Transcript
Nneka-Shay Grant (00:00) hi there. Hi… I just remembered, I have to let them in.
Nneka-Shay Grant (00:16) What is this?
Erica Lloyd (00:30) Awesome. Are they in the waiting room?
Nneka-Shay Grant (00:34) Not yet. I don’t see them.
Nneka-Shay Grant (01:11) In… I think they might be coming from another meeting. She said she had one just before this.
Erica Lloyd (01:27) Did she just email you?
Nneka-Shay Grant (01:29) No, and she emailed me last week.
Nneka-Shay Grant (01:35) Oh, okay. I think James is here. I’m gonna let him in, okay?
James Aviles (01:59) How you guys doing?
Nneka-Shay Grant (02:01) Hi, James doing well. How are you?
James Aviles (02:04) Doing well. Thank you. Good to meet you. Likewise. I think I have one more person joining, but she’s gonna be just a couple minutes late, but we can go ahead and at least start with introductions. Where are you guys calling from? Just to start off? Yeah.
Erica Lloyd (02:21) So I guess I can jump us off. So, thanks so much for hopping on. Good to meet you. My name is Erica Lloyd. I’m in New Jersey, so my kids could be in the background. So I apologize. If you see them creeping through… I’m an enterprise account executive here at medallion. Been here for about a year and I have to ask James, I saw the dog. Is that a vizsla, hound or a lab or something else?
James Aviles (02:47) Rhodesian ridgeback? Ooh, I love the dog. Yeah, thank you. We were there in socal, there’s, big bear and we were hiking in big bear and they’re a South African hound. They’re a lion hunter. So, the term keeping a lion at bay comes from this breed. The males are lazy. It would be the females, but the females would take a lion to a tree, right? And the hunters, you know, would, then, but yeah. So there’s supposedly the navy seal of all dogs. I don’t know if that’s true mine’s.
Nneka-Shay Grant (03:29) nice.
James Aviles (03:30) Yeah, very.
JosephineCheatham (03:31) Cool. That.
Erica Lloyd (03:32) Is so cool. And it looks absolutely beautiful.
James Aviles (03:34) Thank you.
Nneka-Shay Grant (03:36) Awesome. I guess I can go ahead and give a quick intro as well. My name is Anika. I know James, we had interacted a bit at him, so I appreciate the time just getting reconnected and getting on to learn a bit about medallion. And I support Erica here just evaluating organizations and how you guys are currently running credential enrollment and whether medallion could be a good fit for how you guys are currently running your processes. So I’ll be in the background here, but love to just hear the conversation today and I’ll pass back to Erica.
Erica Lloyd (04:12) Yeah, James and Josephine. Why don’t you do some intros on your side?
James Aviles (04:17) Jojo go first. Sure.
JosephineCheatham (04:19) Hi, everybody. I’m Josephine, sorry, I missed you at himss. I am fairly new to healthpointe like I’ve been here a long time, but I’ve only been here about four months now and I joined as director of it.
JosephineCheatham (04:33) I will be fully in progress of transitioning everything from James as he moves up into a new role, and I will be taking on all of, I am taking on all of his prior responsibilities as director of it, all things healthpointe, all things technology. Well.
Erica Lloyd (04:52) Welcome and congratulations to both of you.
JosephineCheatham (04:55) Thank you.
James Aviles (04:57) Yeah, thank you. You know, healthpointe. We’ve been in business for over 50 years and been here, for quite a number of those years. I’m moving up to a co, CEO position. So I might not have all the details on how our credentialing is done, but a lot of it is manual. You know, we have 11 locations. We have about 80 Ish providers, 40 of them, are really like, you know, MDS and surgeons. We deal a lot with workers’ comp in California. We have a lot of ortho and pain management. We have psychology and neurology, we have acupuncture and chiropractics and physical therapy, you know. So we have some like mid level providers as well. And, you know, right now we have a current team of three people that are, and one of them’s you know, considering retiring. She’s like the main manager, Eva, you know, I don’t know. She’s kind of talked about it, maybe not talked about it. It all depends on the day and the workload, right? And like how frustrated you are probably, you know, but, you know, she has two other staff members, that do assist her. And, you know, one of the things because this is such an important part of our business. I mean, in work comp, we don’t get, you know, our business right?
James Aviles (06:30) From, you know, from flyers or pay per click campaigns or anything like that. They’re traditional. It really comes down to the contracts you have. So speeding up the contracts, right? And speeding up our enrollment. Because like, one of the questions I asked, Eva is like, are we enrolled in 100 percent? Like have you tried to, you know, enroll in 100 percent of the, you know, the insurance providers, you know, carriers and she’s like, you know, I don’t think I have, you know, but she’s like it’s a lot of work, right? So, right now, you know, this is let’s call it a discovery between us. And then what I’d like to do is, you know, kind of get a demo with her and her team there as well. But, you know, I wanted to understand your pricing model and understand a little bit more about what you guys do and how you do it perfect.
Erica Lloyd (07:20) Thanks, James. Appreciate that. A couple of things to unpack but I guess just let’s just, I think before we jump in there, let me just step back. I know it’s a little awkward now to do it but I’d love to just kind of set a goal here for us. So I think really as you said it, James, we can provide an overview of medallion and I think even higher level and credentialing as you’re talking about a topic. It touches all avenues of the business. So let’s make sure we kind of touch on that as well. We can really just see if it makes sense to continue the conversations. We kind of had a hypothesis and where we think some of the challenges could be. So we’d love you to fill in some of the blanks also if that works for you. And then, yeah, if things progress forward, the next steps would be myself and one of our lead solution consultants leading a more bespoke product demo based on the product SKUs, that would be of value for you at this point. Does that sound good? Yep? Okay. And so, yeah, pricing model just to we can go down funnel, we can go through that as well. We have a consumption based model. So we just understand like what products would be in scope for you, the volume, and then we can put an estimated price together for you as well.
Erica Lloyd (08:37) So I guess kind of starting off when you’re talking about three people, you have 80 providers, are you utilizing any type of technology today to assist with this process? No… no software or anything like that.
James Aviles (08:52) No, yeah. They’re doing it kind of they’re doing it manually. We had looked at. I forget the name of it. Maybe before the pandemic, of like a software that took a let’s call it like an insured, like a packet and it mapped all the fields out. So when you had the next provider, it would, you know, populate those fields. They are using. What is it the chqh or I forget the acronym? Sorry?
Erica Lloyd (09:17) Okay. Yeah. The caqh database. Yeah. So where the provider data is housed. And so, yeah, we have integrations there as well. So I guess just to ground us on the conversation. So we work with around 350 plus provider groups and we essentially kind of modernize the way that credentialing payer, enrollment, privileging, licensing are completed. All the manual things that you need to get a provider credential billable and ready to start seeing patients. So, and I can kind of double click into that. But I think some of the biggest areas that we support are, and this will probably hopefully resonate with you as well. Is a lot of times folks who are doing a manual process are struggling with the time it takes to get your providers in network. So with the payers and that’s leading to revenue leakage challenges with speed to market, as you were saying market share. So it’s not like you can put flyers out. So when you have, a provider come on board, it’s probably essential that they’re able to see patients as quickly as possible. The opex of having people do it. Everyone’s looking for automation and ways to do that faster. And then just like reporting capabilities. And how do you have access to the data points that you need? That I’ll share? I could, I don’t I could share one one slide here. I won’t do death by powerpoint. But any… of these that kind of resonate… more with you… James, or just.
James Aviles (11:01) Sorry that the screen came improved provider productivity eliminate. So the first one resignates operational cost, growing the provider network. I mean, they all caring for patients improved broad. Yeah, I mean, they all resignate equally, probably sorry that, you know, but the speed to market, right? Like, you know, accelerating onboarding providers that’s probably the, you know, the biggest thing, you know, as, we are on a, you know, hiring and we have like three different headhunters right now that I’m looking for, you know, different providers. And it’s an issue where, you know, sometimes, you know, if we don’t get their malpractice, like we’re signing them up because then, I gotta get the malpractice to get the insurance and it’s like, this cascading effect. And if it’s not done timely, you know, I could have a provider show up and like you said, there’s they’re just twiddling their thumbs, you know, cause they’re not contracted, right? So, so speeding this process up is, you know, of extreme importance, okay?
Erica Lloyd (12:11) So, are, you, do you know, have you quantified how long it takes today from the time you hire a provider until the times are effective to start seeing patients?
James Aviles (12:23) I want to say they kind of start like almost, they start at minimum like two to three months in advance. So, you know, and the sooner, you know, the more time they have, the better… and then they’re even when they’re onboarded, they’re still, you know, applying to places even after the fact?
Erica Lloyd (12:45) Oh, really? Okay. Are you losing providers because of that? Because of the time it takes to get them in network?
James Aviles (12:53) Not losing them, but they’re not happy for those first couple of months because they’re so slow. Yeah.
Erica Lloyd (13:00) And there’s definitely a provider shortage and it’s the type of providers that you’re hiring? You said the orthopedists, so these are like really in demand like orthopedists, mental health, MDS, pas, NPS, yeah, not.
James Aviles (13:15) Nurse practitioners, but definitely pas, you know, MDS dos, yeah. Okay.
Erica Lloyd (13:26) And then you said cascading effects. So typically, when people are looking at medallion or looking at some kind of technology investment, they quantify like, okay, if we can make this type of investment, I’m sure your brain’s thinking that way. Have you quantified like the amount, of… times a provider, like the delays in having a provider start like, if we’ve lost X, number of providers. And I guess what I’m getting at there is typically medallion can compressify around at least 50 percent or so the time that you’re that you mentioned that two to three months. So our tip, our turnaround time is typically for non delegated three year means around 52 days to get them in network. And so each day that you can generate revenue, typically for the specialty, we’re seeing anywhere from a 1,000 dollars per day to 5,000 dollars per day that the provider can generate.
Erica Lloyd (14:20) So if we could do that faster compress those timelines that’s obviously some revenue leakage that you could recoup this type of investment. And then the other thing is like claims denial. So as you’re talking about, you get a provider, do you put them on bench or do they see patients? And then you have to backdate a claim or write it off?
James Aviles (14:41) No, they, because we have such a wide network, what we’ll do is we’ll send those patients to other providers. So the patient still gets seen, but that provider that let’s call it the new person, you know, just their patient load is extremely low, you know, so we’re trying to speed that up so that, you know, when they come on board, you know, that they’re they have a good amount of patients, you know, within the first month, so.
Erica Lloyd (15:10) Okay. And okay. So there, there are not just you’re just putting them only like, as they get in network, with a payer with like one payer, then they can see only those. Okay? And that can always be, yes.
James Aviles (15:27) That’s correct? Okay?
Erica Lloyd (15:28) That’s always a fun scheduling challenge. Yeah, Josephine, I see you’re laughing at that one. Yeah, that’s always someone, a fun one is like, okay, well, how do we know who’s in network with which payer? How do we? And then if you, if they see a patient, it can a lot of times end in a write off or a denial or something like that. And you were talking about workers’ comp, are the payers that you’re working with? Are they mostly government payers, commercial payers mix?
James Aviles (16:02) A mix but more commercial less government like, you know, we work with the usdl, but probably the biggest payers like… scif or, you know, that’s probably, you know, southern California. I think I forgot the insurance fund or state fund, is the other name for it. So state fund’s a big one for California. Sedgwick’s another big one. But yeah, we work with a lot of the commercial payers. Okay?
Erica Lloyd (16:35) And so they probably, they’re they, we… work, we, like I said, we work with both government and commercial payers. They sometimes are more sticklers about backdating claims than the government payers.
James Aviles (16:50) Yeah. So that’s why, we, you know, we’ll send the patient to a provider that’s contracted, you know, and once they get contracted, then, yeah, we’re not backdating anything like that. Okay?
Erica Lloyd (17:03) And so, and because when you’re talking about hiring, I would imagine if you had with the number of providers, that you have right now with ad providers, you probably don’t have any delegated agreements you’re probably doing direct enrollments.
James Aviles (17:17) I don’t have that detail. So apologize that would probably be, I sit higher up. So, sorry, I don’t have that detail.
Erica Lloyd (17:27) Yeah, like, yeah, we don’t have to get into the weeds there. But the reason I was asking is because if we have typically, it’s like at least 100 providers or so. And then we, if we get delegated, we can typically compress those timelines even further down to like three days, to be able to get a credentialing file ready. And that’s where you can obviously see some really big cost savings there. When you were talking about the hiring that you’re working with some headhunters to get more providers. Do you know what the forecasted hiring looks like?
James Aviles (18:02) I wouldn’t say it’s something like that, but, you know, we get a number of people to our desk, you know, and then there’s you know, a courting process that kind of happens. You know, we, sometimes, you know, they want to come with us and sometimes they don’t you know, so, but, you know, they’re helping with the introduction. Okay? But do.
Erica Lloyd (18:21) you know, how many providers you’re going to be hiring? Like if it’s are you going to be like doubling or tripling or is it just backfilling normal backfilling like providers that leave, or do you know what that looks like?
James Aviles (18:34) You’re asking what our growth rate is for the provider?
Erica Lloyd (18:37) Yeah. Sorry, that’s probably a better way to explain it. We.
James Aviles (18:41) Probably need an NDA, you know, before we proceed forward with that question, okay?
Erica Lloyd (18:47) The reason and we, do you want to have an NDA you want us to use or we can use one of our, we.
James Aviles (18:55) Have one. We could send you, no problem. Okay?
JosephineCheatham (18:58) I mean, do we need to tell you that to see your product?
Erica Lloyd (19:01) No, that’s okay.
JosephineCheatham (19:03) That’s where I’d like to kind of see it before we start deep dive into some of the statistics.
Erica Lloyd (19:09) Yeah. Of course. The reason I was asking that is because we have a consumption based model each we charge per provider, and we charge. So we charge per provider to get a seat on the platform. We don’t charge for administrative users. And then so obviously, like the growth rate would help inform a price. And then also, if you’re doing payer enrollment, the number of providers times the number of payers that they’d be, we would be completing the enrollment with would also impact what the pricing would look like.
JosephineCheatham (19:40) Providers we onboard with your tool or all of our providers that are already certified.
Erica Lloyd (19:48) Good question. So it’s kind of twofold so to actually have a seat on the platform, any provider that you have whether they’re new or existing would require a seat on the platform and it’s because that would be we were provider data management. So we would store all their files and they would need a seat where the cost is much more incremental or sorry, it’s like much bigger cost is when you’re hiring new providers because then we’d obviously need to get them enrolled with payers. And that would be there’d. Be a cost there. Yeah, just some insight into that. So the, I… guess just giving you a little more insight. So managed service, we use AI automation to complete around 80 to 90 percent of the tasks which is going to reduce costs and human error. And then we have hands on experts that are going to execute the parts that need human oversight for compliance. And because of this process that’s how we’re able to come to these outcomes. And I think it’s really important to highlight that we have contracted outcomes. So we have slas in place especially with payer enrollment to be able to really accurately forecast your business and know when these providers will be in network, our aggregate, we could book up each payer. But for the state of California, our aggregate is around 52 days for non delegated agreements to get providers in network. And typically, we see anywhere from if you’re you know, two to three months, you’re saying we typically see 90 to 120 days plus for both commercial and government payers, sometimes with the with like a medicaid or medicare, you can see that even higher, for those.
Erica Lloyd (21:33) So we have direct relationships with those. And so the couple of different ways. And again, we use automation to do quite a bit of it. We’re because of economies of scale working with over 350 different provider groups, we can submit via roster. And this can obviously give us some economies of scale there. And then direct payer relationships with payer process guides, knowing exactly when to follow up. And then we also even do AI phone calls, AI automation things to accelerate those timelines as well because there’s kind of only so much you can do from a human lens to compress costs. So, and then I’m not sure. And, these are the product SKUs that we have an offering for. And do you, are you, it sounds like, the main ones that would be in scope for you. We provide our data management. So that’s a seat on the platform payer enrollment. So enrolling. The providers with the payers, is that, was that something that would be interesting to see?
James Aviles (22:42) Sorry, I missed it. Someone came to my office, go for it.
JosephineCheatham (22:46) Josephine, yeah, I don’t, we don’t do our credentialers. They’re not enrolling the payers, we are in our billing, is that, am I missing something here? Are?
James Aviles (23:00) They doing it, enrolling? The payers? No, they’re yeah, they’re credentialing, people are doing the, they get the relationship, with the payer itself. And then, they got the providers to credentialed with that payer. Okay? Just curious on a separate topic. And I apologize if we haven’t answered your question, but do you guys do anything with contract negotiations?
Erica Lloyd (23:25) We, we don’t okay. We don’t do it that side.
James Aviles (23:30) Because you’re in the industry, I’d just like to ask, do you know of any companies that do?
Erica Lloyd (23:35) Let me ask one of our solutions consultants because I know there are companies that do that. It’s just not something that we do, but I can get back to, I can ask and get back, yeah.
James Aviles (23:44) No problem. I’m just, you know, you’re in the industry. So, yeah, did we answer your question or do you want to ask it again in a different way? Oh.
Erica Lloyd (23:56) I’m just like, so, for the demo, so we have just to make sure we’re aligning on the correct product SKUs for the demo. I just want to make sure we have the right ones. So provider data management. So we’re end to end, provider data management. It sounds like, are you just tracking all of this on excel right now? A?
James Aviles (24:15) Lot of it’s on excel. Okay? So hold on for one second. Sure.
James Aviles (24:47) All right. Sorry about that.
Erica Lloyd (24:51) Oh, good. So, yeah. So we’re end to end, provider data management. It sounds like you said you’re doing this on excel spreadsheets today?
James Aviles (25:01) Yeah, very, it’s all manual. So, I mean, they’re printing out papers and filling them in and then using, you know, Adobe PDF filler, you know, for some of these tried it once before where, you know, and I think they’re a little bit. This is before the pandemic. I forget the name of the company but, you know, they did some type of credentialing, you know, automation, but it was an on premise server that we had to have and, you know, we scanned in our forms and, it then, you know, you mapped out what the fields were, and it then at that point, you could put in the new doctor and write it. It made it faster. So, yeah… but what other questions do you have? I do have a hard stop at three 30.
Erica Lloyd (25:52) Yeah, this was, I just was, it sounds like provider data management, ongoing monitoring probably is in SKU, if you’re doing that manually checking for continuously checking for sanctions, oig, Sam different things to, so we could, we can show you that one payer enrollment. Like I said, enrolling them, credentialing would probably not be because that’s for delegated agreements and it sounds like they’re not, are these providers are not going to see patients in hospitals at all? Correct?
James Aviles (26:21) No, they are, they, well, they do well. They do surgeries at surgery centers. So how does that work?
Erica Lloyd (26:26) Okay. So then are they probably would need to have be privileged or appointed, at those hospitals?
James Aviles (26:35) Yes. Okay. So.
Erica Lloyd (26:37) It’s a really similar process to payer enrollment. We, that is a service that we offer as well. So getting the, we call it hospital applications because you don’t own those hospitals obviously, right? Okay.
James Aviles (26:46) No, yeah.
Erica Lloyd (26:48) So, if you do not own those hospitals, those are what we call those hospital applications very similar to payer enrollment from a process standpoint, that can typically be a very challenging process, getting them appointed and privileged at the different hospitals. So we can show that one. And then licensing. So if they’re I don’t know if the providers take care of their own licenses or if that’s a service that you provide for the, their providers for the providers, I think.
James Aviles (27:13) You know, a lot of them come, but I think we do help them. So, you know, we keep track of it and I think the staff there do help in some capacity. Okay?
Erica Lloyd (27:25) So we could do license expiration monitoring as well. Okay? So I think as a next step, then we can show, we can showcase a demo so you can actually see the technology with these specific product SKUs? Does that feel like a, would you like to continue on with the conversation?
James Aviles (27:45) Yeah. And I think just before the demo, if there, I just would like to know, you know, roughly, you know, how much if there’s any list pricing that you might be able to give us, I don’t want to waste your time or ours either. So if we could just get some type of pricing or some exposure to that, that’d be great. Yeah.
Erica Lloyd (28:05) Absolutely. Why don’t we do that? I can. And so why don’t, I get, I can get an NDA in place because we’d have to do a little bit of scoping typically folks either reallocate some staff because you wouldn’t need three, three folks. Either they reallocate some staff if they’re using software today, you know, if they switch softwares, and then I have revenue implications where speeding up time to revenue is typically where people find budget for something like medallion plans typically start around minimum of like a 50,000 and plus some implementation depending on where that is.
Erica Lloyd (28:43) So it’s less than, you know, less than a full time employee. And then what, you know, depending on the services that would be included in the scoping. Okay?
James Aviles (28:53) All right. Sounds great. Looking forward to the next steps. And I’ll send you our NDA too, and we’ll go from there. Okay?
Erica Lloyd (29:00) Sounds good. Just while we have, you, do you want to schedule that now? Or do you want us to do that over email? So you can loop in Eva?
James Aviles (29:08) Yeah. I’d like to loop in Eva. So let us get back to.
Erica Lloyd (29:12) You? Okay. Sounds good. All right. Well, it was good to meet you both. Thanks for the time.
James Aviles (29:17) Pleasure. Thank you. Take care. Bye bye.