Transcript
Scott Call (00:00) okay.
Scott Call (14:21) Did you say? I’m the fun one and you’re the stern one? Is that what you’re saying?
Mallory Smith (14:25) Yes, that’s what he said? Yeah, no… and.
Scott Call (14:29) that was before the recording started. So I can’t even defend it. I’m so sorry, ladies for being late, Neil. Thanks to Neil. He’s like, are you joining? I’m like I don’t have this meeting. I was off on my calendar somehow so well.
Fatima Nunes (14:44) We figured it was with the time zone difference. Maybe your calendar was an hour ahead or an hour behind or something. So we gave you all the benefits of the doubts.
Scott Call (14:54) I appreciate that. Thank you. And I hope you just continued without me while you’re waiting for me.
Fatima Nunes (15:01) Absolutely. Well, we were just bringing Neil up to speed on sort of the purpose of the call today. Scott. I know we spoke via email. Yes, I’ll go ahead. I’ll start, you know, we have a couple of slides put together, but really we want to validate the scope of work because there’s a couple of different services and a lot of back and forth especially from us asking questions of you. So appreciate both of you taking the time to answer those. And so we want to validate the math, the scope of work. And then we also have some slides around Roi and a business value assessment, what that could potentially look like with medallion. We made some assumptions around the data inputs there. So really we want to make sure that this session is super collaborative. It’s all of us working on this together because eventually, I know you’ll have to present this internally to Jonathan to Jim. So we want to make sure whatever you present if you were to move forward with medallion is airtight. And so really that’s the goal for today just to hopefully make your life easier in the next coming days.
Scott Call (15:59) That’s great. And appreciate you being careful and we want to get it right? Like we talked about this morning. So, yes.
Fatima Nunes (16:07) Perfect. Okay. So I just went ahead. I started my screen. I started sharing my screen. Are you able to see that should say scope of work? We got you.
Fatima Nunes (16:16) Perfect. Let me move ahead here. And Mallory is actually going to take the lead on these next couple of slides here and walk you through, right? Some of these SKU names might seem familiar to you. Some are kind of like the way internally we reference things. So Mallory is going to walk through what each of these are, what services are included. And then of course, the math on how we got there.
Mallory Smith (16:39) Is that my cue that’s your cue? Oh, Scott, good to see you again you.
Scott Call (16:45) As well. So we’ll go ahead.
Mallory Smith (16:48) And just run through, I’ll give some brief definition just to make sure we’re talking the same language here. So essentially what we have in scope for services on a potential benefit and partnership here is that provider data management. So really think of this as just the software itself. It’s a seat for the providers. We do charge based on provider count. So anyone on your team can have access to it. There’s no additional charge to it. What you’ll get with provider data management is access to the provider profile. They can load and upload their information. Neil. I know that we’ve talked at length that your team wants to be more of a white glove service and you want to go through and load as much as you can for the providers. So they can simply log in, review, sign off and they’re good. It’s going to support the back and forth communication task which can be automated as well as your team can create specific tasks and track them that way as well. This will monitor your provider’s expiration, dates, whether it’s their driver’s license, or their medical license, or their Coi, automatic notifications will be sent from the system to remind them, usually 30 60, 90 days before you can turn those on or off, it’s really up to you and it can be provider specific. So if you have some providers, they’re fine with the reminders. If you have some that they’re not, then you can turn those off too. So that is just the access. When we think of core. Next one is this would match the total number of seats. This is just caqh management. So as a part of that core pdm and what you would see there’s the caqh import feature, which means with three data points, basically the provider’s last name, npi caqh id, you can connect the provider caqh where caqh management comes in? Is it’s going to take any information that’s in the medallion platform, automatically push through RPA technology back to caqh and automatically retest for those providers. So whether it is their license updated and it’s updated in the medallion platform that will get pushed back to caqh. If it’s the quarterly reattestation, it’ll get pushed back. And then all the providers have to do at that point is just log in once a year to the medallion platform, say that they’ve reviewed the information and they’re good to go from there… ncqa compliant monitoring. So with the compliant monitoring, this is just a delegation requirement. So if you do partner with us, we are an ncqa certified cvo, part of their requirements to become delegated with any payer is that you do perform continuous monitoring. So we would make sure that you’re engaged with all of those different elements that are required by ncqa. Then finally ncqa credentialing. So this is really caqh has 100 percent of the elements we need for ncqa. So you’ll immediately see a three day SLA, with normally a one day average for us to complete those files. Your team will make the request. In the platform. We’ll gather everything together, have a file ready for you within at least three days. Typically, it takes just under a business day because caqh brings over all the elements. You make the request immediately. We have integrations with 90 percent of the different elements. We have someone review it as required by ncqa and it’s good to go. So, any questions about those services that we’re looking at today?
Scott Call (20:05) The only thing I’m wondering and Neil, this is mostly for you, not for them, the headcount looks spot.
Fatima Nunes (20:12) On.
Scott Call (20:14) Neil, when we do delegated, we’re not going to be doing 200 a year, right? Because it’s going to hinge on those payer contracts for delegated. So, I’m wondering, do we want to on that last line there? Do we want to reduce that? Knowing that not every contract we have is going to be under contract with payers in that first year for delegated? Probably never, but I don’t know what are your thoughts?
Scott Call (20:46) We won’t be doing PSV on all of our providers, right? Yeah?
Mallory Smith (20:51) Just those that are delegated. So you’ll perform, we’ll need to do PSV on whichever providers you want to be a part of the delegated agreement. So if that is all 200 perfect, if not, we can reduce that number. You are still able to store all 200 providers in the platform. So that ncqa credentialing can be a different volume. What I will say is that we will need, because we are the ncqa certified cvo, we will need to credential all of your providers to ncqa standards so that we can show comprehensively to each payer that, yes, medallion did confirm that they’re ncqa certified. If you’re a vendor that you’re currently working with, if they are ncqa certified, then we may be able to just transition those over. That would require us an additional call where we kind of talk about the scoping there. The big picture is that if we’re going to partner with a payer, they want to know that sure you followed ncqa standards for credentialing but we have no guarantee if your current vendor is not ncqa certified. So that would be the first step. The other great news is that we only have to credential your providers one time and it can count for multiple payers. All the payers we need access to is they’ll see that? Yep, they’re credentialed at least once. So it’s like a whole cost sharing thing. So one time, and then if you have delegated agreements with five payers, the one file counts for all five. Yeah. Okay.
Scott Call (22:15) Mallory, that’s really helpful. I think the middle part of what you said there answered my question. It sounds like and I think we ought to leave it at just as a benchmark, even if we only get a few under delegated to start with it. I think the middle part of what you said there is that we’re going to have to do all of them anyway because you’re held to that standard as an accredited ncqa vendor. So I think, yeah, I’m good. Leaving it right where it is. Yeah. And I think not.
Fatima Nunes (22:46) To misspeak, Mallory, check me here, but I think for some payers, there’s certain requirements on sort of the number of providers, like how big your provider volumes are. And so you want to make sure that when you’re showing it’s hey, we have 200 providers, and at that point, usually the sweet spot’s one over 100 providers. Mallory, would you say that’s accurate? Yes.
Mallory Smith (23:05) Yeah. Usually the volume minimums with payers, you’ll see anywhere from 75 to 100 and above. And if we look at years two and three, we only need to credential the new providers to those standards. So it may be 100 in the first year, but really, it’s just new providers from that point out, right?
Scott Call (23:22) Okay. Good. Thank you for clarifying that. I think that gets it.
Fatima Nunes (23:26) Perfect. And then this now moving, this is more on like the enrollment side and it’s for both the provider and then also facilities.
Scott Call (23:35) Mallory.
Mallory Smith (23:37) so with payer enrollments, I know that our main focus today of course, will be on delegated credentialing but because you did want the comprehensive scope for payer enrollments, this will be that your team makes the request for the payer in the provider platform. We will receive the request, populate the application, submit and do the follow up for them. The math on the quantity that we’re receiving is you’re expecting to see about 130 new providers annually, about 10 payers each based on the responses that you sent back. So that’s where you’ll see the 11 30, the payer revalidations to do this math. We did not mean to put six, six, six by the way, we can make it six six seven if necessary. Yeah.
Scott Call (24:17) You need to, we got to change that number.
Mallory Smith (24:20) No, that’s what I was telling botany when we were doing the math, I was like, we can’t put this. I was like, you can’t like I.
Fatima Nunes (24:25) know, I put it to see if you guys were paying attention.
Scott Call (24:28) Oh, yeah. I saw it.
Mallory Smith (24:31) But typically with payer revalidations, how we’ll do the math to achieve this is you’ll see a rolling annual of payer revalidation because of course, you enroll providers at different points in the year and they’ll be due either at the three year mark or at the five year mark for medicare and medicaid. So we’ll take your 200 current providers that you are billing and seeing insurance plans with multiply that by 10 payers. And then we’ll divide that by three. Since that’s a rolling three year re cred cycle typically. And that’s where we achieved that number there.
Scott Call (25:04) I don’t.
Mallory Smith (25:05) I am curious, Neil, is this typically what you’ll see when you think of just the standard payer revalidations annually? Yeah, that’s about, right. Okay, perfect. I think the other thing to call out here too is just SKU flexibility so we can push and pull volumes from year to year as needed. So ultimately, that gives us pretty good range and we can adjust that number as conversations continue facility enrollment. You wanted the scope for this as well. We are able to do provider group and facility enrollment. So this one, since you’re adding about seven new facilities, they each have about 10 payers that’s one application per facility. You’re going to see about 70 initial per year, and then revalidations you provided 100. So we went ahead and just put 100 in there on how many typical facility revals you’ll see? Is this good there?
Scott Call (25:58) Yeah, I think so. Alright, I promise.
Fatima Nunes (26:01) This is the last one and this should be pretty quick. That’s my.
Mallory Smith (26:07) cue. Again, sorry, I missed that. Alright. So delegation roster generation. This one’s super simple. This is just part of the ncqa credentialing. So typically, we’ll see anywhere from two to three delegated agreements within the first year of partnership. So we’ll give you on the higher end of three. You can pursue as many as you want. But by the time the payers get back to you, we typically see about two to three in the first year, delegated credentialing setup support. This is a one time cost. This is basically just for us to create bylaws policies and procedures for your team to review them to help you set up your committee, get an idea of what will be expected. And then finally delegated agreement, audit management. This every payer will require an annual audit. If you remember from our conversation earlier this week, this is very simple. We’ll grant them access to the platform. They’ll send you a list of which provider files they want to review. They can access them. You can provide them to them. And then we will assist with any follow up calls. Conversations. Any more proof that they need as well?
Fatima Nunes (27:12) What’s.
Scott Call (27:12) that I know you’re going to show us numbers here. But the initial setup support, what’s that number? Just curious, I think it’s.
Mallory Smith (27:19) list price is 5,000. I’m not sure if Asma, do you have a, were you able to get a discount for that? I.
Fatima Nunes (27:27) don’t have, so we were looking Scott, we were looking to finalize a scope because there is volume based discounting, okay. On the entire proposal. I can pull this, I think list price you’re spot on. It’s 5,000. But because of like the overall scope, I think that significantly goes down, okay?
Scott Call (27:44) Great. Just curious. Yeah.
Fatima Nunes (27:46) Absolutely. And I think just highlighting what Mallory said here, our annuals, our agreements are typically three year agreements. And so in year one, right? I know overall, you’re looking at 10 pairs to get delegation with year one, we’re scoping it out. We’re going to help you with three, get delegation established with three of those pairs. So years two, we’ll have an additional three and then years three, an additional three depending on how that goes. So that’s really how the math would work there. Of course, like Mallory said, if you want us to pursue more, we can go ahead and be very aggressive and include four or five. But typically what we’re seeing is about two to three. Sounds good. Okay. Neil, any questions on this? Does this all make sense on your end? Who are?
Neil Brennan (28:27) Usually the first three, is it like uhc, Aetna cigna, who?
Mallory Smith (28:32) It’s the buca, it’s blue cross united, cigna, Aetna humana is one that’s usually really willing to partner as well. So you’re thinking of the correct big five however you want to look at it.
Fatima Nunes (28:44) Okay. Absolutely. And if you wanted to share the list of like the top pairs, just in general, even for like a pair enrollment like analysis on our turnaround times with them, we’d be able, to pull that for you. Like we have a great system that Mallory can help pull that data on if we wanted it, for our next call. Okay. All right, good. So let’s move ahead here. Now that was wrapping up the scope. Really, this slide, is the heart of what we want to work through together today, right? So the speed of the problem today, it’s just an operational headache. It’s directly impacting revenue. So let’s really dig into what that actually looks like current state and then versus future state. If you were to partner with medallion. So on the turnaround times, this is where the impact is the most immediate. Today. If you look at the left side, your credentialing file completion is sitting at about four days. And Neil, I know this is something that’s being managed by your five person in house team. Do you know of that four day timeline? Does that include the time it takes provider, you to gather the documents from a provider? Yeah?
Neil Brennan (29:53) It does, it goes from HR to the provider, gets a link, and then the provider fills out a link, they attach their required documentation. Then they come over and all that comes over to a Google sheet. So it’s about four to five business days from the handoff from HR to the provider, then to us. And then, you know, it usually takes us a day or two depending on, to review all that and then do a ticket over to the vendor. Okay. So probably.
Fatima Nunes (30:21) Around five, six days in total, there probably a week. Okay? With medallion, right? And this is the bulk of the conversation here is around credentialing and how we’re going to be able to perform those files. That number is going to drop down to one day. And we have a three day contractual guarantee that’s going to be in your agreement. Okay? So it’s going to save you several days there. And that’s primarily because of that caqh management direct integration that we have that allows us to pull all the information we need within, I think just a few hours. And so we drop on the payr par, approval side. You’re currently looking at around 150 days that’s the average between four to six months, which is what you’re seeing today… right? We understand that some payers are faster than others, but on average, does that 150 day number resonate with what you’re seeing? Yes. Okay. Yeah. Okay. Good. With medallion. We typically see that come down to around 60 days. I think that our current day today, it’s like 58 59. So we rounded it up to 60 days and that delta really is where the revenue acceleration lives. If you did want to partner with us for direct enrollments in a future state. Now, the bottom half is really around resourcing. We, for the most part, it’s empty, right? We know you have five in house ftes working with two vendors today. We don’t have full visibility into what that’s all costing you. I think, you know, we wanted to leave this on here because ultimately, if you were to present this internally, you’d want to have that cost breakdown to show this is what our all in cost is today and then really have a true apples to apples comparison when you present the medallion investment.
Neil Brennan (32:03) I don’t know if.
Fatima Nunes (32:05) Scott Neil, do you have any idea or a rough guess that you’re all in annual spend on credentialing today? So in house ftes plus both vendors combined, what that number would look like?
Scott Call (32:15) Yeah, it’s approaching about 400,000. Oh, just, sorry, just our internal ftes are about 400.
Fatima Nunes (32:23) Oh, okay. Well, I thought we were going to be out of the car if you were paying two vendors, five people, 400 K. I think we should end the call right now.
Scott Call (32:35) Yeah, that’s our in house cost. Yes. Okay, good. So.
Fatima Nunes (32:39) I was actually I was estimating about 60 K per fte. So I think mine was much more conservative at like 300 K. Okay, perfect. And then for, do you have any idea on like the vendors you’re paying or like the all in I’m estimating like one point two for everything? Yeah. So.
Scott Call (32:54) Fatima, sorry, I also estimated at 60,000, but I added in benefits cost on top of that. Okay?
Fatima Nunes (33:00) Okay.
Scott Call (33:01) So, yeah, it’s a little higher but pretty, you’re in the ballpark right there for sure. Okay, good. And then,
Fatima Nunes (33:09) on the vendor side for these two, I know you’re using facility credentialing, then you also have the payr enrollment team that you’re utilizing any idea on like all in with like vendor spend. I would.
Scott Call (33:21) have to go pull some old invoices and take a look at that off the top of my head. I wouldn’t want to throw that out right here. I’d want to, I need to take some time and look at that. But, okay. Okay. Not sure at the moment. Perfect. Well in.
Fatima Nunes (33:37) A future conversation, right? And after we review the scope of work today, we can update the left side and the right side, of course, the right side really is going to be impacted by the scope of work if you utilize this just for one service versus if you utilize this for all services, so that’s really why that’s all of those are TBD. And then it’s wrapping up here on the revenue leakage side. We don’t have data to quantify that today. And we understand some organizations don’t feel comfortable sharing that, which is totally fine. But I did want to call it out because this is a real area where medallion moves the needle and it’s going to matter to Jonathan to Jim when you bring this to them. So I think just having this here and then in a future state, you can populate it internally before your presentations.
Mallory Smith (34:19) And then,
Fatima Nunes (34:20) that said what we, we’re able to calculate based on all the data that you shared with us was how much revenue we can help you accelerate really just from accelerating the speed at which we’re performing the credentialing as well as the pay enrollment. And that’s really what we’ll walk through on this next slide here before?
Neil Brennan (34:39) You do that? Can I ask a quick question? So with your history of a client our size, once you have converted a client over to delegated converted them over to provider enrollment for like medallion handling everything for them, right? What do you see the requirement for that client to have as far as ftes? If they had, if you had a client in the past that had 10 or had five, like we have five? What do you see the future of them coming over to medallion? Can they reduce the five to three or to two or is five a good number historically that you’ve seen with other clients? But what’s your feedback about that?
Fatima Nunes (35:17) I’ll let you answer that. Thanks, no. I think it’s.
Mallory Smith (35:20) a great question. Neil, we have seen typically whenever you do partner with medallion for the multiple different services we’re considering here, it does allow for a reduction of staff internally. The one that I’m thinking of most recently, we started implementation for this group back in last October, of course, they’re complete with it. But one of their goals is they had eight ftes and they wanted to reduce down to two by the time that the system had gone live and so forth. So we were able to build out… will be at the end of the implementation process as far as gathering the data, migrating that over. And when they could start releasing members or their staff. And then when they got to the end of I think three and a half four months, they were down to two ftes. So again, because we were able to do comprehensive services, they were able to release it. If you think about it, the way you’re able to just immediately really reduce staff is because your team is essentially required for the higher strategy elements and your team will make the request from the platform. But really we’re doing all of the essential groundwork there. So the higher strategy components, Neo could be handled by you. And then if you are looking to reduce, then we could build out an appropriate timeline just to give you an idea.
Fatima Nunes (36:33) Yeah, and I’ll add something there to what Mallory said. So we are able to work with you that’s a session that we do around resource allocation where we get a better understanding of what each person on that five person team is handling today. Like just yesterday, we were on a call where they have one fte managing caqh profiles. Like that’s their only job, just caqh management like that’s the bulk of what they do. And so, with medallion, right? That work is non existent because it’s fully automated. And so, in that scenario, it’s almost like a no brainer. Yeah, you don’t need that person anymore. So it’s just ultimately also what those folks are doing today and that is something that’s if it’s of interest, we can work with you and run a session on that. Is that something that you’re interested in? Neil? Yeah. Well.
Neil Brennan (37:18) Yeah, definitely a reduction in the workforce. I’m interested in. But right now, my current staff has there’s five of them. We’re in 20 states. They each have their own states and they do facility cred provider, cred and communications back and forth and manage all that with the vendors. So they’re doing a little bit of everything.
Fatima Nunes (37:42) In the ideal world, what would the team look like from a size perspective?
Mallory Smith (37:48) Two, I would think.
Neil Brennan (37:49) Two.
Mallory Smith (37:51) Scott.
Neil Brennan (37:51) why are you smiling? I’m just.
Scott Call (37:53) I’m smiling because I’m like let’s see if he comes up with the same number I have in my head… and you did.
Neil Brennan (38:01) Yes.
Mallory Smith (38:02) Yeah, we always.
Fatima Nunes (38:03) Tread carefully with the opex conversation, especially, when heads of credentialing are involved because there’s some folks who are really tied to their team. They don’t want to let anybody go. And there’s others that welcome it, they want it, they want to be more efficient, less people to manage, run faster. And so, okay, I think we’re in the.
Scott Call (38:22) second camp.
Neil Brennan (38:25) Yes.
Fatima Nunes (38:26) Perfect. So, we’ll tailor. Yeah. Okay. Thanks. This.
Scott Call (38:30) Is a question you probably answered the other day when you did the demo for us, but since you brought up caqh just now and,
Neil Brennan (38:38) you mentioned that it’s fully.
Scott Call (38:39) Automated. Is it bi directional? Is the API bi? Directional? So when we can, we also update caqh rather than just a download across to the platform. Yeah. So that is.
Fatima Nunes (38:51) What the caqh management would be, we’d be able to push and pull information back to caqh.
Scott Call (38:56) Absolutely. Okay. We thought that was the case, but Neil and I had that question this morning and it just popped in my head when you mentioned that just now. So I wanted, to ask, so, appreciate that. Okay?
Fatima Nunes (39:08) Absolutely. Okay. So if there’s no questions here, let’s move on to the fun revenue acceleration. And we’ll definitely lean on you all because we did make some assumptions based off the data you shared.
Scott Call (39:20) So I’ll just.
Fatima Nunes (39:20) pull ahead here. Okay. So the goal of this slide really is to show based on what we know about the business, the data you shared, how much revenue medallion can potentially help accelerate.
Fatima Nunes (39:31) And we do want to sanity check the assumptions to make sure we’re aligned. So keep us honest, please, we are modeling and let me see here. Why isn’t it? There we go. We are modeling 130 new providers that are joining new season annually. Today. It takes you roughly about 150 days to get a provider in network and billable with your payers with medallion. Like we just mentioned on the previous slide that drops to about 60 days. And so we’re looking at doing this work 98 days faster for you. We then applied 1,500 dollars per day in net revenue generated per each of your providers. And of course, this comes from the data our current customers have shared with us as well as industry averages. So we’ll definitely want to check that there. And then, so the math is 130 providers times 98 days that we’re going to be doing this work sooner times the 1,500 dollars per day in revenue generated. And then we arrive at 17 point 5,000,000 dollars in accelerated revenue in year one. And these are our best assumptions with the data that we’ve had that we have, we’ve presented this to be fully transparent. We, we’ve presented this to dozens of executives. Some align with the methodology, you know, they think it’s spot on, some want to make some tweaks based off, you know, to make things more realistic, would love to get your feedback on, you know, does this feel in the right ballpark or are these numbers, you know, do we need to adjust these?
Scott Call (41:08) Well, without having somebody from revenue cycle to confirm that net average, I’m kind of at a loss. I can assume that sounds about right. But… I’m really not sure. The only, the only number I’m wondering about a little bit is the 1,500 per day, right? What are, what our net revenue would be for… those billable providers? But I think even if we took a smaller… percentage of that amount, it’s still a very healthy number. So even if we’re overshooting by, you know, several 1,000,000, I think it’s still… quite realistic. And that’s.
Fatima Nunes (41:55) ultimately, what we’d want to partner with you on, we want to make this airtight, make it as conservative as possible. So we actually, what we see internally is about 2000 and we used the payer mix that you have today heavily medicare and that gave us 2000 and then we dropped it down to 1,500 to be extra conservative. But I think especially as this moves up the ladder, we want to make sure that this is going to be digestible for everybody who sees this. And I think what, what’s really driving this is that you’re adding such a high volume of providers per year, right? And so that’s really that that’s going to move the needle, right? 130 new providers and we’re going to be doing this work so much faster.
Scott Call (42:37) We can’t forget to take the, you know, 16,000,000 or so out that Medellin is going to charge us to do all this work.
Fatima Nunes (42:45) I’m.
Scott Call (42:45) kidding. I’m kidding.
Fatima Nunes (42:47) No, no, no. It’s OK. We’ll walk you through everything. I think you’re going to be pleasantly surprised just now, understanding a little bit more about how you’re thinking about the opex reduction and just using our best judgment around how much you might be paying with those other two vendors. I think this is going to be very realistic. So I’ll yeah, no, go ahead, Scott, please. I.
Scott Call (43:08) Was just going to say just as a reminder to you and mostly myself, this, you know, this incorporates all credentialing for delegated facility and provider, right? So this would take this is the whole enchilada, right? Yeah. Getting the revenue, you know, nine day centers is definitely very good. I mean, we could end the year much better than we would without it because we’d be getting the money within 20 26. Yeah, that’s if we, you know, had delegated up and running by the end of the year and see these effects. But, yeah.
Fatima Nunes (43:46) Absolutely. And this site here, it’s the direct enrollments.
Fatima Nunes (43:48) So if you were to partner with us on the peer enrollment. So if you’re not delegated yet, the next slide I’m going to show only focuses on the delegated credentialing and what those numbers would look like. And I think, you know, I’m going to share the editable version of this deck with you all that way you can play around with it. This is not set in stone. It’s meant to be a work in progress. And then we can walk through the credentialing there. And then I guess just, I know Scott, you remind me, I know you report directly into Jonathan. Is that correct? I do. Yeah. Okay. Do you feel like, how do you think this is going to land with him? Do you think this is, you know him best? Probably the way he evaluates things, do you think this is going to be in line with the way he’s thinking about this?
Scott Call (44:32) Yeah. I mean, I think the formula makes sense, right? The way that you’re calculating again, I think he’s probably going to look hard at that 1,500 per day. You know, I think, you know, Neil and I can certainly get that data before we take anything to Jonathan to make sure that it’s accurate. So we’re not just kind of throwing a number out there, right? So, yeah, I think it’s fine at this point.
Fatima Nunes (44:58) Absolutely. What I would recommend and I’d love the opportunity to do is if you sent us via email, your payers, like the payer list, the states, Mallory can pull the turnaround time analysis. And then this 60 days sooner average, I mean, our 60 day average, we can tell you exactly kind of like what we’re looking at across the board for your payers in those states. And then we’re able to tailor this even more and throw in a slide here saying, hey, this is not just like all the payers, this is our payers specifically, this is what we’d be looking at and that would make it much more realistic as well. Okay. Yeah, that’s my.
Neil Brennan (45:34) Only concern is about the 1,500 per day. I would really have to have some buy in from RCM to give us a true average because as, you know, we have a provider mix, right? We have MDS, we have dos, we have pas aprns, and then we have all different types of counselors from level one to four with various types of degrees and things.
Neil Brennan (45:54) So to try to get a daily, yeah, I think an MD, 1,500 a day, yeah, would be probably revenue generated for an MD. But since we have such a mix of different types, I would want to have their buy in to get a true average to put into the calculator to see that’s a good call out.
Fatima Nunes (46:10) Absolutely. So even if, from that one 30 breakdown, do you know what the provider breakdown is of those 130 new providers per year?
Neil Brennan (46:18) Yeah, I would say 70 percent of our new providers because again, this one 30 that we put into the scope email back to you was an average of us losing 10 per month, gaining 10 per month just due to the turnover. So, you know, 10 a month is 120 providers a year. We tacked on an extra 10 just to give us even one 30 for give and take. And so I would say 70 percent of the turnover is related to counselors leaving either getting fired or burnout, and then leaving the MDS and the dos, they seem to stay longer. And then the pas and the nurse practitioners are probably near that, but it’s really the counselors that have the high turnover. So because we have MDS that have been there for years that haven’t left. I’m saying 70 percent of that one 30 may be that type of provider mix that are the lower generating revenue providers due to their provider type. Absolutely. So I.
Fatima Nunes (47:21) know we have our note taker here. I didn’t take notes on that, but we’ll go back Neil, and we have, I mean, we just have a lot of data internally based off the customers we work with. We’ve done this analysis so many times that we might be able to get you like a range that then you can share with like HR revenue cycle and say, hey, is this reasonable? And that makes your work a little bit easier? And then if they say, yeah, this looks good, then we can take the average of what that provider mix is.
Neil Brennan (47:48) Okay. Good. Mallory, were you?
Fatima Nunes (47:49) Going to say something? I see you came off mute?
Neil Brennan (47:53) I.
Mallory Smith (47:53) thought you were making a joke but no, we do have the AI note taker on here. No, I think, I know what we can do with these numbers and we can take 70 percent of.
Neil Brennan (48:04) The provider volume.
Mallory Smith (48:05) And do the lower number once we talk with those internal resources and see what we can put together. I love that it’ll be a big math equation and I’ll put everything on the screen for you guys. So we’ll make sure we have an appropriate revenue per day.
Mallory Smith (48:23) I’m going to pull ahead here.
Fatima Nunes (48:24) This is what it looks like for the delegated credentialing, same methodology. But this is where the delegated credentialing is going to change. So when you have delegation in place instead of the 60 days to credential, we’re going to drop that down to three days. So of course, against your current 150 day baseline, that would be significantly 147 days faster. We ran that same math, 130 providers, 147 days sooner, 1,500 per day. And you’re looking at 28 point 6,000,000 in accelerated revenue.
Fatima Nunes (48:55) Of course, I think based off everything we just discussed on the previous slide, we would need to update this to be more in line with the business today, but just wanted to kind of separate the two so that you can see it cleanly with delegation. And then with direct enrollment.
Fatima Nunes (49:20) I think… we covered everything here. And then this is really just the last piece the business value assessment. So it really brings everything together. We like to break everything down mainly to do this homework for you all because we understand this is the way that internally they’re going to be looking at it. So the three main buckets are revenue acceleration. How fast, you know, how much revenue are we going to be able to capture because of this new process, then revenue leakage, how much in claims getting denied write offs because of inefficient credentialing process that’s obviously TBD and then the operating expenses. And then I broke that into two your current state today. So put staffing payer, enrollment, vendor, facility, credentialing vendor. And then in a future state with medallion, of course, it would be the medallion services and future head on staffing those services depending on the scope of work.
Neil Brennan (50:21) So really just.
Fatima Nunes (50:22) breaking it down. Is this helpful? Is there anything that we can add or change here to make it? I guess?
Neil Brennan (50:32) Easier. No, it’s straightforward.
Neil Brennan (50:41) And then.
Fatima Nunes (50:41) I do know we’re three minutes over time. If you all have like five more minutes, what we’d love to do, Mallory had put together like some implementation slides. It’s really high level to walk you through what that would look like if it’s of interest, we can do that in the next five minutes. If not, we can leave that for the following call. I’ll follow your lead.
Neil Brennan (51:00) There.
Fatima Nunes (51:03) Neil, but I made you all late so I’m more than willing to stay.
Neil Brennan (51:06) A little few minutes extra. Yeah, I’m free until I’ve got 11 minutes before my next meeting. Okay? Perfect.
Fatima Nunes (51:16) I appreciate that. So.
Mallory Smith (51:18) What I’ll do is I’ll share my screen and just take you through what you can expect when we think of implementation. Obviously, the majority of the time will be spent with the data migration. So whenever we present price and you’re thinking that there is potential partnership here, then we’ll have another call just to scope out where all your data currently lives and so forth. So let me go ahead and share my screen. But this is just to give you an idea of the personnel that will be involved with it.
Neil Brennan (51:46) So I’ll start off.
Mallory Smith (51:46) With, of course, you’ll still have me usually during the first month or so of the implementation process. So to make sure that it’s a smooth transition, I will have an internal kickoff call with the appropriate implementation team, account managers and so forth to make sure we’re aligned… new Fatma, if you will be your account manager, they’ll own the partnership itself. If you’re looking for any expansion opportunities, contract questions, anything of that nature, this would be your person for that, the engagement manager. This is the person you’re engaging with. This will be your day to day contact. You can email them. You can call them. They will be with your account during the life of the partnership itself. So in addition to the agents that will be submitting the applications following up, seeing all of their notes, you’ll also have a person that you can contact in case you have any questions that come up. And then finally the technical solutions manager is also going to be partnered with the implementation manager. So these two individuals will be driving the implementation itself. We’ll typically see about eight to 12 weeks for implementation. If we go with option one for delegated credentialing. I’ve seen that we’ve been able to submit credentialing requests within five weeks. If we do the pay or enrollment as well. Then really we’re thinking like eight to 12 weeks as far as long as we get the data migration efforts over. And I may have mentioned this in a previous call or not. We are able to go through and prioritize based on the services that you want to start first. So something that Fatima and I built for a customer last week, they were actually Fatima. They were also transitioning from two different vendors in this space. So we put together a segmented startup plan for them. And when they can stop requesting enrollments to be submitted by the other team, when we can take those enrollments over, we do offer part analysis. We’ll of course, do transfers. So we’ll have all of that built out for you just to give you a realistic flow and so that’ll be part of the implementation process itself. So again, you’ll be covered from head to toe when we think of the account management, your day to day and then of course, the implementation itself.
Neil Brennan (53:53) We can only.
Mallory Smith (53:54) move forward if we get to keep Fatima.
Neil Brennan (53:56) I was hoping.
Fatima Nunes (53:58) You’d say that well, I’ll send you the order form after this call.
Mallory Smith (54:04) Fine. We can make that concession. Did we hold too quickly? So this is just a visual, another visual of what you’ll see. So during the implementation process, of course, you’ll have all three engaged. The technical solution and implementation manager will then drop off. Once we have you fully implemented, you’re going live. If you have any questions at that point, you’ll be reaching out to the engagement manager and account manager. And then of course, you’ll have ongoing support. We have a support team. You can call, you can email them. We have chatbot services as a part of the platform itself. So you’ll be fully supported from all fronts there.
Mallory Smith (54:47) As to the timeline on which you can expect, I have this for credentialing as well as payer enrollment. So different ways to implement and get the data migration profile completion. You can expect about two days because of the caqh and resume scanner import from the time that you submit the request for the enrollment application. You do have a 10 day SLA right now. We’re averaging somewhere between three and four days to get those applications out the door, AI agentic, follow up to assist with the follow up calls there. And then of course, we have an internal payers directory that has over a 1,012 100 payers that will follow prescriptive sops to ensure that we’re following up like clockwork and we’re getting the welcome letter and all of this is being tracked within the system.
Mallory Smith (55:34) Credentialing will of course implement delegated credentialing. Is easily the easiest implementation when you think about it because we essentially connect the provider caqh. They have 100 percent of what we need from a credentialing perspective. And then from there, they’ll go through, complete the profile, make the request for credentialing. We’ll verify the information with a three day SLA. Your committee is all virtual. We will help you determine who needs to be a part of your committee itself. And then finally recredentialing and monitoring, this is something that can be auto scheduled. So if we follow the three year recredentialing cycle within cqa, then it’ll be ready. I think we reach out 60 days before the three years is up to initiate that process again. But again three year three day SLA on that as well.
Neil Brennan (56:24) So that’s a lot.
Mallory Smith (56:24) Of information. I can absolutely send this as some slides to leave behind. But just wanted to give you a visual and talk more through what you can expect during the data migration and implementation process.
Neil Brennan (56:35) Yeah. I think the biggest.
Fatima Nunes (56:37) Takeaway, it’s eight to 12 weeks, right? For direct enrollments on average. And then for credentialing, we’d be able to start submitting those files, you know, within five weeks and you’re going to have a full suite of support here that’s going to help you from the moment, you know, from implementation all the way through everything. So, we are going to be very hands on the entire process. So, you know, medallion would become an extension of your team. This wouldn’t be even though you’d be outsourcing a lot of the work to us. You’re not necessarily, it’s not going to be like an offshore vendor, right? You’re going to be in contact with us. If you need anything, it’s not like you’re going to have some vague support email. You’re going to have somebody that you reach out to, if you have any questions or anything like that… anything we can answer around implementation?
Fatima Nunes (57:35) Such a phenomenal job that you just got ahead of everything?
Scott Call (57:40) Oh, I think.
Mallory Smith (57:41) You’re taking it too easy on us?
Fatima Nunes (57:43) I think so too, but I do have a question if there’s and of course, if you think of anything, you can reach out to us on implementation or anything else. But I understand when we first spoke, you’re looking at other vendors evaluating, trying to see what makes the most sense? Both from a cost as well as a services perspective. Can you just share a little bit more about how those evaluations are going? And like who else are you evaluating? Are you more excited about somebody else? Is medallion the front runner? Just?
Neil Brennan (58:12) Any information?
Fatima Nunes (58:14) You can share about that?
Neil Brennan (58:16) Yeah. Well, so far… our consultant, the person who consulted on this, but she gave us the outreach and the introductions to several vendors that we’ve now been speaking with. It seems like Scott, correct me if I’m wrong, but it seems like you all, you guys have a very similar platform?
Scott Call (58:39) All the steps seem?
Neil Brennan (58:40) To be neck and neck with each other, there’s nobody that’s really standing out to me over the others so far as like implementation or the system itself or how things go. And I do like that. Medallion has that back and forth with caqh. Not just like how we used to have a video called Healthstream. I’m sure you’ve heard of it. Healthstream owns them and we could pull that data in, right from caqh but anything we update in the system, it wouldn’t push back. So, I do appreciate the fact that medallion can do that. But I did have a question if you guys handled payer enrollment, provided enrollment for us as well in the future beyond delegated, if there are payers that require rostering on a quarterly basis, yearly basis every six months. I remember under the reports thing during the demo, we saw where we could go and create rosters, but does medallion also create, can create rosters according to what the payer wants for the fields and submit the rosters back to the payers themselves or does it have to be sent from us after we generate it using your software? It will be sent?
Mallory Smith (59:45) From you generating with our software?
Neil Brennan (59:47) Okay. Yeah. Are you referring to like?
Mallory Smith (59:49) The quarterly directory reports?
Neil Brennan (59:52) Yes, right. Yeah. So you can.
Mallory Smith (59:54) Utilize medallion for that absolutely. But typically, that’s not a services that we’ll offer to send that. Now, if we do delegated credentialing, we’ll send those rosters, but when it comes to directory that would lie within.
Neil Brennan (60:05) Your team, okay?
Fatima Nunes (60:10) I appreciate the candid feedback Neil, I guess my only question when you say no other, like we’re all pretty much in line with each other. Do those other vendors? Are they contractually committing to turnaround times as well in their agreements?
Neil Brennan (60:24) I think medallion was the only ones that mentioned specific times without us having to ask… the turnaround time for the others. And they’ve told me, but they haven’t mentioned that it was contractual. And even, I think in our first meeting, you guys asked us if our current vendors also include that language in our current contracts. And I haven’t looked at the contract. I don’t know if Scott’s had time to look at that to see if they’ve committed to any type of timeframe in our existing ones. But that is another that’s a good point that’s another thing that medallion has done. That kind of stands out I suppose over the others. I.
Scott Call (61:02) don’t recall seeing a turnaround time in that I’ll have to go back and look at it like you said, but yeah, I don’t think it was.
Fatima Nunes (61:08) That, yeah.
Neil Brennan (61:09) Absolutely.
Fatima Nunes (61:09) And I think that’s just something as you’re evaluating other vendors. We always like to recommend just asking them. Do you contractually commit to turnaround times? Because at the end of the day, any vendors are going to promise you everything, right? But if it’s not in writing, then you really were working with an organization today in upstate New York that they were promised everything, you know, turnaround times, everything, but it wasn’t in writing. And now they’re having this performance plan with a vendor where they’re like, hey, these were our expectations but you’re not living up to them but they can’t really do anything about it because they were contractually committed to. So, okay. And Scott, we didn’t give you the opportunity to answer. I know Neil answered. How are you sort of seeing the other vendors feel free to?
Neil Brennan (61:55) Hurt our feelings? And Scott, I have to jump because I got a one on one with Steve Scott. So I’ll let you go. You can have the rest of it. Thank you ladies for your time. See you next time. Thank you.
Fatima Nunes (62:05) Thanks so much. Neil. Have a good weekend.
Scott Call (62:07) Thanks.
Neil Brennan (62:07) Neil. Bye, bye. Yeah, I would Healthstream.
Scott Call (62:11) What Neil said, you certainly are right there in the mix. You know, I think Neil and I were saying this morning. It’s going to come down to probably how we feel about serving and support and then also, of course, the pricing in terms of the actual product you’re… all very comparable.
Scott Call (62:31) I would say you have a leg up on our existing vendor because they have all of their information basically resides in SQL database. And then Power BI reporting on top of that, there’s no real time interface like your demo that you shared with us.
Fatima Nunes (62:51) So, we’re kind of pushing.
Scott Call (62:52) Everything over to them rather than having it, you know, be set up seamlessly directly with the providers and such. Now, I think they can do that, but we haven’t been utilizing that. So, anyway, yeah.
Neil Brennan (63:06) I think you’re.
Scott Call (63:07) certainly, right there.
Neil Brennan (63:09) Okay. No, I appreciate.
Fatima Nunes (63:11) The honest feedback there. And I think the last question I know we’re a minute over is there, I know it sounds like it’s going to come down to cost and then really potentially the contracted outcomes can play a role in that, right? Having that peace of mind around turnaround times. Is there a budget that you’re working within that would make it, you know, that, hey, this is where we’re looking to stay within… or is kind of how are you thinking about budgeting? Is there.
Neil Brennan (63:39) a budget there? I haven’t been given.
Scott Call (63:42) a budgeted amount from Jonathan? Basically, they kind of tasked us with go out there and see what you get, right? So I don’t so I would say give us, you know, your very best pricing and we’ll line them up and certainly come back to you if we feel like you’re an outlier, but we’ll you know, we’ll give you every fair opportunity to be because we wouldn’t be talking to you guys if we didn’t like you and feel like you were a viable potential, you know, partner. So we’ll… certainly if for some reason, you come out quite a bit higher, we’ll circle back and say, hey, you know, you’re you might want to see what you can do to sharpen that pencil a little bit, but I don’t expect that. I think everyone will come in pretty close quite honestly, so.
Fatima Nunes (64:34) Okay. Mallory and I have our work cut out for us. We have to figure out how to differentiate ourselves if the S, usually the slas do it and me and Mallory’s personality, but if that’s not going to cut it, we have to, we have to think of something else.
Scott Call (64:48) You can just do this every day, your sales, you know, what you’re doing, you know, how to, you have to get to a good price point. Okay. Well.
Fatima Nunes (64:59) I appreciate all the feedback there that’s helpful. Let’s we’ll coordinate via email. I know we’re three minutes over. We’ll coordinate via email so we can schedule that pricing call early next week. Our head of enterprise sales will probably join. He likes joining those calls just like he’s and I think he’s a great resource to have if in the event we did need to sharpen our pencils whatever he’d go internally and bat for us with leadership. And so he’ll join us. That call will be 30 minutes. We’ll present really two options Scott delegated credentialing which I know is the immediate need. And then the second option which is everything in a future state. Would it be feasible for you all?
Scott Call (65:35) I like that approach a lot that’s great. So, and I was looking at our contracts with the other two vendors we’re currently working with. We have, you know, without cause term clauses… those contracts that align with your onboarding timeline, right? So they’re 90 days. So it would be an easy kind of taper it down while we’re you know, ramping up with you all. So I think I’m not too concerned about the timing of the implementation and all of the offload, and then the onload on your end. So yeah, I think that all lines up really well.
Fatima Nunes (66:12) Okay, good. All right. I’m sorry, last question just because you brought that up. Sure, I know the immediate need is the delegated credentialing, right? All the other services would be nice to have it. And I know we were talking to Neil before you joined. He said in ideal world. I don’t like all these different vendors, big team. I want everything more streamlined. Is that in, are you evaluating that as well in this kind of like first round where, hey, if it makes sense from a cost perspective, we want to move all services with this proposal or are you thinking no first we would move forward with delegated credentialing? And then in a month or so we would add on the other services?
Scott Call (66:50) Yeah, probably. So in talking again with Jonathan about this, my sense is that he would probably want us to go ahead with delegated first and sort of test this new vendor. That’s why we have two vendors right now, right? We signed them about the same time and we’ve been kind of just evaluating over the course of this last year and that’s proven to be profitable to us just from a, in terms of how have they performed, you know, how has their service level been? And so I, my, I’ve heard him say we’ll probably start with delegated and then make a decision about the whole thing from there. So I would kind of expect that. But knowing that like Neil, I would very much love to go to a single vendor. So, if, you know, we do delegated and it, it’s an amazing experience and it’s everything that, you know, we’re seeing here. And I think we would feel quite comfortable moving to a single vendor, absolutely excited to hear.
Fatima Nunes (67:55) That because our credentialing customers absolutely love medallion. And so even if you wanted a reference or anything, I think you’d be very happy with, the delegated credentialing support.
Scott Call (68:06) Thank you for that. I may take you up on that down the line a little bit, but yeah, that may be something that they want to, they want to do at this point. I think we’re okay. But yeah, so that’s where it stands. I, that’s I, I’m glad you asked that because it helped me think through that a little bit. I do think, I mean, I would love to just immediately hand over the whole thing that’s the easy path, right? But, I do think they’re going to want to test it first, see how it goes and kind of go from there.
Fatima Nunes (68:33) Yeah, yeah. We’ll we’ll show you the price. The, the good thing, I think the biggest benefit of moving forward with everything is just the volume based discounting, you’re going to get a significant discount just across the board because you’re doing everything. But, but like you said, right, we want to earn your business. We want to make sure the partnership is right? So we’d work with you at any point to make sure that the price makes sense.
Scott Call (68:55) I appreciate that. We, we get it. We, it’s the logistics behind trying to have two vendors doing provider credentialing. It’s a nightmare, right? I, in fact, I told Jonathan that I said, I don’t really want to, I really want to go to a single vendor for that reason alone, trying to juggle onboarding new providers with, you know, credentialing under delegated. And I mean, just all of that. It’s just kind of messy. So my preference would be to not do that. But my sense is that he’s going to want to do that test period first. Yeah.
Fatima Nunes (69:29) Well, let’s show you the cost first. Maybe there’s a world there’s a half medium where versus three vendors, we’re able to pick up the facility credentialing piece with the delegated credentialing and then we just managing the pay enrollment team vendor and then medallion.
Fatima Nunes (69:44) So there, you know, we can brainstorm, but we want to make sure that the price makes sense first. So, okay, great. Scott, this was super helpful. A appreciate the extra time we’ll follow up via email and if you need anything, please let us know.
Scott Call (69:58) Sounds great. Have a wonderful weekend. And if you celebrate, have a great Easter absolutely.
Fatima Nunes (70:03) You too.
Scott Call (70:04) We’ll we’ll look forward to scheduling with you that pricing conversation.
Fatima Nunes (70:10) Okay. Thanks, Scott all.
Scott Call (70:12) Right. Thank you so much. See you later.
Fatima Nunes (70:13) Thanks Mallory.