Transcript
Josh Brunell (00:00) hey, Michael. Hey.
Michael Santos (00:01) Josh. How are you?
Josh Brunell (00:04) Doing well. I took the day off yesterday and it was one of those days where you take off but you’re like doing you’re not doing fun things. We had to move back into our house. We had a flood situation a couple months back and we’ve been living in an airbnb since. So I took the day off yesterday. I’m very happy that I’m back home, but I’m like, I feel like now I’m behind on work and I have all these boxes still down.
Michael Santos (00:36) Yeah, I get that.
Josh Brunell (00:39) Looks like William’s joining now.
Michael Santos (00:41) Good.
Samantha Bouchard (00:53) I got back from Orlando Tuesday and we had the best weather and I’m so jealous that that’s like your daily life.
Michael Santos (01:05) It’s about, we probably have another episode in four to eight weeks and it’s going to get pretty gross, but we’ll manage, oh, it.
Samantha Bouchard (01:13) Was just life changing for this Boston girl which is now dreary and 45 degrees. So.
Michael Santos (01:21) 45 degrees and eight.
Samantha Bouchard (01:23) Steps sunshine changes everything.
Josh Brunell (01:25) You sound better. You you look like?
Samantha Bouchard (01:28) Yeah, like sunshine glow. Yeah, like vitamin D does wonders. Yeah.
Josh Brunell (01:35) Michael, Sam was very sick for like three weeks. Like she had this ongoing flu virus and like,
Samantha Bouchard (01:43) sinus infection?
Josh Brunell (01:44) Yeah. And so she?
Samantha Bouchard (01:46) Was she?
Josh Brunell (01:47) Was she was needing in need of some direct sunlight for sure? I’m glad.
Michael Santos (01:53) I’m glad you got to go down here.
Samantha Bouchard (01:55) It was lovely.
Michael Santos (01:57) Yeah. Well, William, I don’t know if you’re still connecting, but can you hear us?
Josh Brunell (02:06) Yes, I can hear you. Sorry. Bye bye. All good. Thanks for joining William. Nice to meet you and Michael. Thanks for putting the call together just for our context. Did you two have the opportunity to kind of debrief and get up to speed on the purpose of the call or should we kind of discuss that?
Michael Santos (02:26) In, in passing, I did talk to him a couple of weeks ago in the hallway, but just as a refresh William, I met josh or his team at a conference a couple of weeks ago out in.
Josh Brunell (02:38) Nevada and.
Michael Santos (02:39) they kind of work on credentialing and onboarding and so, you know, I know what our structure is and that we’ve got a rigid corporate structure. But what I really want to do is just explore and just understand the pain points that I know that you guys have in the different workflow issues.
Josh Brunell (02:55) And really?
Michael Santos (02:57) Just understand, you know, where we’re at and maybe where this group can add value. And again, we know there’s you know, 42,000 people I have to approve and something like this. So really just having an open mind and saying, what are my current problems? What’s fixable internally? What’s not going to be fixable internally within adventhealth and just really having an exploratory discussion. So, I’m aware of all the hoops that you have to jump through. So it’s really just let’s have a conversation and just understand what’s out there basically.
Josh Brunell (03:26) Okay.
William Sheeley (03:27) I do have a short amount of time. Is it, if we do the medallion platform demonstration and then I might have a better understanding of, you know?
Josh Brunell (03:35) Yeah, why don’t I start with just like a quick overview of what we do and then we can maybe discuss some of your like kind of after we go over that, you could just say, okay, great. Like, yeah, these three points are of interest to me and then we can dive into the demo. Does that work? Yeah. Okay. Cool. So you have a hard stop at the half hour mark. Is that fair to say yes? Because.
William Sheeley (03:58) I’m training someone and I haven’t had much time to train them today. So I need to pick up this afternoon and get with them with that, okay?
Josh Brunell (04:07) We could always schedule more time. Obviously, this is like we’re just kicking off conversation. So yeah, we’ll make sure to be efficient as possible so you can get out of here and prepare your training, let’s dive in. So, yeah, some of the things we heard and maybe even before we go into this, I’ll just kind of give you a brief overview of who medallion is as a company and then the different offerings that we have. But essentially, we started in 20 20 as a provider data management platform. And so we’re helping automate all the manual time consuming processes that takes from, you know, point of hire all the way through to a provider being billable. So initially that was, you know, license state licensure, we’ve then expanded to direct as well as… delegated payer enrollment, cbo, credentialing, even hospital privileging, so a number of different kind of back office functions things that I believe, you know, most provider onboarding teams like yours are probably responsible for to some degree collecting that provider data up front, making sure you have everything you need to ultimately submit whether that’s a payr enrollment application or a hospital application. So the real reason why I think Michael thought that hey, this might be a good opportunity is we typically impact organizations and teams like yours in three ways. One we’re of course, you know, providing better automation and a platform from a visibility standpoint. But we’re fundamentally driving down the time it takes and from an administrative point of view, for your teams to be working on this as well as helping to reduce the turnaround times to get providers in network billable faster. Obviously, that has an impact on revenue which I know Michael cares about on the finance side. And we help do this of course, like by allowing your team to scale through technology, opposed to having to continually to staff, you know, credit specialists, or payer enrollment specialists every couple of months as you guys are adding more and more clinics which it seems like are popping up every day. So that’s a little bit about what we do. I’ll briefly kind of talk about like the different products. But like essentially in the platform demo, what we would walk you through is like our portal if you will of where we’re collecting our database, if you will, where we’re collecting the provider data. We have a unique partnership with caqh. So we help get the data into medallion very quickly through that bi directional integration. You can link a provider’s profile directly in the system. We only need a caqh id, no username or password needed as well as. Their last name and SSN. And then that allows us to get usually about, you know, 80 90 percent of what we need to then submit the payer enrollment application. And then, so that way we’re actually starting ahead not having to send a welcome letter to a provider with, you know, 30 documents. We only might need, hey, updates on these pieces of information to then cut down that time it takes to get the apps out the door. And then we also offer a number of different automations to submit the apps, track the status of those as well. So different mechanisms. But I think overall, what would be helpful is if you can maybe help us understand more. So about like the overall process we heard from Michael like, hey, what’s the business impact at a high level? Like, yes, you’re growing, yes, you’re expanding into new states that adds complexity to it. Also. Like we understand there’s some bottlenecks that are happening with, I think the corporate credentialing team and some of the limitations between juggling between kind of two different groups. So I just wanted to understand like, hey, what are your key challenges and things that you would see value in automating? And then we could directionally kind of walk through the demo and cover those items. But I’ll let you maybe share a little bit about, you know, yourself, your role, and then we can go from there. Sorry.
William Sheeley (08:24) I’m not on camera, camera’s not really working. Tried. It didn’t work with zoom. Sorry about that.
Josh Brunell (08:30) It’s all good. It’s all good. No worries another time. Yeah.
William Sheeley (08:34) Exactly. But what I do, I am the provider onboarding manager for all of primary health division. So primary care plus centric care, PCN, laska, CV hospice what we do is from start to finish, once we get a provider candidate from recruitment, we start their credentialing journey and onboarding journey. One of the biggest things is we work out of MB staff, that is our credentialing system. If you’ve heard of it. Yep… everything, all the notes that you have in front of me right now that I’m reading it, basically, when we get the provider, we start their credentialing meaning, we do an initial application, which we call the provider onboarding checklist application. We send that out to them. They complete it. We make sure all the attestation doo… documents, all those are signed, donkey signed. And then also the application is filled out its entirety with the correct information. Once it’s done, they submit, we import it into MB staff into their profile. And then we start doing our automated… sections within their profile to make sure they have this information for the practice. They have this information for the facility that we’re going to put them into. They have this information, correct? Because all of this information that we put in there is being sent out to the payers for delegated process. And then once that POC has been completed on our side, we send it for managed care to approve, and that starts the government process, medicaid, medicare applications. And then one of the biggest things is malpractice. So there’s essentially three teams within managed care. Managed care is the big overall then you have the government risk management and then delegated. Do any of those words? Have you heard those things before? Yeah, I’m hoping so. Yeah.
Josh Brunell (10:22) Yeah.
William Sheeley (10:23) Perfect. So it’s all encompassing different departments. We are the go between the providers and the practices to manage care. And so how we automate everything is that we follow everything rules from government team. When we need to get applications submitted, risk management needs past 10 years of certificates of insurance to get their malpractice, so that they can request claims histories, get all the information we need for them, so they can give us an Advent health certificate of insurance and then delegate it once they receive that Coi, all of those documents, delegate. It then sends it out on what we call an act report. And that act report goes out to the payers and that starts about 60 to 90 day process or days to get active with all payers essentially because some payers get, are made active sooner than others maybe like within the first three weeks, but some payers take the full 60 to 90 days. Yeah.
Josh Brunell (11:23) Yeah. Sorry. I think maybe you’re about to answer the question on the delegate for the delegated team. So it sounds like you’re doing, are they doing both? Like are you submitting rosters essentially to that team or are they responsible for maintaining those rosters for those?
William Sheeley (11:42) They’re responsible for maintaining those rosters to make sure all the information on those rosters is sent out to the payers. So they know like, this provider needs open panels or this provider has, is going into a practice that already has a full patient load. So they need to be closed to new patients and so forth. So it’s just those little details and understanding, like and also their hours of operation. Like if a provider is working four days a week, they need to know when they’re working. So if they are open panels, they know, the payers know that we can send them to this provider because they’re open to new patients and they work on those, these certain days and so forth. So.
Josh Brunell (12:19) And all those teams are using mdstaff as well, right? All of them, yep. And when you are, so that’s great that you have a central platform to track all this across the teams. My question to you is like, what, where in the process do you feel is the biggest friction?
William Sheeley (12:39) Certificates of insurance, but also… it could… sorry, it could be… sorry, excuse me… what am I trying to say? It could be the certificates of insurance or the provider not responding? Those are biggest.
Josh Brunell (13:07) You kind of cut out there, but I think I heard certificate.
William Sheeley (13:13) Certificates of insurance and then delegated… also some applications. They’re like they answered a question wrong? Or they did this. So we try to review all applications that come through. So, yeah.
Josh Brunell (13:26) Yeah, question on that. So, yeah, and correct me if I’m wrong. So, your team is submitting some of the pay or enrollment applications, correct… directly through mdstaff.
William Sheeley (13:41) Yes, we upload medicaid, government enrollment applications and tricare.
Josh Brunell (13:46) Okay. And then the commercial plans are done by another team. Yeah.
William Sheeley (13:50) That’s the delegated team that sends out all the information for the provider to the commercials.
Josh Brunell (13:56) Okay. So maybe this question, I was going to say this might be more so something that they would care about. But one issue that we often hear for obviously organizations that are scaling and expanding clinics at the rate that you are, is that there’s obviously every commercial payer has kind of their own unique set of requirements of what they want when it comes to an application. Yeah, there’s a couple of things that we do a little differently in our process to help with that. And it leads to cleaner applications and less question asking after the fact or things getting bounced back. We have what we call payer process guides in our platform, 900 plus built out. So like, we know exactly what a clean application looks like for, you know, let’s just say you blue cross blue shield of Texas or, you know, whatever kind of commercial payer and whatever specific state, whatever the requirements are, we have them mapped in our platform. So we know exactly what a clean app looks like so that we actually don’t let you submit unless we have all that information up front or if there’s any errors that we spot within, our quality checks, we notify the team. One thing that I heard you also say is provider… collecting provider data or I guess follow up with the provider and getting them to get you the information they’re looking for. Yeah.
William Sheeley (15:21) We try to, yeah, we try to stress to them the importance of what we need from them, very early in the process because within the first month we want to get their POC application that pretty much starts off all the credentialing submit it and for send for approval unapproved within the first like three weeks. And then even if we can get in sooner, even better, but we just want to start everything. And also, we want to get their medicaid and track your applications completed within the first 45 days and submit it. And then their Coi, we want to get that pretty much within the first 30 to 45 days as well. But you’d be surprised how many providers do not have their past certificates of insurance or they tell us their provider, their company kept up with that. I was like that’s great. But you will need a copy of it. So that is another thing like, well, how do I get those? Like you’d? Have to go to your HR or the past company or, they say the company went out of business. I was like, well, was there somebody that was there now or anything like that? That kept records? Because usually when you leave a place, we give tail certificates and coverage of your past things so that they can leave with that and they can do with what they need. That is a big pain point right now because without that information, we can’t submit for their Coi for adventhealth. Because if we don’t have all their claims histories, then their premiums go up. Michael knows about this. So it’s one of those things. Yeah.
Josh Brunell (16:53) Do you find that when you’re onboarding a new provider, that a lot of the data you’re looking for is often… in caqh or they have like profiles that are somewhat up to date with their, it could be?
William Sheeley (17:09) But we do not personally keep up with caqh because we do not use that. So, is.
Josh Brunell (17:16) that done by another team. It’s.
William Sheeley (17:19) done by the provider themselves. If they want to have a caqh profile, they’re more than welcome to, but they have to maintain it because we do not have the bandwidth to maintain a caqh profile for them? Okay?
Josh Brunell (17:33) Well, I think that’s where, I think that’s where we should start then, Sam, and, yeah, and before we dive in… so it’s going to be a bit of a change of process. But, I can tell you this like the change management is well worth it for what we see as far as taking that ownership on from the provider. So instead of having them manage their caqh profile, we actually have the concept, of a profile and medallion. So they would get an invite and we’ll walk through what that onboarding process looks like and opposed to them having, you know, a laundry list of things that you need, they need to collect or update in caqh and then get to you. We, we can actually automate a lot of that process by bringing it over and then actually have medallion be kind of that single source of truth because we could write back to caqh and keep that updated on their behalf. So that saves both the provider a lot of time and your team typically a lot of time during the onboarding process as well. And so could walk through what that looks like. But overall timing you said ideally three weeks is like the or is kind of the ideal time frame of when you submit provider, what you’re looking for until ultimately everything is usually is collected and then sent to the appropriate team. Yeah.
William Sheeley (18:54) We would love that to happen within the first three, three weeks to a month because we want to try to get everything but maybe there’s some delay because when we get people from recruitment, maybe we get new grads that don’t have a state license yet or a Dea that’s a hard stop for us. We can’t go any further until they obtain that. Essentially. Yeah. So we always try to.
Josh Brunell (19:13) Essentially.
William Sheeley (19:14) Work within the time line of 90 to 120 days out for their start dates. So we have more than enough time to get everything. But if there’s delays on the provider side, the delays on the practice side because, they can’t get us a supervising because the supervising doesn’t want to supervise an app right now. So they have to find somebody there’s little details that it would take me a long time to go into everything. But it’s just those, yeah, those things. Yeah.
Josh Brunell (19:40) We could dive into those on another call. I mean, Sam, no, no, we just have about 10 minutes like we obviously won’t be able to get to the end to end demo of medallion, but I think just from the things that we just talked about, the provider onboarding experience, would love to kind of show you William about how we think about that a little differently than how you’re handling it today and how it could I think dramatically improve both the provider experience as well as just shortening that three weeks down significantly. So, let me just stop my share real quick and then, Sam, do you have any questions before, we dive in no?
Samantha Bouchard (20:18) I think we’re good. Let’s let’s get to it. Make the most of this 10 minutes. Awesome, William, Michael, please feel free to stop me if you have any questions, but, I will kind of dive in. So what you’re seeing here is our provider data management solution. So nothing too new, but a profile for every provider. We’re going to have all your group practice storage over here to the left. And then the primary thing which William has alluded to is that data collection is key so you can perform all of these downstream functions. And so we have AI and automation built into all of these downstream functions. But what we’ll highlight starting is just how do we get the data? How we simplified that process? So you would come here as an administrator, type in a few key pieces of information and invite that provider to the platform. From here, they are going to receive a welcome email which we can co brand with your information. We can modify this text, William, to really align with your timelines, your overall onboarding strategy that you have today. Once they get started, they’re going to be brought through a customized onboarding flow. And this is where we allow them to kickstart their profile with the caqh integration that josh mentioned. We have a couple other ways to get data obviously manually filling out. We want to avoid the fact that we can use OCR technology from their resume to extract data and put it in the right place in the profile kind of like turbotax, if you’ve ever used that with your W ii. And then our primary and most utilized integration would be the caqh profile. So, Michael, I know you’re a little bit removed from this. But the reason caqh is such a great data source to use is that it has to be attested to every 90 days. And for a lot of the commercial payers, if the data in caqh is outdated, it can cause an automatic rejection. And so it is something that does need to be regularly maintained. So it’s a great data source for us to pull from one of the differentiators with medallion is we don’t need their username and password, which I’m sure William knows can be hard to track. Down. And just like another piece of information, we only need their caqh id, their social and their last name, this id tends to be in all emails from caqh. It’s really easy for them to find. So with this information, we are able to link their caqh profile and pull in up to 80 percent of the data that is needed to perform. These downstream functions. So it’s 100 percent of the data that’s needed to do a ncqa credential file so that the items that are needed for your delegated agreements, and then 80 percent of the rest. As an administrator, you have the ability to fill in any pieces here. But ultimately, this is what the provider’s portal looks like. So they have access to their profile. All of their documents are stored here and ultimately, they can upload, they can take a picture of this, take a picture of their diploma. It’s going to automatically scan in any documents that are additionally needed. We make it as simple as possible for the provider to get through. And what we found with this technology is that we’re able to reduce what we see from like a 30 day timeline which William, it sounds like you’re dealing with today to on average two days to get all of this information from providers. So we have drastically reduced the document collection time through this process. I’ll pause here. And then we can talk about the caqh management piece because this is bi directional so we can pull information. We can also push information as well. But before we get there, Michael, William would love to hear your thoughts on what we just kind of went through and how this compares to your process today.
William Sheeley (24:37) So everything is done through medallion. You don’t have to send an email or is everything like you can send out communication through medallion? Essentially, right? And then they, you would send them the profile and they would upload all of their documentation.
Samantha Bouchard (24:51) Yep. Exactly. And if you had a specific task for them, William, you can generate a task that would appear in their task list which allows easier tracking for you and your team, but then also for the provider. But the other thing, is because of those payer guides and all of the requirements that we have built into our technology. We also have the capability to auto generate tasks that are required for the payers that you’re looking to enroll with as well.
William Sheeley (25:20) Okay. That’s my only thing. It’s the caqh is going to be a big thing. Because again, each, the reason we say we don’t do or keep up with the provider caqh is because all of our credentialing is done through mdstaff. So the caqh is basically if the provider wants to maintain that for moonlighting outside of adventhealth, anything that they want to do with that they are able to do. But for us personally, we have it in their profile, their caqh information if they have one, but it is up to them to do all that. So.
Josh Brunell (25:57) And we know it’s the reason why a lot of organizations do it that way is because like you said earlier, like you just don’t have the bandwidth like when you have hundreds or thousands of providers and you have to do quarterly attestations to make sure that the data is up to date. It’s a huge daunting task to keep up with. And so we help to automate a lot of that process. And so you can focus on providing like a really great like onboarding experience that’s quick efficient. And then also it gives you visibility in the process as well. But yeah, that was just like high level. How do we get medallion data into medallion? There’s still a lot to show around as you can see on the left things around credentialing, your providers, submitting, direct payer, enrollments, delegation… delegated… credentialing, privileging, and then ongoing monitoring of expiration, any sort of items that are expiring as well. So I’m sure some of that is similarly tracked in mdstaff. But it’s not really the tracking with medallion. That kind of makes us different. It’s the way that we automate the process. So we’d love to show you that if you have more time in the future.
William Sheeley (27:13) Yeah. I should… I’m probably going to be done with training here soon this person, but I’m also onboarding another person for my team on 420. So training will begin again and I’m cross training a lot of my other employees. So, sorry, Michael, I’m doing a lot of different things right now because we had a couple people leave off my team. So I’m just trying to rebuild the team and get it back up and running. So, and.
Michael Santos (27:36) I think, you know, we’ll continue the conversation at a time that makes sense for you also. But I also know right? Bringing a platform like this is really bucking to try to ruffle feathers. So, I think I really want to continue this but also dig deeper on the pain points even if it’s internal pain points between our adventhealth teams. Yeah, you know, we’ve existed for almost three years. So either they should have fixed it already. They need to fix it fast or we need to say there’s something better that’s going to make life faster, save us money. And I’m also thinking right, if I’m advertising, hey, I just opened up a new clinic and you walk in, we don’t accept blue cross yet because they’re still getting credentialed, you may have lost that patient forever because they’re just going to go somewhere else if they’ve got to find them. So there is money on the table on that. And if, you know, we have providers that are not fully credentialed and we’re turning away patients. So I’ll stay on with you guys for a little bit, but.
Josh Brunell (28:30) we’ll.
Michael Santos (28:30) find a time where we can also dig deeper and we can finish more of the demo as.
Josh Brunell (28:34) Well, perfect. Yeah, because.
William Sheeley (28:36) what I’ve seen is it’s medallion’s really cool. The automation is really nice because our mdstaff system that’s our housing of everything, all of our communication gathering documents, we get through emails, calls, text messages to the provider. But if everything can be automated through there to where like the provider can go in there and it’s themselves to like upload things instead of just through the one time application because after their application is submitted, they’re not allowed to touch mdstaff at all because that’s.
Josh Brunell (29:09) so, yeah, yeah, that would fundamentally change. And all emails that are made as well can also be tracked. Like we have a paper trail in the system. So like any notifications, any phone calls to payers, like all that’s tracked in the system. So you have like a system of record of when actions are being taken, not just a housing system where you’re copying and pasting info and docs into.
Josh Brunell (29:37) So, yeah, okay. Perfect. Awesome. Thank you. William. I appreciate your time. It was nice meeting you. It was great meeting you. Thank you. We’ll talk again soon when you have more bandwidth. Yeah.
William Sheeley (29:47) So, sorry about that, but thank you so much.
Josh Brunell (29:50) Thanks for being, William. Bye, good to meet you too. Yeah. So I know we didn’t get into a lot of it Michael the other areas of the platform, but just from my initial two cents, like I think getting… connected to the delegated team, I don’t know if that’s going to be after our next meeting with William or prior, but I think they would be the ones that would. It sounds like William, there’s some things we could obviously help with his team, but on the delegated side in particular, like that is typically where we help both reduce the time like when it comes to commercial enrollments, like reduce the amount of time it takes for their data collection process and getting apps through the process faster. But I just kind of want to get your two cents of what we covered and see if it makes sense to you conceptually.
Michael Santos (30:44) it’s making sense to me but also being someone that does not gather the physician data and solve that. So, I knew that was happening but I’ve never seen the detail behind it. So it’s you could show me anything and I’ll be like that’s. Cool, right?
Josh Brunell (30:58) Yeah, but.
Michael Santos (30:59) I will say is, yeah, I think, you know, we’ll find time over the next few weeks that will work with William where we can continue the demo. What I will say though is once it gets out of… beyond William and I and there’s probably a couple other people I could bring where it would be friendly.
Michael Santos (31:20) It’s going to become very territorial and political. And, I purposely know that and that’s why I was phrasing the things that I know there’s different people involved, but that’s what I’m trying to do because I know there’s restraints. I know there’s workflow issues we’ve been, you know, a 304 100 provider group for almost three years now. And the other, some of the other teams are from the corporate office. And so it will be a very big thing to say, hey, we think we should do something different. And so that’s why, you know, I would, there probably be a few more meetings in between if other stakeholders are going to say this isn’t to produce enough value 100 percent. So, yeah, I don’t know. It’s just I gotta loop in the right people in the right order and get buy in from local executives before we go to corporate people and say, hey, we want to use a totally different program but we will become really large and I need it to work. And so I’m willing to step out of my Lane, but I gotta just tread carefully and get the right people involved. Yeah.
Josh Brunell (32:27) 100 percent. And I think I’ve me and Sam have worked on a number of… customer evaluations before where, hey, we need to build up a business case prior to us presenting that to the corporate team. And so like, I would love to do that maybe. And we, and if we need to meet with a couple folks happy to do that, but I think we have already a lot of good info based off of what William had shared. A couple questions. I had, it sounds like. So he’s having capacity constraints. You guys are higher trying to hire and staff up for his team or his back filling of some sort. He.
Michael Santos (33:08) Has three direct reports and two happened to have left. One was because she, they had a sick parent, they moved to Georgia. And the other I think found a different role in the org. So he’s replacing two thirds of his direct report. So he’s in a bit of a crunch. They’ve been there for a couple years, so they’ve been pretty stable. So I think he’s just trying to get them up to speed so they can help with current workflows. So that’s not normal. Though that’s the first time that’s happened. So. Okay. So.
Josh Brunell (33:37) He’s got, so there’s like four total on the provide on his team. I.
Michael Santos (33:42) Think so. Yeah, because then like there’s the, that’s the true onboarding off boarding team that’s kind of within our division. And then in that same group, there’s a different sub team that’s the true like physician recruitment and on like they do orientations, but that’s they don’t do this stuff. Okay?
Josh Brunell (34:01) That’s helpful. Yeah. On the caqh side, I know you’re a bit removed, but we often see that organizations will manage that on behalf of the providers because of some of the downstream impacts that Sam had mentioned. And so like I think that in itself when you think about the amount of time the provider spends probably updating that and then having the delegated team then having to go and… you know, make sure that they are updating their profile or I’m sure they may even be going into the profile of William’s teams not because it is a requirement for some payers. So like I’d be curious to learn more about that. But overall, yeah, taking the process on William’s side from, you know, three to four weeks down to just two or three days. That would be our impact. And then also honestly probably helping him to where if you run into this staffing constraint again, like he would probably be able to manage just with one one team member opposed to having to continue, to grow that team. So yeah, that’s the cost saving elements of it too. So.
Michael Santos (35:14) Just for a historical context, so you can think about it from my lens, is this adventhealth primary care network, right? We were, we became official one 124. But a lot of these clinics, they existed under different adventhealth medical groups, different tax cities that weren’t managed by us. They were just in a big group. So, right? It’s an exclusively primary care medical group. And generally primary care tends to lose money. Specialty is where the money is at. Well, we’re being challenged in our primary care group to go from a multi 1,000,000 like 50,000,000 plus annual loss to break even slash positive in three years.
Michael Santos (35:50) So everything that we think we knew we’re doing differently and some of the, some of that loss is okay. We’re gonna get into value based care contracting, yada, there’s new upside revenue opportunities on that. But some of it is also, you know, look at my cost structure. I’m right? I’m also at the same time as I’m reducing my loss, I’m rapidly expanding my footprint and that’s also one of our directives while still also reducing my annual loss significantly each year by millions. So when I think about when I build new locations, I build new providers, not only did I want their volume to go up as fast as possible, but they need to be profitable as soon as possible. And if we’re not credentialed on day one, which I think happens a lot, right? That’s a problem. Yeah.
Josh Brunell (36:37) Do you also find? So two things I heard yeah got to reduce costs to, you know, reduce that loss down to break even, and then accelerating profitability and revenue for your providers and new sites as they’re opening. Do you often find one of the mechanisms that may be also leading to… some issues is we see organizations run into claims denials and write offs due to errors or delays in the credentialing process. Do you find that it’s happening at your locations as well?
Michael Santos (37:12) Probably very likely… at some point, I might connect you with our rep cycle team once we can get further past this because they’re the ones that would see a lot of that. And I know they also have some pain points and some of them are internal pain points between our different teams. But that’s also my thing, right? Is okay. You’ve had two and a half years and you did not build your team up. And now you’re starting to build it up, but is it too little, too late? Kind of thing? I don’t know.
Josh Brunell (37:41) But,
Michael Santos (37:42) there’s been issues like that or, you know, the other team that handles the credentialing after William’s team touches it, they’re overwhelmed. Well, sure. But we’ve told you we’re going to add all these people a year ago. So it’s not that shouldn’t be that big of a surprise. So I think, yeah, I think let’s keep building as far as painting the problems and the different pain points. It’s more than just the data issues. I think it’s also, yeah… there’s the write offs and there’s certain teams that I think either they’re overwhelmed or stuff like that. So I’m only adding more providers and then there’s the transfers and the, you know, the off board. So we’ve really got to make the process better especially if I’m going to scale the way that we’re going to. And when we scale out to the other states, there are probably going to be different tax ids. So now it’s not William’s team works with like five business lines, but now it’s going to be okay. Well, now it’s it is a business line, but there’s a different legal entity, different group npi because we’re in a different state and they’re going to create a new company for that. So then it’s just increasing your complexity.
Josh Brunell (38:48) So, yeah… I hear you. Yeah, it’s a daunting task I think. Yeah. So the way I’m kind of thinking about this is like almost putting together like a one pager like an executive brief that helps to align your core objectives of what you just laid out with the outcomes that medallion can provide. So that like as you’re having internal discussions, you have something to share internally of how this aligns with your overall business goals. And then two, we could also lay out like not, you know, sometimes people don’t like seeing like, you know, hey, you’re bringing me into this meeting, forcing me to change a system or a process or a platform when you’re not in my department. And so one thing that I think could help ease that is we can provide you with some insight into why and how revcycle teams and leaders benefit from medallion versus just saying like, hey, we’re coming in and just start, you know, questioning everything they do. It’s like, hey, this is a platform that, you know, I learned a bit about. These are the impacts that they’re seeing with other revcycle leaders just want to get you on with them to see if like because I’m sure these things might be important to you like. And then that way it’s kind of making it more so like, you know, not calling their baby or whatever term you want to use. Cool. Well, thank you for the additional time here and insight. I will, I kind of want to put that kind of draft business case together to review it with you before we share it out. You want to share it out with different teams and start looping other folks in.
Josh Brunell (40:35) Does it make sense for us to get like 30 minutes on the calendar next week where we can reconnect and review that?
Michael Santos (40:42) Yeah, maybe Tuesday. Okay.
Josh Brunell (40:50) And then I may just send a couple of questions if you don’t know the answer to them because they’re outside your department, that’s okay. But if you have like a couple data, other data points that you could just validate or provide… ahead of time. I think it would be helpful. So Tuesday, yeah, we’re wide open between noon… or, yeah, noon and… two 30.
Michael Santos (41:21) You said noon to two 30 eastern?
Josh Brunell (41:24) Yep.
Michael Santos (41:25) Let me see. Let’s do one 30 to two on April seven. Tuesday. Perfect. And then it can just be the three of us and then we can develop that document and then we can check in with William in another few days on how his training volume is doing, and then we can convene… at some point later. Okay. Perfect.
Josh Brunell (41:52) I’m sending that out now. Thank you… for the time, Michael. And thanks for the intro to William. Sounds like he’s got his hand full right now. So let’s work on this next week and then we’ll loop him back in when he’s got the time.
Michael Santos (42:07) Yeah, I think he has at least some initial interest which is good. If he didn’t that would be a bad sign.
Josh Brunell (42:14) Yeah, yeah, I would assume so because yeah, we’ve worked with a lot of customers using mdstaff and like it is really popular especially amongst like larger health systems just because it kind of allows like a lot of different teams to do a lot of different ways of tracking, but the automation isn’t really great and getting the data in and as well as just like submitted out. So that’s where it struggles. So, yeah.
Michael Santos (42:40) And now that, you know, it’s mdstaff which I have heard a bunch of times that I forgot. And then you start to learn the process that William was describing a little bit better. Then now, you could kind of paint a more detailed picture of, okay here, we know kind of what, how mdstaff works versus how your product works because that’s the selling point there is, right? What are we doing today versus what could we have? And how could it be better?
Josh Brunell (43:05) Yep. 100 percent. Yeah. So, and we do have… like very referenceable customers too, who’ve made the switch? And so if we get that far along in the process like happy to connect you or any leaders to those customers, I like it cool.
Michael Santos (43:22) All right. Thanks for your time. Really good to see you again and we will continue the conversation.
Josh Brunell (43:26) Awesome. We’ll talk next week. Thanks, Michael. Have.
Michael Santos (43:28) A good day, Michael all.
Josh Brunell (43:29) right. Bye.