Transcript
DeWayne Hiebert (00:00) hey, Duane.
Peter Bosworth (00:02) How are you?
DeWayne Hiebert (00:03) I’m doing okay. How are you?
Peter Bosworth (00:05) I’m well, thanks doing well.
Peter Bosworth (00:12) So, sorry, I’ve been in back to back meetings, but a few things, I know that we’re I think you said you were out of office next week or we missed our cadence. So we’re doing this week and then we’re following up again.
DeWayne Hiebert (00:31) Yeah.
Peter Bosworth (00:34) We.
DeWayne Hiebert (00:35) met last week because I asked the week before I had a conflict and so we wouldn’t normally meet next week anyway, but I am out all next week and then we’d meet again the following week. Yeah, I couldn’t remember what we decided if we were going to keep our call today or not, but it was on the calendar, so.
Peter Bosworth (00:59) I’ve got some, I think we can make good use of the time. I think our next meeting is may fifth, but we will, you know, I just sent a, I just sent an email that was just the email that went out to all of our customers about the increased caqh sync fee that made it seven dollars and 35 cents. So that’s in your inbox just so, you know?
DeWayne Hiebert (01:27) I just saw it pop up.
Peter Bosworth (01:30) And then.
Peter Bosworth (01:36) Any questions on that?
DeWayne Hiebert (01:42) Do you, do, you know, was it free before I can’t and now it’s seven 35 or was it some lesser amount?
Peter Bosworth (01:51) It was, we just, yeah, it was free before we just absorbed the cost. Okay? This and again, you will only incur this cost if you are leveraging.
DeWayne Hiebert (02:08) It.
Peter Bosworth (02:10) okay. Yeah.
DeWayne Hiebert (02:13) And I guess just… to make sure we’re not… doing things frivolously. It’s it’ll be seven 35 every time that we would do an update.
Peter Bosworth (02:28) Or is it just a virtual connection?
Peter Bosworth (02:36) That’s a good question.
Peter Bosworth (02:42) I believe it would be. Let me, let me caqh. Sync.
DeWayne Hiebert (02:57) Yeah, hopefully, not the second bullet there talks about this is a cost we would have incurred if we created our own.
DeWayne Hiebert (03:08) Account. So, hopefully, it’s a one time thing, but.
Peter Bosworth (03:15) Yeah, per provider per year.
DeWayne Hiebert (03:17) Okay. Based.
Peter Bosworth (03:19) On when we actually initiate the import. So you imported, if you initiated on April seventh, you’ll… get charged seven 35, but you can do unlimited syncs.
DeWayne Hiebert (03:31) For the rest of the year until. Okay. Yeah. Right. That’s good to know.
Peter Bosworth (03:37) Yes. Okay. So then my next item… was wanted to just share a few slides on our roadmap, if that’s something just to give you some visibility into like how we’re thinking about the rest of the year, and automation, and happy to answer any questions you might have on this as we go through it. But if that sounds good?
DeWayne Hiebert (04:07) Sure. Yeah, always interested.
Peter Bosworth (04:10) Okay. So, yeah, this is something… that’s relatively new but big… initiative for medallion is incorporating more agentic AI into our workflows. And what we, I’ve always believed is just that like AI in healthcare, there’s been concern about the lack of oversight, and we certainly are aware of that concern and do a lot in terms of how we’re using these workflows, everything is monitored by a specialist to reduce compliance risks. So just wanted to name that off the bat. But yeah, we are, the whole medallion kind of business model, is contractual outcomes, right? So we’re not just leveraging AI for the sake of improving our own team’s efficiency. It’s so that we can get you to par faster. And so some of the outcomes we’re driving on our Q2 roadmap. So faster time to revenue through AI driven execution. This would be some examples of this are.
DeWayne Hiebert (05:25) ways.
Peter Bosworth (05:25) in which we’re automating payer follow up, really want to reduce the burden of the provider experience. So the caqh sync, you know, right now, we also have the resume scan that we can do, and then, yeah, supporting just enterprise organizations with all of these different workflows. So, Q1 results… we’re constantly adding the amount of applications that can be automatically generated and filled using AI. The challenge of course, like with medallion and with payer enrollment is that all of these different payers have different applications. And so it’s mapping to each specific state and each specific payer’s application. The AI follow up has been going on kind of on a per payer basis. But do.
DeWayne Hiebert (06:25) you know, those… applications like for our three states, do you have a list of those payers that qualify?
Peter Bosworth (06:42) I had, I shared, the list of states that we’re doing the rosters for which was kind of falls into this ways in which we’re leveraging automation. I can check, oops, how we’re on this part too. Yeah. Let me, I don’t know that off the top of my head, okay?
Peter Bosworth (07:14) Just take a quick note of that.
Peter Bosworth (07:24) Okay. And so then for our QT roadmap, what we’re building right now is so in terms of the core platform, reducing manual data entry by auto filling more of the provider profiles using new data sources and integrations, kind… of intentionally vague because we are using caqh, but we’re also like doing a lot of research into where we can where there’s like basically third party proprietary databases, we can pull information from real time integrations. Yeah. So we launched like a integrations tab on your, on all of the like instances in medallion so that you can quickly create an API if you want to. And then managing provider and assets organized by groups while maintaining data access and streamlining workflows. So leveraging our groups and those associations that you’re making more and more in different ways. So, yep, automating pre submission checks to ensure application completeness. So this is like a QC thing… and then expanding coverage to increase the number of payer forms and rosters handled end to end via automation. So, yep, that’s an ongoing effort and I’ll make a note to find out which percentage of and which specific payers, I guess we are leveraging automated submission for in your payer mix.
DeWayne Hiebert (09:01) Okay.
Peter Bosworth (09:08) Yep.
Peter Bosworth (09:13) These are less exciting. So for credentialing verification. So continuing to just expand on the, our automation of primary source verification and then reducing all sanctions by tracking like tracking all sanctions alerts in one place. This is something you might not have visibility into, but like the ongoing monitoring report, it lives in the analytics section of the platform. However there’s certain checks that are happen off platform and we send them to your team. And so we’re working on consolidating all of that and like platformizing all of the checks.
DeWayne Hiebert (10:03) Okay.
Peter Bosworth (10:06) Strengthening our npdb verification workflows so yeah, just having those alerts come through via email in real time as well as, in the audit log.
Peter Bosworth (10:24) So right now, I guess we’ll go to next. So increasing autofilled fields on provider profiles. So more of the same, just how can we reduce friction with providers? And yeah, like leveraging the associations that you are giving us in the group and practice structure. So the teams feature are you familiar with our teams feature? It’s a feature where basically you can, if you have a credentialing if you have somebody that only works on your New Jersey groups, I know it’s a little different for advocare but basically permitting.
DeWayne Hiebert (11:05) yeah, we’re very familiar with it. Basically, we’re every one of our care centers has an office manager. So we’re actually setting every single one up as a team with the office managers, the team manager, so that they can see all of the information related to the providers in their care center.
Peter Bosworth (11:31) Okay. And.
DeWayne Hiebert (11:32) Hopefully assist them at where they can with profiles, help… identify and tell the providers what they need to do that they haven’t yet. And then, you know, see status. So, yeah, we’ve let’s see we’ve set up quite a few teams so far. Let’s see… members.
DeWayne Hiebert (12:10) Yeah, we’ve set up 100 teams so far. Okay? So we probably have 75 more to go. So, okay.
Peter Bosworth (12:26) Great.
Peter Bosworth (12:38) Okay. So… we… want to automate the caqh, data syncing. So basically just exactly what we were talking about, where we’re constantly refreshing that I’m sure like or figure out the price aside, like always having the most up to date information flow over into medallion. And then I think this one’s more exciting is like automating the outbound and inbound payer, email workflows. So, you know, we have like, some of this set up already, but to really build it at scale to generate follow up and process replies with payers, really unlock a lot of turnaround time progress.
Peter Bosworth (13:31) And yeah. So the other, we’ve launched like a team, an admin home feature, which so that’s been live some kind of improved vision on what is blocking certain requests. So that’s kind of happening right now. Any questions on this slide?
DeWayne Hiebert (13:56) Okay. No, I don’t think so. I mean, I think the only, you know, the thing right? In terms of, I think, our biggest challenge at least with some of the providers is they… want it, right? They want to know everything they haven’t done, and like the task may give them one thing. But then there’s something else down the road that comes back and they have to do as well. So maybe that’s not known until a later point, but I think wherever it’s possible to give them, you know, here’s everything you haven’t done that’s… always helpful.
Peter Bosworth (14:38) Yeah. And one other.
DeWayne Hiebert (14:44) So, and,
Peter Bosworth (14:46) with credentialing, yeah… reviewing and tracking the sanctions alerts in one place. So that’s what I was discussing about having one report for all of the different sanctions, increasing visibility and configurability with roster delegation and roster generation. This is something that you’ll learn more about once we’re up and running with delegation. And then facility credentialing is not something that I believe advocare is concerned with.
DeWayne Hiebert (15:23) No, no, we don’t have any facilities. Okay? Thank goodness. Yeah.
Peter Bosworth (15:30) Thank goodness is right. Okay. And then in conclusion, these are some of the areas that we’re discussing going forward. So payer contract management, centralizing all of your contracts in medallion the… key terms, the renewal, dates, all of that in the platform rate benchmarking and price transparency. This would obviously be a big project, but how your rates compare to market benchmarks, the idea there being just like if we have access to all of this data from all of these different customers across the entire country, aggregating… it and like taking the median of that and providing you with some kind of benchmark we think could possibly be helpful for customers going forward.
DeWayne Hiebert (16:29) Yeah. We actually… so we have a payr contract management system. We’re actually in the implementation, I have three big implementations here all happening simultaneously. So not only the implementation… with you guys, which I would say, you know, because not everybody’s on the system. We’re still in the implementation phase… but then also Experian with their contract management system.
Peter Bosworth (17:03) So we’ve.
DeWayne Hiebert (17:08) we are hoping to go live with that on April 23. So we’ve loaded all of our contracts, all of our fee schedules for the past three years. And we’ve… uploaded… about 5,000,000 historical claims so that’s going to be ready to go the whole rate benchmarking and price transparency, you know, with the, you know, the transparency requirements, we.
Peter Bosworth (17:51) We.
DeWayne Hiebert (17:52) actually work with, our malpractice broker. They basically set up the… you know, the technology to get the information that, you know, payers are required to make publicly available. So, you know, any, anytime we go into a negotiation, we take our top 25 codes for… the payer we’re negotiating with. And then we have a set of provider organizations, some health system owned providers, some independent providers that we think are the good comparison group for us and we get all of their rates. So we’re already able to bake that into, to our negotiations. And then the over and under payments that, that’s something that Experian will do for us. So.
DeWayne Hiebert (19:05) Right now, we have solutions for all those things, but we’re always looking for, you know, being able to do more,
DeWayne Hiebert (19:19) Under one platform at a lower cost. So, if you have that in the future?
Peter Bosworth (19:28) Yeah, that is the hope. Yeah… I think the thing that a lot of the… medallion thesis is based on is like if we’re pair enrollment requires so much information. And so, how can we like take that information and apply it to other use cases? Yeah, like prior authorization was something that we discussed however that’s a really saturated market. Yeah, but it uses the same information we’re already capturing same with this. Okay. So that’s kind of that’s… kind of it in terms of roadmap. Yeah, and excited to keep you in the loop as these start to.
DeWayne Hiebert (20:29) Launch. Yeah, definitely. And, you know, certainly great, to see, any work done that makes the whole credentialing process smoother so, hey, let me ask you a question. Is, is Janine, no, hale no longer with medallion? I haven’t heard from her for a while and I actually included her on an email the other day and it bounced back. So, I assume that meant she was no longer with you guys? Yeah, that’s.
Peter Bosworth (20:58) correct.
DeWayne Hiebert (20:59) Okay.
Peter Bosworth (20:59) Yeah. So Jason would be the point of contact? Okay. Yeah. Is there anything I can pass along to Jason that you were wondering on?
DeWayne Hiebert (21:14) No, I mean, we meet with Jason right now. We’re meeting every other day. So we have a set time. We have an hour on Monday, 30 minutes on Wednesday and 30 minutes on Friday, just to go through high priority stuff and try and coordinate, you know, some of the stuff that, you… know, we’ve been doing like horizon. Yeah, I saw that getting scheduled.
Peter Bosworth (21:41) Yeah.
DeWayne Hiebert (21:42) We’re trying to kind of get that done. The.
DeWayne Hiebert (21:50) you know, there’s minor things that are popping up that I’ll like I’ll bring one up with him tomorrow. So we had a provider, who is… it’s? One of these where he’s already credentialed, right? And this is a very large care center. I don’t know. They have probably 12 15 providers, something like that, and they have four practice locations and they added another one. So, you know, our first challenge was it was hard to add the new location because all their profiles weren’t completed. They weren’t on the, you know, they weren’t on the platform. So, you know, we basically just, we sent, the demographic updates… you know, sort of offline. And now we’re reconciling them back up. But for one of the smaller payers for one of the providers, you know, some of the providers, in the practice, they were done. They’re they’re set up at the new location.
DeWayne Hiebert (23:00) But then there was one where for some reason as part of this new location for this provider or for this payer, with which we have a group contract… they had him sign an individual contract. So, you know, there was no need for a contract. We have a group contract. This is just a demographic change. So it wasn’t even credentialing him. So I don’t know where the person who was handling this came up with the view or the information that they needed to have this provider sign an individual contract. But now we have this provider who signed an individual contract, which obviously, we don’t want him tied to that because it’s about at a reimbursement rate that’s 50 percent less than what we get paid.
DeWayne Hiebert (23:53) So, you know, we have to make sure, that doesn’t result in payment issues. So…, we have those kind of things that are still happening and challenging which, you know… one of the things and we’ve talked to Jason about this and I’ve had my team working on it is that, you know, we, but… to start, right, we provided some information that is kind of supporting your, you know, your processes and procedures right here’s. How, you know, here’s our contact at Aetna for example, right? Where to send things. We’re going back and we’re making that much more detailed and, you know, hopefully it’ll be helpful because I said, I want to be able to clearly articulate and make sure Jason and the team understand are on the same page if you’re talking with Aetna. Here’s exactly what needs to happen if you’re adding a new practice, if you’re terminating a practice, if you’re just adding a new provider, right? If you’re just adding a new location, if you’re terminating a provider, if you’re terminating the whole practice, you know, if the provider’s credentialed or not credentialed, all of those different scenarios, you know, exactly what needs to happen because I think that’s probably one of our biggest current concerns because this came up against yesterday and happens to be the treasurer of our company, which isn’t good. He was like, how come this provider’s not credentialed… yet? She started two months ago. And we’ve always been saying, well, you know, it’s with amerihealth and we say, well, amerihealth’s run behind. They take forever, but we did a little more investigating and the real issue is the provider was already participating. An application never needed to be filed. It just needed to be, you know, a link letter associated… with them with our tax id. So something that could have taken a couple weeks is now taking a couple months. And now we’re back at the, you know, starting over. So, I think that’s another challenge that, you know, we need to find the right solution… for. And I think, you know, we’ve started to, we do our own assessment and analysis before we even, you know, add anybody to the platform about who they’re participating with and who they’re not. So now we are providing that to Jason or we’re uploading it so that, hopefully, you know, your team can follow the same.
DeWayne Hiebert (26:54) View and not, you know, send you an application for somebody that just needs a link letter.
Peter Bosworth (27:01) Right. And that it.
DeWayne Hiebert (27:03) Should be, you know?
Peter Bosworth (27:05) Easy for us to document in our project plans for you per payer?
DeWayne Hiebert (27:12) Yeah, yeah, hopefully. So, yeah… I think like I said, we’re just, we’re going to be, we’re putting the information together to be much more explicit, you know, scenario driven payer driven, et cetera. So. Okay.
Peter Bosworth (27:30) Yeah. Okay. Great.
DeWayne Hiebert (27:35) Well, I will check… with Jason.
Peter Bosworth (27:39) On how that’s going and getting added as it comes in.
DeWayne Hiebert (27:43) And, okay. Yeah. All right. Sounds good. I need to hop on a four o’clock all right. Thank you, Dwayne talk to you later. Bye bye.