Transcript
Joshua Levitan (00:00) Nick.
Nick Scallion (00:01) Hey, what’s up, man? I’m letting in Mike.
Michael Fitzpatrick (00:17) Hey, Nick. How are you?
Nick Scallion (00:19) Hey, Mike. I’m all right. How are you? Not bad. Huh? It’s a time it has been. Did you have a good Easter?
Michael Fitzpatrick (00:28) I did. It was a great time we host here. How about you?
Nick Scallion (00:32) Start of Easter weekend was good. Got some family time, watched the March madness yesterday took a turn. My kids had the stomach bug last weekend thought we had rid ourselves of that. And then I got it yesterday. So I was down for the count while my pregnant wife was carting around my two children to church and family and stuff like that. So not great. We’re on the mend now and feeling a little better.
Joshua Levitan (01:01) Wait, I’m sorry, I need to interrupt, Michael. It’s a pleasure to meet you. I’m Nick’s coworker here, but we talk four times a day. Nick. I didn’t know you were expecting.
Nick Scallion (01:12) Yes, that’s right. Congrats.
Joshua Levitan (01:14) Brother. Yeah.
Nick Scallion (01:15) Thank you. Yeah. So we got boy girl and now girl coming late summer. So right in the thick of it, no dull moments seems.
Joshua Levitan (01:26) Like this is something we could have chatted about. I want our one on ones, my man.
Nick Scallion (01:30) I know dude. We’ve been busy. We’ve been busy but yes, I appreciate it. Thank you.
Joshua Levitan (01:34) We have been busy. Not to mention, I’ve been out for two weeks that’s right. Nice to meet you. My man. Josh. I ride shotgun here with Nick a little bit more about technical context translating between business value, software, paying industry, all that good stuff.
Michael Fitzpatrick (01:51) Excellent. So.
Nick Scallion (01:53) We probably, I’ve been chasing you and you’ve been saying, Nick stay at bay for a little bit while I get stuff figured out, which I totally understand.
Nick Scallion (01:59) Hopefully I wasn’t overstepping there, Mike. So just pumped that we’re reconnecting now and I know that there was basically there was a lot of other items related to the shared service projects, credentialing and payroll and being one that was important but kind of trying to get some other ducks in a row. So maybe we kind of get a sense of kind of what’s been moving Mike and how that impacts picking this project back up and then kind of see what makes sense from there.
Michael Fitzpatrick (02:23) So on our side, I don’t know if it’s been, maybe I can’t even tell you how long it’s been that we’ve connected, but we’re expecting for at least the larger mso initiative to start to move through the executive or the senior executives councils… or approval kind of mechanisms. At this point, I don’t have anything on what the pulse or the color is on whether that’s going to move or not. Yep we should at least have some better clarity or direction within the next. I’d say probably two weeks or so.
Nick Scallion (03:03) Okay. So basically, I assume you and probably a couple others on your team are kind of creating like a thesis or like a vision for what this would look like. And then you’re kind of going through like getting some other perspectives and approvals on kind of like vetting that and going to the next step. Is that sort of what you foresee?
Michael Fitzpatrick (03:21) For the most part, so that’s the overarching framework or foundation is already kind of compiled put together and has the support of say one of the six or seven executive vice presidents.
Nick Scallion (03:37) Okay. The.
Michael Fitzpatrick (03:38) Physician, medical groups and all of the affiliated entities. So he’s essentially driving that one through. And if that moves forward, then we’re likely going to see some, you know, restructuring and that would define, you know, overarching next steps for all of the shared services.
Nick Scallion (04:00) Okay.
Michael Fitzpatrick (04:00) Likely being one of them, okay. For immediate change. We have an executive joining us over the medical staff office. Okay? Who will be privileging, you know, cross functional with insurance based credentialing here. I believe she’s set to start at some point this week. So I’d give it the next two to four weeks will really help to define what comes next. Okay?
Nick Scallion (04:30) The, there was one thing related to all of this. Obviously the shared service, larger product was kind of the reason we were pausing things. But then you had also mentioned there was kind of some balls in motion with finishing up getting delegation for a lot of the other payers that you were working with. I know you were like primarily delegated, but then there was kind of some onesies and twosies, with some of the entities that weren’t delegated. You figured that would probably make an impact on like the scope of work and what’s direct enrollment, what’s delegated? Did you guys, how did that kind of resolve itself? Sure?
Michael Fitzpatrick (05:02) So for our, we’ll call it the flagship medical group, we are affiliated with. All that… we can be at this point. So all the majors are in and then we have, you know, your individual plans who either do or don’t so there still will be some manual application processes, you know, governmental things of that nature for the other entities. A few more of the majors are on but not widespread. Okay. So there still will probably always will be a mixture of.
Nick Scallion (05:34) Yeah, that makes sense. And I say that just because that, you know, when more delegation becomes more widespread, it reduces the number of enrollments that you guys are sending out on a month to month or year to year basis. And that’s sort of the construct of our pricing, right? So like some organizations will kind of do like per provider, right? And our pricing is going to be more service based, right? So how many payer enrollment applications are being sent out or credentialing files are being generated, rosters being submitted, that kind of thing. So we can as it makes sense, revisit kind of the scope of work that we looked at last summer to see how that impacts pricing. Assuming things go well in the next couple of weeks. And there’s kind of buy in to look at each of these elements, credentialing being one of them. Do you already have like a level of confidence that medallion is a good way to go? Or is there going to be like kind of like an RFP and re engaging other vendors? Like what is, what does it kind of look like? Assuming that, yes, we want to improve the credentialing function. We’ve talked to one or two other vendors, like where do you kind of go from there specific to this swim Lane?
Michael Fitzpatrick (06:35) So I don’t think, I don’t think we have that outline just yet. I think that would be the next step on whether it is going to be an outsourced solution or if we’re looking to either improve or supplement what we have internally. And that’s where the medical staff office essentially folds in the overarching picture. Just remind me, from the medallion perspective, are… you all also, are you like ncqa for primary source verification?
Nick Scallion (07:07) Yeah. That’s right. So we, in those instances, we would be the sub delegate for those plans that you guys have. Okay?
Michael Fitzpatrick (07:16) Do you, also, do, I guess primary source verification for like medical staff privileging or is this? Yeah. Okay. So then, yes, then, that is going to be probably the next step on… determining if the organization itself is going to become an ncqa, CDO, yeah, source it internally or if it makes sense to outsource the entire picture, right? Not just the insurance credentialing piece that.
Nick Scallion (07:47) Makes sense. So, and I try to dust off my notes a little bit. So, you guys were using healthstream with the internal team for your non delegated enrollments, but then you had a third party that was conducting the psvs for you guys, but they weren’t like a full end to end CDO. What did that look like? Again? Remind me just for that piece, correct?
Michael Fitzpatrick (08:07) Internally, we were using prudential stream or healthstream. For I’d say all just about all of our insurance credentialing workflows, roster board delegated, and just the system of record for all the physicians credentialing med staff villages, et cetera. Yep, there are two of our major facilities that are not yet fully utilizing prudential stream. There’s a lot of balls in the air in terms of sequencing what needs to happen first before a larger decision is made on who’s going to do it.
Nick Scallion (08:46) Okay. So.
Michael Fitzpatrick (08:48) We’re bringing up or at least the executive… over the med staff office is tasked with getting everyone onto the systems.
Nick Scallion (08:57) Right.
Michael Fitzpatrick (09:00) Either building or outsourcing, or buying a solution for CDO?
Nick Scallion (09:08) Okay. Use.
Michael Fitzpatrick (09:09) A third party vendor for primary source verification, license, credentialing, things of that nature? The med staff also does something similar, yeah, where there’s obviously overlap. We’re doing the same thing twice for physicians running through that process. So that’s the kind of internal alignment.
Nick Scallion (09:30) That comes next.
Michael Fitzpatrick (09:31) And as part of that, then the evaluation phase of do we keep it internal, right? Build versus buy? Okay?
Nick Scallion (09:40) That makes sense. I think when we had spoken last summer, we were at the time only talking about the insurance credentialing, both direct enrollment and delegated cred. We didn’t really talk about the med staff cred. So if… the consensus is that maybe you want to work with a single vendor that can handle all three, we’d probably want to start opening those conversations up a little bit because I don’t think we’d really had any discovery on what. And I’m sure you folks are probably following the same accrediting bodies as everyone else, right? And general processes, but we can open that up so that, yes, we can include both med staff and insurance credentialing or just one. So think of it as like we can be a la carte in that we can kind of fit in this however you folks so choose. So may make a lot of sense to have one single vendor and the data housed within one area, right? Like we can talk through some of those benefits. But if you guys decide MSL wants to keep doing what they’re doing, but we do want to think about things differently on the enrollment side and the delegated cred side, then we can also be on that path too.
Michael Fitzpatrick (10:36) Agreed. And that’s essentially what we need to determine first before any of these conversations start to press or become truly meaningful. Yep, where at least what I see from the system perspective is we’re looking for alignment across med staff privileging and insurance enrollment, right? It just makes sense at our volume scale, okay?
Nick Scallion (11:00) That makes sense. I’ll and I’m sure it’s been ages I can bump the, and I’m sure that some of this will have changed. Maybe your turnaround times or staffing have changed internally. But the analysis that we looked at is that I think if I was going to just try to give a couple bullet points to support the narrative, if there was an appetite for paranormal and credentialing to look differently and using a vendor, right? With the way that we’re automating things, right? Like humans do still have to be in the loop whether it’s for mcqa or state board. So like there is a human element where we will have some operational staff that are checking some of those boxes but where we can automate, right?
Nick Scallion (11:33) It’s requiring a lot less admins to be in scope. So what we were looking at is that and I forget how many admins we recommended, but it was probably, you know, two or three probably for your scope of work could be done to support that. So, the idea being that the total cost of ownership admins plus software would be substantially lower with medallion with the primary fee really just being our investments since you’d only need a handful of administrators that are really kind of just ushering providers through. Hey, if I can fill out this link medallion’s already pulled, you know, X data here, like the five or six things that you need to provide and then click a couple buttons who need to be enrolled with medicare medicaid and these delegated plans. So there’s that idea of the total cost of ownership going down with medallion. And then just as a refresher, the turnaround times, right? For both like delegated credentialing, we’ll promise to have a full ncqa packet, not just the psvs but the whole file ready for your committee within three business days. The average turnaround time is one. And then on payer enrollment, we can SLA to two different metrics one being the time it takes to submit applications to the various payers via their preferred mechanism. So that could be like Pecos snail mail, email, whatever that is or the total time to get a response time back from them. And when we had originally looked at your turnaround times, I think they’re between like 60 and 90 days. And then we looked at like the top five to 10 plans that you guys were doing direct enrollments with those were closer to about 40 days for medallion.
Nick Scallion (12:56) So the idea being can we do this cheaper, right? And then can we also have guaranteed outcomes in that they’re protected on the? Turnaround time, so that’s the benefit there. It is a lifted shift though, right? Like you guys are doing this in house today. So there’s naturally going to be a little bit of a shift there. But that’s where we’re pulling and so anything that we can do to kind of support the narrative, if you guys are getting some momentum after these next conversations, we can dive in a little bit deeper to make sure that this is reflecting current state, not what it was nine months ago and kind of go from there.
Michael Fitzpatrick (13:24) Yeah. No, that makes sense. From the SLA standpoint, that is when you have all of the information, right for a complete file. Yeah.
Nick Scallion (13:34) So that’s yes. So both of those are both of the slas kick in. When a request is being done. A request can be done after a portion of information has been received by the provider. So they need to have a fully completed profile, but they got to get us something. And so typically that trigger Mike is going to be like when we get the caqh integration done. So like their first name, last name, npi… and social, and then that’ll basically build out the start of a profile like 70 percent of the information we need for direct enrollments. So once we’re kind of getting the profile started and ingesting that information from caqh, that’s when we can start making some requests. And then, yeah. So once a request is in that’s when the timer starts.
Michael Fitzpatrick (14:14) Okay. And you’re sourcing, are you sourcing information from anywhere or is it all coming from all certifications or those admins as you mentioned, so?
Nick Scallion (14:24) Caqh is the primary. So we’ve got a few different data sources that we’re looking at like mpez as well. But like caqh is going to be the primary point where like if we get, and we can even show you this on like a demo. If we do that welcome email, it’s like, hey, dr Mike atlantic is partnering with medallion. We need you to go ahead and create a profile. So you can give us these four data points. About 70 percent of the information that our full profile needs is pulled directly from caqh. So, the idea being that like, instead of getting the application that most physicians are getting, where it’s like, hey, fill out 100 columns worth of data and attach these 12 documents. We’re pulling everything in caqh, which most of these providers are going to have up to date profiles. If they’ve been billing at any point recently, right? Josh, anything to add to that, yeah?
Joshua Levitan (15:07) Caqh is the main source. We’re also going to verify that like because we have all of these, all this infrastructure to run primary source verifications in an automated way like obviously, for a cred packet and security rules, we have to have a human verify that before it gets put on a cred packet that goes to a committee. But we’re using the same data sources to basically verify what we’re getting from caqh as well before you even get to like a cred packet or anything like that, just to make sure that we understand.
Michael Fitzpatrick (15:35) It, so the critical dependency is one, a populated caqh profile and two, if that information is up to date and accurate. Yeah.
Joshua Levitan (15:45) If it’s not populated or if it doesn’t exist, like if someone is straight out of residency, we’re going to use like more rudimentary but still pretty quick tools to try and get data in. So a lot of that’s like document scanning that then has optical character recognition on top of it. So scan your resume, right? We’ll pull that all in. And then throughout the entire process, we’re going to basically compare like a golden record to what exists for the provider right now. And if they’re missing anything, we just auto task that out to them and say, hey, you know, please upload this document or like, hey, we noticed a work history gap, you.
Nick Scallion (16:17) know, provide.
Joshua Levitan (16:20) Some information, but there’s calls to action in there in our app via email. Sometimes depending on what customers want, we’ll call or text using our AI agents to try and reinforce that message as well and bring those cycle times down. Again. It depends like for someone like yourself, right? Like cause you’re doing a high level of verification. When we’re talking about medstaff and ncqa, we’re going to clean all of that up. Anyway, at that point in time, there’s going to be accurate information there has to be in the earlier stages or for customers that might be focusing mainly on pay enrollment or something like that. We want to verify as much as possible, but we don’t want to create too much legwork in terms of unnecessary oversight. I think this is a good point in general too. As we move forward in these conversations too. We’ll probably try and map out your process on a visual flow. We’ll say at what point is, what data critical? We know it’s all going to be confirmed at the end. What do we need at what point? If you need medicaid enrollments? And those take forever. Can we start pushing something like that out before we actually verify everything to med staff standards including case logs and peer references, et cetera. Or do we need to based on your bylaws, make sure that we do the credentialing first and then start hitting other aspects. So there’s a lot of variability but there’s a lot of different ways we want to use the platform and make it match your bylaws, your policies and your workflow, not uproot anything that you’re currently doing just because of a tool switch that’s the underlying mentality and.
Nick Scallion (17:53) obviously in parallel, all.
Michael Fitzpatrick (17:56) of the initiatives, the efforts on our side are to revamp all of these processes because.
Joshua Levitan (18:01) They.
Michael Fitzpatrick (18:02) are they’re contributing to?
Nick Scallion (18:04) The.
Michael Fitzpatrick (18:05) delays and the reason for this conversation?
Joshua Levitan (18:07) Yeah. And look, I think there’s advice that we can provide there, but we try and fancy ourselves not as consultants but as an operational layer that takes away the mundane. We don’t want to dictate to you. We can certainly provide best practices. What we see work with other customers, like what we see work with the modern tech stack. But we’re not branding ourselves as like this is a consulting engagement where we’re going to tell you how to operate. It’s. Like we want to support the pieces of that operation that are incredibly low value time consuming work that’s manual and repetitive, and use that as a way to enable whatever the next generation of your evolution, you know, with growth is.
Michael Fitzpatrick (18:48) Okay. Thank you for the refresher. I think over the next month or so, we’ll hopefully have some clarity on this side and then we will… reconnect and I’ll introduce you to a few more of our stakeholders and folks here, we’ll go from there all.
Nick Scallion (19:06) Right. Let’s do that. And I’m just going to make just a trailing remark after josh as well. Just what we hear with a lot of the other vendors in this space, payer enrollment data, right? When they’re effective, when they’re up for revalidations, can kind of be a telephone game or hard to retrieve internally. So, as I’m thinking about, you know, I don’t know what else is going to go into sharing service. But if there’s anything with billing, scheduling, things like that, right? Just want to mention that being a tech first platform, right? We do have a bi directional API so that information can speak with itself as opposed to just having to talk to whomever in the mso office. Hey, when is so, and so up for revalidation? Are they par with so and so, right? This information can be more readily available at folks’ fingertips. So just want to mention that piece as well as you’re thinking about kind of modernizing the approach. So, Mike, anything else top of mind before I let you run, might be able to get a couple minutes back for you?
Michael Fitzpatrick (19:52) No, I think this was, again, this was helpful and once we start putting the pieces together?
Nick Scallion (20:00) Cool. All right. I’ll do this.
Michael Fitzpatrick (20:02) We’ll really dive in, I’ll.
Nick Scallion (20:04) Do this. I’ll just bump that slide deck just because as you’re having these conversations, you might want to just think about some data points that are going to support one way versus another. And I think hopefully this will give you an idea of how we’re thinking about this from our point of view with other customers. So I’ll bump you that slide deck. And then, yeah, I guess sounds like next two, three weeks end of April, probably a little more clarity about what’s next. So looking forward to it, please let us know what the feedback is good or bad would love to just have the ability to respond and put our best foot forward.
Michael Fitzpatrick (20:32) Of course, we’ll do. Thank you. And just again, for clarity, if we’re not looking at a full solution, there still is point to point based depending on which area we wanted to fully outsource if that’s the case, yes, that’s the level that we’re at this point, right? One is determining overarchingly if we’re going to do it, how we’re going to do it. But knowing that there’s flexibility if we already know there’s one specific area that’s where we could either start or then that becomes the overarching solution with the down and middle. Yeah.
Nick Scallion (21:06) Got plenty of customers that for one reason or another are only willing to start with a piece of the pie, right? Medallion, just do our direct enrollments medallion, just do our cbo medallion, just do our mdstaff credentialing, but right, once we get that, I think the good news is once you get that initial data into the medallion system, right? The implementation becomes a lot more smooth if we want to start any of those other processes because the biggest lift is just getting that provider data into the system. And then it’s maintenance from there on out, which is a really low lift. So, yeah, kind of a land and expand is certainly within scope if that makes most sense for you guys.
Joshua Levitan (21:39) Excellent. All right. Thank you all.
Nick Scallion (21:42) Right, man. Thanks so much for the time. Mike. We’ll talk soon. I’ll send you this note and we’ll chat here in a bit. Have a good rest of the week. Thanks guys.
Michael Fitzpatrick (21:49) Have a good.
Nick Scallion (21:49) One. All right. See you bye.