Transcript
Peter Bosworth (00:00) hi, Kim. How are you guys doing? Doing well? Thanks. How are you? Good. Excellent. I’ll give people a moment to trickle in here.
Peter Bosworth (00:34) Awesome. I think Kim, did you know if Salvatore is planning on joining?
Kimwaters (00:38) Yeah, I think sal and at least one other from the athena side are supposed to be on. So maybe just give them like one more minute and if… for some reason they’re not able to be here today, then we’ll want to just talk about like what you guys are currently doing with athena and like what’s possible from an API standpoint.
Kimwaters (01:01) But even if it’s not solvable like via API, there’s probably other ways we can accomplish what we’re trying to get to, okay?
Peter Bosworth (01:13) Here’s, some athena health people. Perfect.
Peter Bosworth (01:37) Well, in the meantime, I’ll keep an eye out for sal from athena joining, but we, yeah, we’ve got about 27 minutes left on this call. Thanks for everyone making time on this Monday. So the point is we’re going to discuss the athena health integration. And so we have a few folks from medallion’s side here. We’ve got Adalee and Samuel awani, who heads up our technical solutions team. And I think what we typically do with every scoping discussion is we, you know, we really want to understand like what exactly we’re looking to pull or push and scope out the kind… of full extent of the integration. And we have like a doc that we’ll fill out on our end. But yeah, we’re going to be using an API, but it looks like there’s somebody else from the athena side here, hey?
Jobin - Athenahealth (02:33) How’s it going?
Peter Bosworth (02:34) Hey, good. How are you? I’m.
Jobin - Athenahealth (02:36) good. I’m good. My name is Jobin. My role is director of platform sales here at athena. So my role is just to kind of figure out what is this integration supposed to look like. Is it a good fit for our API model? And then, you know, discuss any questions, answer questions. And then if you want to go into packaging pricing, we can do that as well too.
Matthew Punches (02:55) So just, I guess fill in the gap too on that Jobin. So it’s going to, yeah, in order to move forward with this access, medical will have to buy the platform package, acquire the platform package unless medallion decides to build their integration via the marketplace. Yeah.
Jobin - Athenahealth (03:15) That’s one way to avoid paying for it is if medallion builds a marketplace integration that’s like a global integration, Peter? Yeah, it looks like is Peter the only one from medallion on this?
Peter Bosworth (03:25) For Samuel, let Samuel introduce himself. Yeah.
Sami Alouani (03:29) Hey, everyone, and maybe before we talk about like packaging and pricing, let’s just make sure we’re aligned on kind of what the goal is and what medallion can offer and then we can figure out, you know, based on that, what the ideal approach is. But, yeah, and you know, first off, I’m going to kind of just riff on what we’ve seen our mutual athena and medallion customers ask for in this regard. And then access team, please keep me honest on whether or not this meets your needs as a first step. But ultimately, the goal here is given medallion’s role as kind of the source of truth when it comes to the payer enrollment process. We know, you know, given we’re the ones doing the work, ultimately enrolling providers with payers. We’re going to know we’re going to be the source of truth of what providers are enrolled with, what payers at what time, and given what effective duration. And so that information is really useful when it comes to like the RCM functions that athena would house with regards to, you know, releasing claims, and knowing that dr smith is billable to athena based on, you know, the date of service relative to the effective date of that contract, et cetera. The goal is, you know, we have that information. Athena ultimately needs that information. And today, there’s kind of some manual swivel chairing that happens on the axis health side where they have to kind of go to medallion and say like what’s the source of truth information? And then go into athena and ultimately manually update that in the payr module within athena. And so, the goal of the integration that we’ve seen is the ability for us on the medallion side to build an integration to programmatically push that information into athena. So that there’s not this swivel chair motion. And, you know, when a provider is enrolled at the payr, it is programmatically reflected in athena. So first, before we talk anymore axis team, how does that sound to you? Does that capture the need? Is there something different you’re looking to achieve here?
Kimwaters (05:14) Yeah, I think you’re referring to just like effective dates and basically like working enrollment task type info in athena that allows like claims to finally drop, right? So, I think there’s definitely components to our process that we’re not necessarily expecting an integration for like when something when a clinic moves from fee for service to rhc, there’s a whole lot of rules that have to be turned on cases that have to be created. That kind of thing. I think that’s still like a human in the loop kind of a situation. But yes, as far as like updating provider effective dates for plans, that is something that is currently manually being done that we were hoping could be solved from an integration standpoint.
Sami Alouani (06:02) Awesome. Okay. Thanks for confirming Kim. So through our conversations with other mutual customers, and also we’ve kind of worked with several athena folks, you know, with those customers. Our understanding is that in the marketplace option today, there is no public API that can be used to update effective dates. So there’s no patch endpoint. And so on the medallion side, while we remain, we’re ready. On our end, we have the endpoints to expose that information. We have the team and infrastructure to support the integration and hosting of the integration. The real question for the athena side is, you know, do you all have any potential solutions that we can ultimately develop against? And we’ve talked about, you know, whether it’s a public API that I’ve heard, you know, is being explored maybe later this year on the athena side or a flat file transfer where we can ultimately kind of deliver something in an import template structure that you all could define, you know, to an sftp for programmatic ingestion, you know, a direct import spec, right? Like we could even explore HL seven style integration via interface if that’s something that you all are open to. But yeah, the tldr is the alliant has the infrastructure and the expertise and hosting ability for this. We’re just looking for the athena side. If you all have any options for opening up our ability to write that information?
Jobin - Athenahealth (07:21) Yeah. Gotcha. It sounds like you already work with a few athena clients though. So how are you doing with the athena clients? Is it all the same way we’re.
Sami Alouani (07:29) not that’s the key. So we have multiple athena clients that have the same ask, but right now, we have not come up, yeah, we haven’t found a solution with athena yet that would allow for us to do this.
Jobin - Athenahealth (07:40) Okay. Gotcha. And what are all the avenues you’ve explored so far? And sorry, I’m getting caught up with this and I don’t see sal on this call yet either. So apologies for that. Yeah.
Sami Alouani (07:49) No worries with accesshealth in particular. This is the first conversation. So we haven’t really tried any avenues. We’ve worked with at least four other groups where we’ve you know, gone through like the account management rep, the, you know, like a professional services development group. Okay. Yeah, we’ve gone through different kind of owners on the athena side of the account there, but nothing global like we haven’t been able to have a conversation of like, hey, medallion and athena get in a room without, you know, these people having customer specific conversations which I think is a healthy place to start to be clear.
Jobin - Athenahealth (08:20) Yeah, no, I kind of agree there because one of the things that we could potentially do here is even if there isn’t like an API exposed specifically for a provider effective date, we could potentially use like a custom field, leverage a custom field to like hijack that, and then be able to put in the provider effective date that way. So, I mean, the nuance here of course is that you’re going to have each payer is going to have a certain number of insurance packages, right? And so you got to keep track of all that. Is there a way where you can create an integration where?
Sami Alouani (08:52) You.
Jobin - Athenahealth (08:54) are able to take the provider information from athena, check it against your system for credentialing purposes and then be able to return back like, yes, this person’s credentialed here’s, a date or like a way for people, athena customers are like, you still utilize your application. Does that kind of make sense?
Sami Alouani (09:12) It does. And that’s 100 percent what we’re looking to do here. So what we would need you all to do is two things I guess in that scenario is like surface that information for us so that we could look up the provider and have exposed, you know, their existing effective date information if applicable, and then a publish endpoint where we can say, hey, yep, we read this. We’ve confirmed that dr smith and athena matches dr smith and medallion. There’s no effective date in athena. There is an effective date in medallion. And then to close the loop, we would need a post or a patch API to ultimately write that information back or again an import spec, whatever that is. But the concept of medallion kind of driving here and doing the reading and the writing is 100 percent something we are open to and excited to own there just a matter of, okay.
Jobin - Athenahealth (09:56) Exposure. Yeah, that was just our apis are at rest. And so sometimes it’s like a hiccup when we talk to a few vendors, but it sounds like that won’t be a hiccup over here, which is great. And obviously, like API doesn’t have to necessarily be the route that we go about this. Like we could explore NHL seven. We could explore a flat file. I’ll be the first one to say like API is kind of more my world. So I might just that’s the wrench that I see in my toolbox. Okay? And do you have four other customers that also want to take advantage of this? So one of the things I’ll do is like I will reach out to our product development team and see if there’s any API endpoints that we have that are not publicly facing right now that we can make available for this purpose. And then if not, then figure out like what are we building along those lines? I think that’s just like the cleanest way of doing this especially when you’re thinking about creating like a potential global integration that any of our clients can tap into. And then you can kind of set up really quickly. But if for whatever reason, that’s not the case either, then I think we just got to go down a little more of a custom route which probably involves like figuring out which API endpoints we can hijack for this purpose. So we’ll just do a little mapping exercise to see what custom fields that we can use for this. Or, you know, an alternative in this is that, you know, we have an embedded app functionality. And so a user in athena could log in and then be able to go into your application. You know, it could be single sign on as well too and then be able to search a provider and then determine like their effective dates where the credential is for. I don’t think it’s like the nicest experience if I’m being honest with you in regards to like all the extra steps you would have to take here, but just another potential solution in this as I explore.
Kimwaters (11:39) And if there’s no like endpoints that can be exposed or custom solutions? Like the only other thing that I was even aware could potentially be an option, it would be like some kind of RPA… yeah, we could. But either way we should be able to get there. I think is the goal, right? Like, yeah.
Jobin - Athenahealth (12:04) Yeah, I think we could, I’m not a fan of rpas, just because like anytime something changes like by a little bit like a button gets moved a little bit, everything goes down and there’s no real good way of monitoring it. That’s not.
Kimwaters (12:14) Ideal. It’s not.
Jobin - Athenahealth (12:15) Ideal. It’s not ideal, but it could be a potential solution here. Okay?
Skip Carter (12:22) Is the preferred method, this is skip with access? I would think the preferred method is to do the API on the marketplace especially if medallion has other customers that are interested in this tool? Is that kind of where we all landed on this? I know we talked a lot about API and I know we don’t have the enterprise that we need to do that. But through the marketplace that’s something that the vendor can do. Is that right?
Jobin - Athenahealth (12:52) So, with the marketplace, the issue at play right now is like, I mean it could be one of the options there. It could be marketplace. It could be a custom integration that is built for access. And then Sam, Sammy and his team are able to build it for other athena clients as well too. It’s just which API endpoints are available. So that’s what I’ll have to do a little homework to like dig into and see like how we can go about this and what endpoints we can utilize for it. Cause my ideal route would be apis as well too. And figuring out if it’s a direct integration or global integration via the marketplace. I think that’s like a second order question that, we can identify pretty quickly… and just to confirm Sammy, you guys haven’t talked to anyone on the marketplace team, right? I don’t want to make sure that I’m not using up another resource if we’re already engaged.
Sami Alouani (13:41) Yeah, not directly. No, the goal was kind of, what you what we’ve yeah, we’ve yet to kind of have a fully closed loop on, you know, the point of contact set athena that we have spoken with so far. But one of the action items was to work with the marketplace team on their end to figure out if that is something that’s doable or not. Right now, we know it’s not like we’ve confirmed that there’s nothing in the marketplace today that supports this.
Jobin - Athenahealth (14:03) So, yeah, it would have to be like a private API if you have it or something on the horizon. So that’s or, we get kind of creative, which is fine. That’s what my team ends up doing a lot of times anyway. I guess one thing that would be helpful in this is it sounds like the ideal state integration would allow for information being passed from athena regarding provider details. So, anything such as like basic demographics about the provider and then anything else from a data flow perspective, whether to or from athena besides the effective data as well? That.
Sami Alouani (14:35) That really is the biggest thing. And, and frankly like, the get of the provider information is less important frankly, than the post, the ability to post. And the reason for that is like, you know, we can do things like npi based lookups, we can house, you know, external athena provider ids if we need to. So like the ability to read provider data is not nearly as important and for what it’s worth, you all already do have, some good provider endpoints for reading just not with those payloads. Don’t contain anything around the actual pay. Yeah, one.
Jobin - Athenahealth (15:06) Yeah.
Matthew Punches (15:06) Something to add Jobin. If you’re going to go and, you know, campaign for these new API endpoints, provider numbers would be good to post. So as we put in like Dea and all the other numbers that medallion records, you know, through the onboarding, we’d be able to create a provider profile. And then after the provider profile is created, we then go in and add provider numbers, which would be the Dea npi. But last I checked that’s impossible. But hopefully you have some magic.
Jobin - Athenahealth (15:36) Yeah, we do have the ability to update information on providers. So if you want to like update, yes, that’s the.
Matthew Punches (15:43) Only one though it’s not the numbers we need the provider numbers, table, provider numbers. Okay. Yeah. And that’s the challenge.
Jobin - Athenahealth (15:51) All right. Let me jot that one down. I haven’t heard of that one before, so.
Kimwaters (15:54) You.
Jobin - Athenahealth (15:55) said provider numbers like npi Dea as well too. Yeah, it’s.
Matthew Punches (15:58) called npi and other numbers on the table in athena, it’s under gear billing and it’s npi and other numbers. Is the table got it.
Jobin - Athenahealth (16:06) Npi and other numbers?
Matthew Punches (16:10) And Tom hunt, if you know, him on the platform side, he’s a great resource for this for you at athena. Okay?
Jobin - Athenahealth (16:19) Wonderful. Love working with Tom. I love Tom. He’s got a great sense of humor. You either love it or you don’t love it. No.
Matthew Punches (16:26) I love Tom, Tom’s great, good.
Jobin - Athenahealth (16:28) Good, good. He’s always cracking me up. So I’ll reach out to Tom as well. That would be helpful. And if, for whatever reason apis.
Kimwaters (16:39) I appreciate that from the athena side.
Jobin - Athenahealth (16:43) Yeah, yeah. And if for whatever reason apis aren’t around here, then we do have the flat file ingestion, obviously like not my favorite or we could perhaps go an HL seven route.
Jobin - Athenahealth (16:54) I would have to like do some more digging on that and talk to my HL seven team to see if that’s reasonable. But it seems like there’s gotta be a way that we can do this, just not our usual bread and butter use case as you can see.
Kimwaters (17:07) Amanda, anything besides effective dates that make… any sense that you’re going in and updating?
Amanda (17:20) Well, it just depends on the contract. If it’s you know, medicare specific medicaid commercial, and then also the departments, if it’s by the npi, the group npi, if it’s for that clinic, we have to go in and flag the nursing homes, that bill under that clinic and some table spaces… things like that. It’s kind of case by case. But that’s what comes to mind. Are you?
Matthew Punches (17:44) Talking about building the conditions for those like to exclude certain things or add certain things depending on the contract. Well, just.
Amanda (17:51) In payor enrollment, when we add the effective date, add in the correct departments and the applicable, you know, if it’s medicaid and mco contract for that state, the packages that would, yeah. Yeah.
Jobin - Athenahealth (18:11) Okay, great. Well, I can get started on the research and figuring it out. And then hopefully, by the end of this week, I’ll have some type of answer and a couple of recommendations for appropriate coercive action. Sounds like there’s a few people on my team. I mean, at a company that I’ll have to reach out to. So it might take a while to synthesize the entire story here, but shouldn’t be too much of a problem. Is there anything else that you all wanted to talk about today?
Kimwaters (18:36) No, I think this is great.
Jobin - Athenahealth (18:37) Well, go ahead. So I.
Sami Alouani (18:39) was going to say Jobin, I’m also happy to just shoot over an email to you with the names of the people that we’ve worked with so far. So you don’t have to reinvent the wheel as far as the conversations we’ve had.
Jobin - Athenahealth (18:48) Hopefully that’ll help please, yeah, if you want to shoot over an email with the people, if there’s threads that you want me aware of like that’d, be great too. If you could just highlight areas… Tom and I worked, you guys did this with included health? No?
Matthew Punches (19:03) This was a client I worked with that had the same asks. They were a platform client, and that’s what I was writing you the name of it, Tom hunt. If you tell them they want to do what included health tried to do, that’s going to be a good start on the enrollment side.
Jobin - Athenahealth (19:15) Okay. Gotcha. And how many years ago was this?
Matthew Punches (19:17) 12, 18 months ago?
Jobin - Athenahealth (19:19) 12, 18 months ago. So, pretty recent. Yeah. Okay. Got it. Cool. I’ll reach out to him as well. Perfect. Thank you. And then, yeah, Sam, if you want to do that, and then if there’s any relevant threads there, just so I can make sure I’m getting the important information that’d be super helpful as well.
Sami Alouani (19:36) Sounds good. Yeah, will do cool.
Kimwaters (19:39) Thank you guys for getting on. Appreciate it.
Jobin - Athenahealth (19:41) Yeah, of course. I’ll get started on this right away.
Matthew Punches (19:44) Appreciate it. Take care bye.