmfts and lpcs. And really, it’s more on the provider side because they have to produce the evidence of, the hours and all of that. But once we get that, I think they go well, no, they got to go through the certification piece first. So that actually might do you do the lpcs and the lmfts if.
Vanessa Persha (09:31) I’m not mistaken. Those provider types are on the roadmap for like in sequential order for the next batch of provider types. We’re looking to automate. Currently, it’s just these types here on my screen.
Kbiscor (09:45) Okay. Gotcha. Yeah, it is actually really a pain. I’m not talking about automation just in general, there’s just a lot that we struggle with the providers for whatever reason. Evernorth… we don’t have a ton… and that’s a cigna product. There is some work being done by contracting with cigna. But I did notice on, the graph and I know it’s hard because, it is low volume and it’s, it is definitely skewed just based on, what we sent over, where we were with some of the work. But I can tell you like kaiser north California, we are now delegated with. So we’re sending a roster, Molina is still one that we need to send individual apps for regions is definitely one and they are one of the harder payers to get, you know, full… circle pacific source. Same thing… you know, there’s definitely some payers that we could definitely add on here. I think… where I’m going in my head is I anticipate us having a lot of virtual provider enrollments. And the way that virtual is set up is we have them tied to a, it is a physical location. In some cases, it is the obc location, and in some states, it is not, it is a location, you know, that is set up for us to have because we need to have a physical presence in the state. Yes, I.
Vanessa Persha (12:04) Forgot what that’s referred to. It’s like a ref, I know what you’re talking about. Yeah.
Kbiscor (12:10) Yeah. So, but the good part is we don’t have, you know, five or six locations. It’s just one, it’s either the main obc one or one set up for this specific purpose. Okay? So in that case, if I understand correctly, we just, I don’t want to say, just quote unquote. We just need to go in and set up that location, and it’s just a one time, you know, we’re not setting up six locations. It’s one tin one npi, one street address, phone number, po, box billing address, and then we can send the request for those payers. Yeah.
Vanessa Persha (12:59) So, we would want to make sure you have a group profile for the tin, the group tin and npi, that single practice location listed and connected to that group in medallion. And then you can start like linking providers in medallion to that group and practice location. And then that will allow you to submit the requests for the payers. Okay?
Kbiscor (13:24) Okay.
Vanessa Persha (13:28) And you were saying that the effort there would be, is that for the Molina and the regents or were you thinking of another payer for those?
Kbiscor (13:38) That’s what I’m trying to get from contracting. Now, this population is spread out. So they are, it, the virtual network, is technically, it’s national, but… when I say that they’re not truly national yet, they are definitely segmented into very specific states. So they are not in every state. We are not in every state with virtual providers yet. The highest state right now is California. And I don’t know that there’s going to be a ton of contracts in California… but we do have providers licensed in, you know, Florida, Massachusetts, New York. So, fidelis… you know, will be a payer, right? So it, it’s going to be the same payers that we already have under obc, It’s going to be the same tin that we have under obc, it’s just going to be a different npi. Okay. So.
Vanessa Persha (15:04) Your in office providers will bill under one npi. Your virtual care providers will have a separate npi?
Kbiscor (15:11) Exactly.
Vanessa Persha (15:13) Okay. So I’m thinking what we would want to do is, the group for your in office providers, is that group already created in medallion?
Kbiscor (15:23) No, okay.
Vanessa Persha (15:26) I think for the sake of keeping it simple with the enrollments, we probably would want to create those as two separate groups in medallion. So we have one npi utilized for each group. And then you can affiliate all of your virtual providers to the one that’s meant for virtual care? And then, is, are these your able to providers by chance?
Kbiscor (15:55) Yes.
Vanessa Persha (15:55) Okay. So, is the intent here? Because I heard you saying like you’re national but not quite national.
Vanessa Persha (16:01) Is what contracting like, are they working towards essentially… consolidating all of these separate contracts with the payers into one national agreement? Or is the intent still to keep them separate agreements based on region?
Kbiscor (16:20) No, the latter, so they will still be separate agreements by region. Okay? Now, when they can get a national contract, right? That, that usually is preferred. Yeah. But I mean, Vanessa, they’ve got, I mean, they’ve got 150, some odd payers. Some of them are not at all national. They are very, you know, in state or regional, you know, Tri state type of payers that will never be, you know, national.
Vanessa Persha (16:53) Payers.
Kbiscor (16:54) So… yeah, they’re and they’re adding, you know, they’re adding payers, and then, you know, we have some payers that, you know, we’ve lost not because we’ve terminated the contract because the payer has dissolved. You know, I think there’s been a few recently. So, yeah, I, they’re not looking to, you know, collapse all of this, it’s more getting that footprint for, the virtual care formerly able to. Yep. Yeah.
Vanessa Persha (17:33) Okay. I’m curious if it would be worthwhile to do an exercise where, like if you had a master list of all of your contracts that are in place today, we could start like scoping the payers and looking like standardizing the names that we utilize in medallion and try to catch early enough. If you have any payers where you may be contracted, and we don’t have that payer in our payer directory or as part of our standard process, that way, we can start gathering the information that we may need to process your enrollments when that time comes. What are your thoughts there? Oh?
Kbiscor (18:17) Yeah. I could definitely send over, you know, our naming convention is right? It’s legacy. It’s what we put in the system years ago, and I’ll be honest, we, you know, we approached our contracting partners well over a year ago when they brought on a new emr system operations did, and said, hey, if you want us to change the naming conventions, we will do that so that our reporting can match up to your reporting. And, you know, as we’re going into, you know, a new credentialing system and, you know, the response was, well, it won’t help us. So we weren’t in a rush to do it. But I would like to eventually get there because I think it will make sense whether they see it right now or not eventually, it will, it’ll be more efficient if we’re all talking the same language?
Vanessa Persha (19:20) Yeah. So.
Kbiscor (19:22) Certainly, we can send that now. I just don’t know yet which ones, you know, will.
Vanessa Persha (19:30) Stay, but,
Kbiscor (19:31) I just don’t know what, because what they’re going to do there, in some cases, they might have to do an amendment to.
Vanessa Persha (19:39) Add the,
Kbiscor (19:40) npi to the existing contract.
Vanessa Persha (19:44) Right.
Kbiscor (19:46) They may say, you know, we don’t want to do it. Now, we want to wait and negotiate when.
Vanessa Persha (19:55) the contract, you know. So I.
Kbiscor (19:56) think that’s where I’m saying like, I can give you the list. I just can’t tell you for sure that.
Vanessa Persha (20:04) Half.
Kbiscor (20:05) of these payers are going to be ones that end up making the cut. Yeah, no.
Vanessa Persha (20:11) I understand. And I think we have a template where we do payer scoping that doesn’t get into like, you know, npi group affiliation, things like that. It’s just strictly like your payer names. The payer states that you’re in and then any lines of business that you have with that payer. So I think it may be worthwhile we can, I’ll pull a copy of that template out. I can share it with you just to see what data we’re looking for. And then I can start doing some payer mapping, try to match as best as I can do our existing payer names and then fill in the blanks from there. And then at the very least, once you know who’s go and no go, we already have your payer mapping done and there’s no need to do that once we’re ready to pull the trigger.
Kbiscor (21:00) Okay. Yeah, no, that sounds great.
Vanessa Persha (21:02) Okay, awesome. I can work on that. Molly. Did you have anything else… that you wanted to add here? Not?
Molly Dwyer (21:15) For the payer recommendations, I think Carrie and Leslie, we had a call a few weeks ago. Was it last week? Am I losing my mind last week or the week before? But just around like this as an interim solution, figuring out priority payers. And the larger priority is to move all of your enrollment data and really be using medallion as a source of truth so that we can expand the number of payers that we support you with. So just wanted to call out. I know that Derek is meeting with Pat again on this Friday to talk more about like the data migration initiative. And then I also have some time set up next week. But if there was anything on your end or any updates on your end, definitely want to understand them as well.
Kbiscor (22:05) Okay. Yep, absolutely. Yeah, I think right now that’s kind of where we sit is just waiting more, for our contracting partners on their… inputs… to figure out where we’re headed. We know we definitely know there… is a need to expand the medicaid footprint. The goal is to expand that into all states. But like I mentioned, we’re limited in some states right now. They’re just not set up with the they’re just not operational in those states. And then in other states, we know that there’s going to be a PC ownership change. So we’re not even going to pursue until, that is complete. But there are definitely some other states that as long as they have providers, we can start that work. And then what I’m also asking contracting for is what are the mco payers that they want in those states? Because that also falls into this bucket of work. So which is where we were earlier in the contract was, hey, we’re going to enroll all of these providers and they all need to be enrolled in medicare and medicaid. And we’re going to have all of these mco payers. And then that kind of shifted into a different scope. And there were lots of changes. And it sounds like now we’re headed right back to where we started. So I just really need them, to, put that to paper and finalize that. Yeah.
Molly Dwyer (24:06) I hear you. I think having like having a defined list is going to be, you know, obviously give us so much direction. I think the other like big piece though that we are missing that just like jog your memory is like the current blocker for or creating a lot of friction is just, the data piece. Like we don’t have a full view of the data from your previous enrollments and group and provider practice locations. So having that full picture will just make once these payers are prioritized, make everything go so much faster and just more streamlined for you.
Kbiscor (24:40) Absolutely. And that’s kind of where I’m going right now is okay, right? Do we, how much do we invest in the… current and some of it, you know, needs to be, so we can finish up what we have out there. Versus kind of like where I was headed with. Hey, with virtual it’s one state, one npi, one address, one, you know, billing address, phone number, fax number, and do we start setting those up now and kind of preparing for that? And, you know, does that make more sense than trying to boil the ocean with enrollment?
Molly Dwyer (25:29) We’re.
Kbiscor (25:30) going to need because that’s the other thing that I’m asking the business for is what is, their hiring plan? Where are they focusing? You know, their hiring efforts at the clinics because if they are not focusing hiring efforts in let’s say the northeast, you know, for whatever reason, maybe, you know, in the last year, they just have had really poor response, you know, with Rex and they’re saying, you know, what we’re gonna, you know, sit still, and invest our efforts elsewhere right? Then, you know, that’s not somewhere that I need to really worry about in terms of new enrollments. It’s somewhere else. And so I’m just so right now dependent on ops data. And I know Pat, you know, he has been helping too to try to push for, you know, finance to give information while I’m pushing contracting so, but I think heading down the virtual road, might be a good next step. Yeah.
Molly Dwyer (26:45) Totally agree. I think like our recommendation would be like let’s definitely pick away at things that we can accomplish in the short term and then a larger conversation which includes Pat, and Derek and Vanessa and myself to get this data over and get your priority payers. Once your team gets that to you like, that can be that can be worked on, you know, at the same time or concurrently? Yep.
Kbiscor (27:10) Absolutely. Yep. Now not to say though that the stuff that you already have, right? I want the team to figure out, okay, right? Go in there. If there’s four locations that we need to enter the data on, just let’s get in there and enter it and, you know, focus there, but don’t focus, you know, everywhere if that’s not what we need today.
Vanessa Persha (27:37) Yeah, absolutely. Just out of curiosity, can you remind me, Carrie, how many able to providers did you guys, do you guys have active right now?
Kbiscor (27:48) Right now, I think they just, they’re just under 200. Okay. Yeah.
Vanessa Persha (27:56) And then the other thing I wanted to call out, I heard you say there was some PC changes that are coming down the pike potentially that’ll be one thing as well. Like if we have any of that, any of those locations in medallion today, if there’s change of ownership information?
Kbiscor (28:12) We’ll.
Vanessa Persha (28:13) just need to make sure that those get updated in medallion. So if we have anything that’s in process or any new enrollments that come in after those changes that we’re submitting that accurately?
Kbiscor (28:26) Yep. Absolutely. I know.
Vanessa Persha (28:30) Sometimes the medicare and medicaid, it’s like as soon as you submit that change of ownership information, like any providers you had in process all of a sudden, like they stop. Yeah. Okay. Well, I think I have a pretty good idea of, you know, where we want to go next. I will get you that template for the payer scoping so we can at least start looking at some of that if we need to set up some time, so I can walk your team through how to create the group profiles, get the practice information in there. I’m happy to do that for those able to locations we were just talking about. And then, yeah, we’ll go from there.
Kbiscor (29:13) Okay, perfect. Awesome. All.
Vanessa Persha (29:15) Right. Anything else for Molly or myself? No?
Molly Dwyer (29:20) Thank you all so much. Excited to make some movement on this yep.
Kbiscor (29:24) Sounds good. All right.
Vanessa Persha (29:25) Thanks, everyone. Have a great day you.
Kbiscor (29:27) Too. Thank you. Bye bye.