Transcript
Naomi Denson (00:00) good afternoon. Good afternoon. How are you? Good. How are you? Good, good. I’m just gonna wait for Jack to join.
Naomi Denson (01:04) You look crazy. You don’t hello. Happy, almost Friday. Hello, everyone.
Andrew Principe (01:16) Morning. How are you guys?
Naomi Denson (01:17) Good. How are you? Good. Thank you.
Jack Schell (01:21) Morning, everybody or afternoon depending on where you are?
Naomi Denson (01:25) Good afternoon. It’s 11 o’clock.
Jack Schell (01:28) good, nice. How’s everybody doing?
Naomi Denson (01:34) Good, good doing.
Jack Schell (01:36) Well, cool. Yeah, apologies over here. I’ve been battling allergies the past like week. So if I sniffle or sound off, I just am getting ahead of that. I need to apologize. No worries. Yeah.
Jack Schell (01:57) Andy and Melissa. I know that I sent you a note earlier this week and thank you both just for ensuring to make the time to meet today so that we could chat.
Jack Schell (02:05) Yeah, I definitely just also to reintroduce myself. I know we met a couple maybe two months ago, but my name is Jack Shaw. I’m senior account manager aligned to Louisiana primary and obviously they’re in implementation right now. Naomi is your implementation manager, ensuring that everything’s going smoothly on that front. And then Jacqueline is the dedicated engagement manager. So ideally, once you know, Louisiana primary is live, Jacqueline is going to be that operational subject matter expert. And, you know, you’ll have me and her as your dedicated account strategists from the medallion side, but, you know, we were talking internally and I do understand also Andy, from your note that there’s just some challenges internally in getting things organized particularly on the credentialing front. Yep. So I’m hoping that we can talk about a couple of things today. One would love to just get the details from you internally of just the challenges that you’re facing so that we can have some context to that and what it is that you’re navigating just so that we can make our team aware who you.
Andrew Principe (03:13) Know our.
Jack Schell (03:13) Leadership of course now is curious just what the timeline’s looking like for golive for them. And then second given the services that they purchase, want to talk about potential paths forward… depending on what, you know, you share in terms of what the challenges are and see if there’s any reasonable path forward with some of the services essentially. Yeah. So first, if we could just start with, you know, we’d love to get your update on what challenges are being faced internally right now.
Andrew Principe (03:44) So new executive director came on in July. The old executive director was involved up through the contracting process and absolutely 100 percent in support of working with y’all that’s not the issue… very different work style, created some chaos that really kind of came to a head in December and is forcing, you know, I want to be diplomatic, you know, but I’ll say forcing essentially a bit of a fissure between the primary care association who I believe executed the contract although I don’t know and the aco which are separate entities. But there was a management agreement in place at the time that has almost completely consumed my time because now I’m reporting to two boards trying to figure out what this transition looks like. And it’s been very difficult to get more day to day things to rise to the level of importance that they need to rise. We just finally were able to convince Yvette that the formation, the ratification of policies and procedures and the formation of the clinical credentialing committee is a priority and I just, there’s no, there’s very little internal capacity to actually do those things and it’s all being sucked up by these other challenges. So I have a half hour with Yvette, the executive director right after this, and I will again, we want to clear those two milestones and hurdles. The second area that’s been impacted by that. And I do have, I think what I need is an updated sub license so that we can start.
Andrew Principe (05:30) So two of the health centers came back after the sub license that we created was approved with legal feedback that they said their attorneys would not move forward without. So we’ve redrafted the sub license agreement. It’s sitting in my inbox. I have three health centers including a fairly sizable one that want to jump on board as soon as possible. And I’m excited about at least two of them. I don’t know the third well, but at least two of them I know are very functional organizations. And so they’re going to be probably a lot easier for us to interact with. I know we have some challenges with the current ones and I figured we’d probably talk about that a bit today. And so that’s kind of where we’re at.
Jack Schell (06:16) Okay. All right. Definitely appreciate you taking us through that. It helps provide context and what you’re up against, yeah, with regard to the aco and the agreement between the association and the aco? Does that potentially affect like the number of health centers that would leverage medallion in any way or?
Andrew Principe (06:40) What’s the?
Jack Schell (06:42) Impact of that agreement on just like their operations, I.
Andrew Principe (06:46) Think that what we would probably do is re, execute an agreement beyond the three year period, but I don’t know that I, well, first of all, I need to find out because if the proposal is executed by the lpcaco LLC… I don’t see an issue at all, if it’s by the lpca five one C4, I think they’re four then we will eventually want, to Tran, to, you know, to transfer.
Andrew Principe (07:21) We can do a transfer if that’s something that you guys are open to. But definitely, as any subsequent agreement should be held by the LLC, not the five one, C3 or four, whatever, whichever it is. And I just don’t know the answer to that quick access to that.
Jack Schell (07:40) When we get through a couple of these topics, I can probably try to pull it up as we talk through updates of current health centers. Okay? So like organizationally operationally, we’re still going to forge ahead regardless of the status between the LLC, and the aco. Yeah.
Andrew Principe (07:59) Absolutely. Cool.
Jack Schell (08:01) Just wanted to. Yeah.
Andrew Principe (08:03) The only way the only way that this current we’ve we, I’ve covered in the entirety of the two ways or three ways that this impacts you folks, this transition. It’s the, why we haven’t been able to get the committee’s and the policies and procedures done, why we haven’t added anybody new to the contract. And then the third being that we may need to look at moving the contract. So, I’m not. Okay. Yeah, there’s nothing else that impacts this. It’s it’s still full systems go. The pcas wanted to make sure that other, you know, if somebody’s not in the network, they can still contract. We said absolutely because we want them in the network eventually or sorry, credential. So, so, yeah, we are full go that, that’s not the concern.
Jack Schell (08:43) Okay. Appreciate the clarity there. Just to ensure we’re all aligned as well. And obviously, Naomi from our side is closest to this. But so far with medallion, we have been working with three health centers two, two, a bit further along a third one on its way. And then you’re talking about three additional that you want that are going to be jumping on as soon as possible. Okay?
Andrew Principe (09:07) Yeah, great.
Jack Schell (09:09) Now, with regard to the services that are in contract for lpca, obviously, we’re talking about the holdup with getting a credentialing committee organized, at their level. But there are, also, there is also the opportunity to get started with payer enrollment, direct payer enrollments prior to, you know, the committee being formed and credentialing being stood up since we know that they weren’t doing any delegated agreements before, correct?
Andrew Principe (09:44) That’s correct. We have none.
Jack Schell (09:45) Right. So, you know, I believe Naomi shared with me that there is one health center that is actually already submitting payer enrollment requests, which is great to see. No, not through.
Naomi Denson (09:54) Us. I just know that, sorry, just with the email that Melissa sent me yesterday about the la blue, I know they are actively enrolling providers, but they’re not doing it through the lpca medallion instance, got it. They’ve invited their providers, but they haven’t actually started doing any work in medallion.
Jack Schell (10:15) Okay. Apologies for mispeaking and thank you.
Andrew Principe (10:18) For talking to me.
Naomi Denson (10:20) Priority.
Andrew Principe (10:21) priority. Okay.
Jack Schell (10:24) Well, ultimately, what I wanted to explore is we obviously want lpca to be able to start seeing the value at their health center level of medallion as soon as possible. Yeah. And so if you’re working on getting the committee set up, that can essentially be one work stream, we can still work toward getting the committee set up and working toward the delegated credentialing but, you know, the health centers, we can get them onto medallion as soon as possible. And I assume that the health centers individually have, are enrolling and doing that work and that’s work that we can take on for them once we get their information into the platform and get them trained on how to submit enrollment requests. And so I wonder if, you know, we kind of passively wait for updates from you on the committee on the credentialing side while we work to get the health centers up to speed and feeling comfortable with just the direct payer enrollment requests. So that doesn’t slow down because somebody has to be doing that at the health center level today. And so what if we kind of had two work streams and we focused on, okay, in these meetings, let’s get the health centers comfortable with the idea of submitting enrollments through medallion and forge ahead there while you work in the background to get the committee set up. And then once that’s ready, we revisit the credentialing set up. Okay? Would that help us? Do you agree that might help us get unstuck or maybe just get more folks in and ready and comfortable with medallion?
Andrew Principe (11:56) Yes, I think so. I will. Melissa, do you know offhand which CEO is priority?
Melissa Mendez (12:05) Tamara? Okay.
Andrew Principe (12:07) All right. I can follow up there. Baptist. Are they going to be able to do? I thought that what came back from you folks was that we know they’re not done with their piece, but will they be direct provider enrollment once they are, they?
Naomi Denson (12:29) Can, once we have data and their payer process scoping sheets back and, you know, get everything set up. And I know there was some talk about them potentially going through with credentialing with their own internal committee and needs. But reviewing their policies and procedures. I had some feedback to Melissa regarding that. It leans more towards the joint commission. And Melissa, the team is putting together that document of what the ncqa files obtained. They sent it to me in the draft version. I’m just waiting for it to be finalized before I send it over to you. So I do have that. Thank you. It should be ready. I just need to check on it if it’s ready now. Okay?
Melissa Mendez (13:08) Thank you. And I did explain to Baptiste the, you know, what falls under medallion’s scope and what remains health center responsibilities. And they were totally fine with it. They understand that they have to maintain those requirements that are not ncqa credentialing requirements that you’ll be taking on.
Naomi Denson (13:27) Perfect. So we do have a potential to go live with some credentialing at just one health center level, Jack that would then rerun to lpca later on. Yes. But that one’s the one that we initially started with. And then they got really quiet and then there was issues with their data. So we’re waiting on corrections for that. I don’t know if you’ve heard from them… yet, Melissa on data updates. I.
Melissa Mendez (13:54) met with Teresa yesterday actually, and I think she understood that the data import template is really important. She did kind of do the same thing and send me some data that she had received from her current vendor, but it’s not, you know, it’s inconsistent. It’s not in the format that we need. It. Some of the data is completely missing. So, I’m filling in their data import template with the information that I can, but got back to her and let her know which gaps are, you know, what the gaps are so that they could get that complete data. I’m meeting with them again on Monday, and she had said that she wanted to get the data import template to me at least the basics for the provider practice location and group profiles, at least get those shell records in there and start the caqh import. And they were going to send out that communication giving their providers a heads up about possibly getting an email from caqh so that medallion could access their data and do the import. So I’m expecting to get that to you very soon, but I am still waiting on it. Okay?
Jack Schell (15:13) Awesome. So we talked about priority baptist, and then the third one that we were there was a third one we were already working on, right?
Naomi Denson (15:21) Southwest Louisiana.
Jack Schell (15:23) Okay. Yeah. The primary health care center? Yep. Yeah. Okay. So essentially, what I’m getting at is that with those three, it would be great if, you know, with baptist, it sounds like we have a separate… which is kind of a separate exception right now where they are actually moving forward with credentialing. But with each of those three, since we’re still waiting on the credentialing at the lpca level or the committee at the lpca level, if we could get those three going on their pay enrollment requirements now, that would be great. And then as you have these other three that are coming in data import templates, super important, let’s make sure that we have all of their data and we get that to them early. And then we can get them trained and going on starting to submit requests for pay enrollment. And ultimately what I’m just getting at here is that there are services today, there’s pay enrollments happening today at the health centers that we are ready to start working. And so are there, I know that the agreements right now, Andy you said you’re working on, with some of those health centers to get them in?
Andrew Principe (16:30) Yeah.
Jack Schell (16:32) What’s the expectation with like how frequently we think these health centers can come on at this rate at this point?
Andrew Principe (16:39) My, so just to kind of give you maybe a little bit more nuance, I am so ready to be operating this business and not dealing with this business. And my thought has always been that once we got some people through and they were able to essentially attest to the fact that, you know, it works et cetera, that it’s gonna start to really roll pretty quickly. Okay? And so a couple of activities that I would say we will put on the table once I get these three sub license agreements out, that is the first step and something I have it on my list of things to do early next week when I have a nice big I’m flying to Europe so my clients can’t get to me the same way, which means I can focus. So I’m planning to try to get those out to those health centers on Sunday, Monday, three, four days from now, then the very next opportunity that we have to present to the full membership, which will probably be later this month. I had intended to re, canvass for additional health centers to now make the switch and come on board. So I’m just prognosticating, I don’t have good data here. But because I know the clearing backlog, I would imagine that I will be able to pick up, you know, three more by the summer mid summer. And then I want to prepare something at the annual conference they do in the fall to try to pick up a next big tranche of health centers. Does that make sense?
Jack Schell (18:33) Yeah, yeah, that does make sense. Okay. Then I think perhaps what makes sense is we should talk about the three that we’re actively working on right now? Yep, and quickly, just like status of, are they fully set up? If they are fully set up? You know, is there any reason that we’re not seeing requests come through? And maybe Naomi you have like the 10,000 foot view you can provide on the three of those. Is there anything that you’re waiting on? Obviously baptist we’ve already talked about but for primary and for Louisiana for priority and Louisiana primary the.
Naomi Denson (19:19) Things that I would be most concerned about like for payer enrollment, is that new version of the payer process scoping template, Melissa, just so that we can have a full view of their payers and their processes. The original one that we started with way back when was very minimal and didn’t really call for any detail about processes. And lately we’ve had some advancements and, you know, different kinds of customers coming on board that build certain ways. So we want to make sure that we understand like if they have any nuances or rules with certain provider types or billing by practice npis versus group npis that are in the profiles et cetera. So, I think we received one from southwest Louisiana, but if we could have them ramp that up to the new template so… that we could do a full review before they start doing any actual enrollments requests with us. But that’s the only thing that I see other than inviting providers and getting the profiles completed. Okay? So we do need southwest Louisiana to.
Jack Schell (20:29) fill.
Naomi Denson (20:30) in the new payor scoping, if we’re going to move forward with payor enrollment, I would feel more comfortable just because that update’s been recent. We’ve implemented new processes on reviewing these to really make sure that we are hitting the ground running correctly the first time and just have them take a look at the new template… especially where rosters are concerned. If they do any roster submissions that’s vital for us to know especially if we don’t already have those rosters and it’s something special that they do or can do, and then the billing piece, any notes on, you know, if there’s certain payers that they bill a certain way under a certain npi or primary et cetera. That’s all important detail that we’ve identified in the last couple of weeks that really makes a difference in success. Okay?
Jack Schell (21:28) And then for priority, is there anything outstanding for priority from?
Naomi Denson (21:34) An implementation perspective?
Jack Schell (21:36) They’re.
Naomi Denson (21:36) still working on the payor process scoping template, I haven’t received any version of that from them yet. Okay? And then they were going to be adding existing enrollments manually… don’t know if they’ve started that yet.
Jack Schell (21:49) They weren’t going to use the import template. No, I don’t believe no.
Naomi Denson (21:52) They were, Melissa had shown them how to manually enter them. They have the import template, but they are just going to manually put them in. I guess, I mean they can still send the import template if that’s what they want to do. But happy to do that. Can.
Melissa Mendez (22:10) I get clarification on the. So, yes, the medallion representative reached out to one of priority’s providers working… on an application for Louisiana blue, and I was confused about that because I know priority hasn’t submitted any payer data. I know they haven’t submitted any requests. Another thing I was confused about was why they reached out to the provider directly because I thought we had talked about tasks coming through and being assigned to the admins. And so I was confused about those two pieces, why the provider was reached out to directly and why they like where that request even came from. Because I know that priority hadn’t submitted it.
Naomi Denson (22:55) Yes. So, this comes up occasionally where the provider has two profiles in medallion. So they reached out to priority because she’s listed as the credentialing contact in… her priorities admin or priorities credentialing contact where the provider is listed as the contact person for additional needs that might be happening somewhere else in medallion? Okay?
Jack Schell (23:22) I see.
Naomi Denson (23:25) Does that make sense? Yeah.
Melissa Mendez (23:27) So this provider works at one of your other clients with one of your other clients?
Naomi Denson (23:33) Yes, it’s having work processed through another client.
Jack Schell (23:37) Okay. I.
Naomi Denson (23:38) See. Okay.
Melissa Mendez (23:40) That makes sense. Yeah.
Naomi Denson (23:42) It just said medallion, this happens a lot where customers in implementation are like, my provider got this and I haven’t even invited them yet. We haven’t even told them about medallion yet, but it’s because of work being done in another organization. It’s not really directly related to priority, got it as far as medallion is concerned.
Melissa Mendez (24:00) I see. Okay. Thanks for clearing that up.
Naomi Denson (24:08) Anything else that you wanted to add Jack?
Jack Schell (24:12) No, I just Andy to your point. I want to make sure that these three that we’re actively working on, are you guys hearing me now?
Andrew Principe (24:23) We were, it’s better again?
Jack Schell (24:25) Okay. I just want to make sure that we can create these three organizations as success stories, early success stories so that you have success with the other health centers and bringing them on. And then hopefully just like these two work streams, make sense, like, you know, we know that enrollments need to happen today. So let’s try to get folks into medallion and doing the enrollment side of the things while we work separately on the delegated credentialing side of the house. Yeah. And like appreciate the updates on like timeline. And when you’re speaking to lpca, I’m curious like moving forward, is there any opportunity to involve anybody from lpca directly in like strategic conversations about medallion?
Andrew Principe (25:12) This is part of the part of the problem that we’re facing is that… technically the person who would have done that and I guess still should until this separation occurs is at the pca. And I think we need to be clear so that the contract was signed with the aco, so that’s good. That’s a good thing. I would like Melissa for you and I to talk offline about getting Suzy involved in some of these conversations just if nothing else as a ramp up. I just don’t know that they, that, so Suzy’s at the pca, not the aco. So that presents a little bit of a challenge if these organizations are going to be separately managed. And there isn’t anybody at the pca currently that really holds that title aside, you know, or that role aside from the executive director, Yvette, who I’ll be meeting with in three minutes. So I think that it’s probably best let’s get Suzy, Melissa. We can talk about a plan for getting Suzy involved. She wants to learn about the program because so Suzy’s role for your folks’, understanding is to provide training, yeah, and technical assistance on health center operations of which credentialing falls into her category that’s all pca members, not necessarily just aco members. She wants to get ramped up on this because she knows it’s going to be important piece to understand. But again, not, I don’t think the strategic decision maker or thinker that would be Yvette. So if we get, if we get… if we get Susie involved in some of the day to day, I think then we just need to get Yvette to one of these conversations and maybe we extend it to an hour, sure.
Andrew Principe (27:01) And I can kind of, I can actually kind of write down a plan for what I want to try to accomplish this year, you know, going forward. And in addition to those two things, you know, Melissa, when I’m back, we, you know, we probably want to have a conversation with the credentialing lead. And whoever signed the contract from each health center just to make sure that we understand, what the barriers are. Phillip was surprised. He thought we were the barriers. Phillip is a baptist. He thought we were the barriers, it turns out they were the barriers. So Susie might have some techniques for how to work with these folks because she’s a known quantity with them more than we are. Yeah.
Jack Schell (27:48) Cool. So.
Andrew Principe (27:50) Yeah.
Jack Schell (27:51) That’d be helpful because obviously we want to support you in supporting them and, you know.
Andrew Principe (28:00) Happy.
Jack Schell (28:01) To continue to like strategize here in this room. But, yeah, if we can have somebody like Susie join a call and try to better understand what they need to feel confident using medallion at the various health center levels. Yeah. Then, you know, we want to support with that. Of course. Okay. I know we’re just about at time. I appreciate all the updates and the discussion. I know I kind of co opted your time, Naomi, and we talked a little bit about status, but Naomi and Melissa, I know you two meet regularly. If there’s anything you need to wrap up in this last minute, we have, I think we’re good. Yeah.
Naomi Denson (28:45) And I’ll send over that in cqa packet. Thank you as soon as she confirms that it’s ready. I did tap on her and be like, is this ready? So I’ll send it over to you as soon as she says, yes. Okay, sounds.
Jack Schell (28:58) Good. Thanks.
Naomi Denson (28:59) All right. Thanks, everybody.
Andrew Principe (29:00) All right. Thanks. All right.
Jack Schell (29:01) Thank you. I appreciate it. Thanks so much. Bye, bye, bye bye.